Physician Workforce Study - June 2002

Download the complete Physician Workforce Study (.pdf, 186 KB, 48 pages)

EXECUTIVE SUMMARY

Throughout the past two decades, public and private health care organizations have debated the adequacy of the physician workforce in Massachusetts. Depending on the source of information and political environment, conventional wisdom vacillates between predictions of an over-supply of physicians^[1] and predictions of a substantial shortage across all medical specialties.^[2]

Recent anecdotal evidence indicates that physicians in the Commonwealth are having an increasingly difficult time meeting patient demand for services due to an inability to recruit enough qualified practitioners.

In response to these pressing concerns, the Massachusetts Medical Society (MMS) undertook a study of the physician workforce. The Society, working with leading labor economists, James Howell, Ph.D., Carol Simon, Ph.D., and Andrew Sum, Ph.D., designed a comprehensive research methodology that included both primary (i.e., focus groups, surveys) and secondary (i.e., existing databases) data collection.

METHODOLOGY

The MMS physician workforce study used information from five primary data sources:

1. Focus groups with residents and fellows at four academic medical centers   
2. Survey of residents and fellows in their last year of training in 14 specialties at nine teaching hospitals   
3. Survey of residency and fellowship program directors in 14 specialties at nine teaching hospitals   
4. Survey of anesthesia, cardiology, orthopedics, and radiology department chiefs at nine teaching hospitals.   
5. Survey of practicing physicians in 14 specialties:

RESULTS

Survey of Practicing Physicians

The surveys for practicing physicians contained seven questions designed to assess the degree of stress in physician labor markets. In similar professional labor market studies, it is important to note that response rates indicating a shortage almost never exceed 10%. Using this response rate as a benchmark, results from this study indicate that a number of physician specialties in Massachusetts are experiencing labor shortages.

• Overall, 36% of respondents felt that the pool of physician applicants is inadequate to fill vacant positions or expand one’s practice. Results indicated that the physician supply varies by specialty, with seven specialties showing response rates above the sample mean: Anesthesiology, Radiology, GI, Neurosurgery, Cardiology, Emergency Medicine, Orthopedics, and Vascular Surgery.
  
  
• Almost half of all respondents (46%) indicated that they are currently experiencing some degree of difficulty filling vacant physician positions. In four specialties (Anesthesiology, Radiology, Emergency Medicine, GI), over 80% of respondents indicated that they were experiencing difficulty. In four additional specialties (Cardiology, General Surgery, Neurosurgery, Orthopedics), between 40-80% of respondents indicated that they are having difficulty.
  
  
• Over one-third of respondents in five specialties (Anesthesiology, GI, Radiology, Neurosurgery, Orthopedics) reported a significant increase in the amount of time needed to recruit a new physician over the past three years. Relative to other professional occupations, these lengths of time are extraordinarily long and indicate lags in filling physician shortages that can affect patient access and availability of services.
  
  
• One-quarter (25%) of all respondents indicated that physician shortages have forced them to alter services. In addition, 27% of all respondents have changed their professional staffing patterns due to physician shortages.

After combining the results into an analytical matrix, eight specialties were determined to be experiencing a tight labor market due to physician shortages: Anesthesiology, Cardiology, Emergency Medicine, GI, Orthopedics, Neurosurgery, Radiology, and General Surgery.

Survey for Residency and Fellowship Program Directors

• Results from the directors of physician training programs in Massachusetts indicate that the supply pipeline into the state is not keeping up with the demand for new physicians. 
  
  
• Since the 1997 academic year, 55% of residents and 68% of fellows have left Massachusetts following completion of their training. This trend is overwhelmingly the case for the physician specialties determined to be experiencing labor market shortages (Anesthesiology, Cardiology, Emergency Medicine, GI, Orthopedics, Neurosurgery, Radiology, and General Surgery).

Resident/Fellow Focus Group

• Although the focus group participants were very diverse, the individual responses were disturbingly similar. Regardless of specialty training, responses to questions about beginning a clinical career or setting up a practice in Massachusetts were almost always negative. 
  
  
• Overall, the initial themes were that Massachusetts has no future for physicians wishing to pursue a career in clinical practice; opportunities exist for academic/research careers, but reimbursement pressures and shortages of patient care physicians do not allow sufficient time to pursue these avenues; and, compared to other areas of the country, physician reimbursement is much lower and the cost-of-living, specifically housing, is much higher.^[3]

Survey for Residents and Fellows

• While the demand for residency and fellowship slots in Massachusetts remains extremely high, physicians in their final year of training are not very optimistic about their ability to pursue clinical careers in the Commonwealth.
  
  
• Over one-third of respondents had already decided not to pursue a career in Massachusetts and another one-quarter were still undecided about their career prospects in the Commonwealth. 
  
  
• When asked to rate Massachusetts on a variety of personal and professional factors that can impact the decision on where to establish a practice, residents and fellows overwhelmingly rated Massachusetts unfavorably on salary levels, salary arrangements, and the cost of living, and favorably on professional factors such as the strength of their peer group, research opportunities, and intellectual stimulation.

Survey for Hospital Department Chiefs

• Difficulties recruiting and retaining physicians in the Commonwealth is not limited to community-based physicians.
  
  
• Almost three-quarters (74%) of the department chiefs surveyed in academic medical centers reported that the current pool of physician applicants is inadequate to fill their existing vacancies.
  
  
• In addition, 85% of respondents reported difficulties filling physician vacancies. As a result, over half of the respondents (52%) reported altering their services and two-thirds (67%) of the respondents reported adjusting their staffing patterns due to physician supply problems.

CONCLUSIONS

Based on these results, several conclusions regarding the current physician workforce were identified:

• There is a growing perception that Massachusetts is a financially and administratively difficult environment for physicians to practice in. This sentiment was expressed strongly by both practicing physicians and physicians in training programs.
  
  
• Massachusetts is experiencing shortages in several critical physician specialties: 
  
  
  • Severe Shortages: Anesthesiology, Radiology, Gastroenterology, Emergency Medicine
    
    
  • Growing Shortages: Neurosurgery, Orthopedics, Cardiology, General Surgery

Implications for Patient Access to Health Care

The MMS has been monitoring physician supply trends for several years. This comprehensive workforce study shows unequivocally that Massachusetts is facing a crisis situation in the number of physicians available to deliver patient care. As shown by the survey results, many physician practices are already overwhelmed and unable to handle additional volume, and have reacted to this crisis by altering their services or adjusting their staffing patterns to cope with the labor shortage. The MMS is concerned that these shortages will threaten patients’ access to health care. At a minimum, it will increase waiting times for an appointment. It is time to address the underlying causes of this shortage in order to protect the financial viability of the Massachusetts health care system and the overall health of the patients that it serves.