Massachusetts Patients Are Facing Reduced Access to Care, Longer Wait Times for Appointments as Physician Shortages Persist

Contact: Richard P. Gulla
rgulla@mms.org 
781-434-7101
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Massachusetts Medical Society’s 2005 Physician Workforce Study finds physician shortages in 6 key specialties.

New data in study shows number of patients having difficulty getting care has doubled in two years and wait times for non-emergency care are longer than average

Waltham, Mass. -- June 6, 2005 -- Massachusetts patients are facing reduced access to health care and longer wait times for appointments with medical specialists, as the state continues to deal with a shortage of practicing physicians, especially in six key specialties, according to research released today by the Massachusetts Medical Society, the statewide professional association of physicians.

Continued physician shortages and reduced patient access to care were two of the key findings in the Society’s 2005 Physician Workforce Study, the organization’s annual comprehensive examination of the physician workforce in the state. The 2005 study was the fourth annual analysis of the physician workforce by the Society and was based on surveys of practicing physicians, teaching and community hospitals, residency and fellowship program directors, and patients throughout the state.  

The 2005 study reported three specialties -- neurosurgery, anesthesiology, and radiology -- to be in “critical” shortage, and three others -- gastroenterology, cardiology, and orthopedics -- in “severe” shortage. The conclusions on shortages were drawn from an analysis of all four workforce studies over the last four years. The studies examined 14 specialties (the remaining specialties: obstetrics-gynecology, general surgery, vascular surgery, emergency medicine, psychiatry, pediatrics, family practice, internal medicine), all considered to be, in labor market terms, “under stress.”

The Society said the shortages are widespread across the state and are especially acute at community hospitals: 62 percent of physician practices, 60 percent of teaching hospitals, and 87 percent of community hospitals say they are finding it hard to fill vacancies.

One of the principal causes of the shortages continues to be the unusually large number of residents and fellows who leave the state after completion of their training. For 2003-2004, 46 percent of residents and 60 percent of fellows left the state after training. That translates, just for residents, to a migration of more than 2,100 physicians for that academic year.

For each of the last six (6) academic years, in fact, at least 46 percent of residents and 51 percent of fellows have left Massachusetts. 

Massachusetts Medical Society President Alan M. Harvey, M.D., M.B.A., said one of the most striking findings of the study is the how these conditions are impacting access to health care. In a survey of citizens by Opinion Dynamics Corporation, done as part of the workforce study, 15 percent of citizens -- up from 9 percent in 2004 and 7 percent in 2003 -- now say getting health care for themselves and their families is “extremely difficult.” The top two obstacles among those respondents were high costs and the inability to find a doctor or get an appointment. Also, the study found that lower-income and less-educated citizens were the most likely to have difficulty with access.

“When the number of citizens who say getting health care is extremely difficult more than doubles in just two years,” he said, “you know you have a system going in the wrong direction and in need of reform.” The importance of health care access is also increasing among Massachusetts residents: 73 percent rank access as “extremely important,” a rise of 9 percent from the 2004 study.

Harvey called the results of the study “another chapter in the continuing story of a growing disconnect between the reality and reputation” of health care in the Commonwealth, for patients as well as physicians. 

“The physician community in the Bay State continues to face a practice environment considered unfriendly at best, with severe problems in recruitment and retention,” said Harvey, who is Director of Quality Assurance/Quality Improvement and Patient Safety in the Department of Anesthesiology, Perioperative and Pain Medicine at the Brigham & Women’s Hospital. He said the factors cited most often as contributing to a deteriorating environment are administrative hassles and inefficiencies, low reimbursements, the high costs of maintaining a practice, and medical liability insurance -- conditions that have surfaced in all four studies.

Among those conditions, medical liability is one of the most prominent. Since 1992, for example, professional liability costs in the Bay State have risen 132 percent -- causing the higher-risk specialties of neurosurgery, obstetrics, general surgery and orthopedics to limit the scope of their practices.

The study also found that the fear of being sued is playing a major role in how physicians practice medicine in Massachusetts. At least 49 percent of physicians in nine of 14 specialties surveyed in the study (family practice, internal medicine, emergency medicine, general surgery, gastroenterology, neurosurgery, obstetrics-gynecology, orthopedics, and radiology) said they have altered or limited their scope of practice for fear of being sued. Such reaction includes an increased focus on “defensive medicine,” practiced because of the threat of liability. This finding echoes a major study reported just last week in the Journal of the American Medical Association.

Because of such conditions, Harvey said only half of the physicians responding said they would choose medicine as a profession again and only one-third said they are satisfied with the current practice environment.

Waiting times increase for five physician specialties

The 2005 workforce study also included a survey of physicians in five specialties (cardiology, gastroenterology, internal medicine, obstetrics-gynecology, and orthopedic surgery) by Merritt, Hawkins & Associates to determine average waiting times to get an appointment. For all five specialties, average wait times for new patient appointments were three to six weeks, beyond the typical wait time of two weeks that defines a busy practice. Average wait times were calculated for each of 12 Massachusetts counties.

The 2005 Physician Workforce Study follows the release of the Society’s annual Physician Practice Environment Index, a statistical indicator of nine selected factors that shape the overall environment in which physicians provide patient care in the state. The latest index for 2005 fell for the 11th consecutive year, to an all-time low, led by increasing professional liability costs, housing costs rising at a rate more than twice that of physician income, and the number of physicians 55 and older rising three percent, continuing a decade-long trend of the aging of the physician workforce and an indication of the state’s inability to attract young physicians.

Medical Society officials say the findings of the workforce studies, along with the constantly declining index, are mounting evidence of an ever-eroding practice environment for physicians in the Commonwealth, which is affecting patient access to care.

Key Findings from the 2005 Workforce Study

Physician Responses

• 83% of physicians rate the profession of medicine as rewarding
• 49% of physicians said they are dissatisfied with the current practice environment.
• 48% of physicians said they are dissatisfied with the number of hours they spend on patient care versus administrative tasks.
• 39% of physicians are considering changing their profession due to the current practice environment
• 64% of physicians report that their patients are having difficulty in receiving a timely consultation for specialty care

Teaching and Community Hospital Responses

• 60% of teaching and 87% of community hospitals are currently experiencing difficulty filling physician vacancies
• 97% of teaching hospitals said retention of physicians has become more difficult
• 94% of community hospitals said retention of physicians has become more difficult
• 52% of community hospitals said that physician supply problems have made it necessary to alter the services they provide
• 36% of teaching hospitals said that physician supply problems have made it necessary to alter the services they provide

Public Opinion Poll

• 15% of residents say obtaining health care is “extremely difficult,” up from 9% in 2004 and 7% in 2003
• Cost and inability to find a doctor or get an appointment are the two biggest obstacles to care among those having difficulty

The 2004 Massachusetts Medical Society Physician Workforce Study was conducted under the auspices of the Society’s Committee on Medical Service with economist James Howell, Ph.D., of The Howell Group and Andrew Sum, Ph.D., Director of the Center for Labor Market Studies at Northeastern University, as consultants.  

Download the Executive Summary (.pdf, 19 pages))

Download the MMS 2005 Physician Workforce Study (.pdf, 82 pages)