Massachusetts Medical Society Study Records Shortages of Primary Care Physicians for the First Time

Contact: Richard P. Gulla 
rgulla@mms.org 
781-434-7101
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5 years of data confirm continuing physician shortages and difficulty in recruitment and retention

Waltham, Mass. -- June 27, 2006 -- The Massachusetts Medical Society today released the results of its 2006 Physician Workforce Study, its annual comprehensive look at the state's physician workforce, and this latest research confirms and expands on what the society's four previous studies have discovered: that Massachusetts continues to face shortages of physicians in key medical specialties and that recruitment and retention of physicians remain difficult. The 2006 study also contained one alarming new finding: a shortage of primary care physicians.

Kenneth R. Peelle, M.D., president of the Massachusetts Medical Society, said "It is ironic and troubling, that in a state known for its leadership in health care, the physician workforce is so much under stress. We need to improve the viability of our physician practices, improve our recruitment and retention, and reduce the shortages of key specialties.

"The shortage of primary care physicians is especially disturbing," said Dr. Peelle. "The results of these studies should carry a strong message to health care officials and policymakers alike: it is imperative that we improve the practice environment for our physicians. If we do not make that a priority, our patients will suffer as access to care will continue to erode. Above all, this is an issue of patient care."

Refuting the notion of an oversupply of physicians in the state, Peelle said a Medical Society analysis of physicians in Massachusetts recorded a total of 23,548 physicians with a full and active license with a Massachusetts address only as of January 2006 -- 19 percent fewer than the total number of physicians registered with the Mass. Board of Registration in Medicine. When physicians in academia are taken in account, along with those in corporate positions and part-time clinical work, the actual number of physicians engaged in full-time patient care is even less, said Peelle.

3 specialties show shortages for the first time

The 2006 data showed three specialties emerging in short supply for the first time: internal medicine, family practice, and psychiatry.

The findings on internal medicine and family practice are particularly disturbing, as it is the first time shortages in primary care physicians have been recorded in Massachusetts. The Society's study discovered that the most critical shortage facing community hospitals is family practitioners: 54 percent of community hospitals are currently experiencing shortages in this specialty, more than double the average percent (21) over the three prior years. Internists were also in short supply, ranking fourth. The results on primary care physicians in the study are consistent with and support recent warnings of a crisis in primary care from the American College of Physicians.  

Seven of the 14 physician specialties studied by the Society over four or five years are experiencing severe or critical shortages: anesthesiology, cardiology, gastroenterology, general surgery, neurosurgery, orthopedics, and radiology. 

Recruitment and retention remain difficult

Community hospitals continue to face the greatest difficulty in recruiting and retaining physicians, with 92 percent expressing difficulties filling vacancies. By comparison, 67 percent of teaching hospitals and 65 percent of practicing physicians say they are experiencing difficulty in filling vacancies.

For practicing physicians and teaching hospitals, the average time to recruit new staff is 12.8 months and 13.8 months respectively.  And based on five years of data, physician recruitment times are consistently the longest for the specialties of neurosurgery (25 months), gastroenterology (20 months), and orthopedics (18 months).

Medical Society officials say that this continuing stress on the physician workforce results in part from a deteriorating practice environment. The Society's Physician Practice Environment Index, a statistical indicator of nine selected factors that shape the overall environment in which physicians provide patient care in Massachusetts, has fallen for 12 consecutive years. The index takes into account such factors as physicians' cost of doing business, median physician income, and professional liability costs.  Thirty-seven percent of physician respondents said they are considering changing their profession due to the practice environment.

Professional liability continues to have multiple impacts

The study again found that professional liability continues to have multiple impacts on the practice of medicine. First, high liability costs negatively affect the state's competitive position to recruit and retain physicians. Since 1992, liability insurance rates have increased 132 percent in Massachusetts, and 42 percent of respondents said that insurance premiums account for 11 percent of more of their total operating expenses. Base rates for all specialties will increase another 5 percent on July 1. Second, physician concern over liability is negatively affecting patient care: 46 percent of practicing physicians responded that they altered or limited their services because of the fear of being sued.

Regional disparities across the state

The study also looked at disparities in the physician workforce across five regions in Massachusetts: (1) Boston metropolitan area, (2) New Bedford/Fall River/Barnstable County (Cape Cod), (3) Pittsfield (Berkshire County), (4) Springfield, and (5) Worcester.  Sixty-three percent or more of the respondents in each area reported difficulty filling positions, with  three areas -- New Bedford, Pittsfield, and Springfield -- seeing more severe physician shortages than the others. In those three areas, more physicians are reporting the need to alter services and adjust staffing patterns to meet patient demands.

Patient access to care remains strained

The study's two public opinion polls (one of physicians' offices and one of Massachusetts residents) revealed a continuing strain on patient access to care. The number of people who waited more than two months to see a primary care physician has jumped from 10 percent in 2005 to 16 percent in 2006. The average wait times for patients for five specialties (cardiology, internal medicine, obstetrics/gynecology, orthopedic surgery, and gastroenterology) exceeded three weeks, with the lone exception of orthopedic surgery, and the number of female respondents who reported waiting more than one month for an appointment with an OB/GYN doubled, from 20 percent in 2005 to 40 percent in 2006.

The 2006 study was the Society's fifth annual comprehensive examination of the physician workforce in the state and was based on surveys of practicing physicians, medical staff presidents in community hospitals, and department chiefs in teaching hospitals. In addition, the study included two telephone surveys: one of physician offices regarding waiting times for patient appointments, and one of Massachusetts residents regarding health care issues. The study was conducted in consultation 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.  The complete study, along with an executive summary, is available at http:///www.massmed.org/workforce.

Additional Findings from the 2006 Workforce Study

Practicing Physician Responses

• 84% of physicians rate the profession of medicine as rewarding
• 42% of physicians said they are dissatisfied with the current practice environment
• 47% of physicians said they are dissatisfied with the number of hours they spend on patient care versus administrative tasks
• 37% of physicians are considering changing their profession due to the current practice environment

Teaching and Community Hospital Responses

• 67% of teaching and 92% of community hospitals are currently experiencing difficulty filling physician vacancies
• 58% of community hospitals said that physician supply problems have made it necessary to alter the services they provide
• 41% of teaching hospitals said that physician supply problems have made it necessary to alter the services they provide

Access to care/public opinion poll

• Residents who say obtaining health care is difficult increased from 17% in 2003 to 21% in 2006
• Cost and inability to find a doctor or get an appointment are the two biggest obstacles to care among those having difficulty