Waltham, Mass. – September 14, 2009 – The Massachusetts Medical Society today released its 2009 Physician Workforce Study and reported that while fewer physician specialties are operating under severe labor market conditions than in previous years, the situation in primary care continues to weaken. The report’s key findings include:  

• The primary care specialties of family medicine and internal medicine are in short supply for the fourth consecutive year.
• The percentage of primary care practices closed to new patients is the highest it’s ever been as recorded by the Medical Society.
• 7 of 18 specialties studied have been classified in short supply, 5 fewer than last year.
• The specialty of obstetrics and gynecology was found to be in short supply for the first time in the eight years of conducting the analysis, adding to primary care difficulties.
• Recruitment and retention of physicians remains difficult, especially at community hospitals and especially with primary care.
• The fear of being sued remains as a substantial negative influence on the practice of medicine, affecting access to and availability of physician services.

This latest study is the Society’s eighth annual comprehensive look at multiple aspects of the physician workforce and builds on the previous seven years of data.

“While the latest study shows some improvement with fewer shortages in specialty care,” said Mario Motta, M.D., President of the Massachusetts Medical Society, “it also shows a deteriorating condition of primary care. Not only do we have continued physician shortages, but more practices are closed to new patients, and the shortage in OB-GYNs adds to the dilemma, as many female patients look to those physicians for their primary care.”

Noting that primary care is the gateway to the health care system for most patients, Dr. Motta said the shortages have ramifications within Massachusetts and the nation. “With our state health reform initiative, we quickly learned that universal coverage doesn’t equate to universal access,” Dr. Motta said. “While the Commonwealth adjusts to the disparity between the supply of physicians and the demand for health care, our analysis can be instructive on a national level about what physician supply means for access to care when universal coverage is implemented.”  
 
Dr. Motta also said that recruitment and retention of physicians remain difficult, partly due to a lingering poor practice environment in the state. The Society's Physician Practice Environment Index, a statistical indicator of nine factors that shape the environment in which physicians provide patient care, dropped 1.5 percent in 2008 and has fallen in 15 of the past 17 years. The index takes into account such factors as the cost of maintaining a practice, median physician income, liability insurance rates, and hours spent on patient care. 

Principal Findings: Massachusetts Medical Society 2009 Physician Workforce Study

7 specialties on shortage list; OB-GYN appears for the first time

The Medical Society’s 2009 analysis found 7 of 18 specialties studied in short supply: dermatology, family medicine, internal medicine, neurology, obstetrics-gynecology, urology, and vascular surgery. Obstetrics/gynecology was listed for the first time since the study began.

In 2008, 12 specialties were experiencing shortages. Coming off the list of shortages were emergency medicine, general surgery, neurosurgery, oncology, orthopedics, and psychiatry.

The Society’s eight-year trend analysis of the labor market conditions of all specialties surveyed found that eight specialties have been operating within tight labor market conditions over the last four years. These include the primary care specialties of internal medicine and family medicine, dermatology, neurology, neurosurgery, psychiatry, urology, and vascular surgery.  These shortages are consistent with reports and studies from the Association of Medical Colleges and national specialty groups that have found shortages of those specialties on a national level.

Primary Care: Long waits, more practices are closed to new patients

The primary care specialties of internal medicine and family medicine have been under intense pressure with the addition of some 440,000 newly insured residents as a result of the state’s health care reform law. That pressure continues, as the 2009 study marks the fourth consecutive year that both of these specialties have been found to be in short supply.

More practices closed to new patients: More primary care physicians have closed their practices to new patients, continuing a trend from prior years. The telephone survey of physician practices showed that the percentage of family medicine physicians who are no longer accepting new patients has increased over the past three years from 30% in 2007 to 40% in 2009. The percentage of internal medicine physicians no longer accepting new patients has also increased, from 49% in 2007 to 56% in 2009. These are the highest percentages of primary care practices closed to new patients the Medical Society has ever recorded in its Physician Workforce Studies.

Wait times: Long wait times for appointments for new patients continue to be a problem, resulting in delayed access and care. For internal medicine, the average wait time is 44 days, six days shorter that last year’s figure of 50 days. For family medicine, the average wait time is 44 days, eight days longer than last year’s figure of 36 days.

Community hospital shortages: The Medical Society's study also found that primary care physicians are some of the most critical scarcities facing community hospitals: 75% of community hospitals reported shortages in internal medicine, and 58% reported shortages in family medicine. Both are substantial increases (19% greater for internal medicine; 14% greater for family medicine) over the 2008 study.

Specialty care: Continuing Strain, Difficulty with Referrals

A large majority of physicians – 69% -- reported difficulty in referring patients to a specialist, a recurring problem from previous years. The difficulty is especially acute with the primary care specialties: 85% of family medicine and 77% of internal medicine report difficulty in referrals to specialists.

Recruitment and Retention: Especially Hard for Community Hospitals

A recurring theme throughout all eight years of the Society's studies is increasing difficulty in recruitment and retention of physicians, and both continue to be major problems in overcoming physician shortages. The situation is especially acute with community hospitals.

Inadequate pool for recruitment: The supply of available physicians is weak, with 96% of community hospitals, 74% of practicing physicians, and 46% of teaching hospitals saying the pool available to recruit physicians is inadequate.

Retention: Keeping existing staff has become more difficult for 26% of teaching hospitals, 35% of practicing physicians, and 61% of community hospitals.

Recruitment: Hiring has become more difficult, with 91% of community hospitals, 54% of practicing physicians, and 36% of teaching hospitals experiencing difficulties in filling physician vacancies.
 
Time to recruit: Difficulty in recruiting is reflected in the time it takes to recruit physicians. The survey of practicing physicians indicated that the time to recruitment has increased over the last three years, with 13 specialties averaging more than one year for recruitment: dermatology, 28.6 months; neurosurgery, 24.8; neurology, 19.2; urology, 16.7; family medicine, 15.5; orthopedics, 17.6; gastroenterology, 16.8; obstetrics/gynecology, 14.9; oncology, 14.5; internal medicine, 13.8; cardiology, 13.5; general surgery, 13.5; and vascular surgery, 12.5.

Job Vacancy Rates The job vacancy rates for physicians in teaching hospitals in 2008 was 4.6%, nearly two and half times the rate for all occupations in the state. The specialties with the highest job vacancies rates were vascular surgery (16.4%), dermatology (16.3%), family medicine (14%), oncology (12.3%), neurosurgery (10%), urology (9.3%), pediatrics (9%), and gastroenterology (6%).

Professional Liability: A Big Negative Influence on the Practice of Medicine

The 2009 study again found that professional liability (medical malpractice concerns) and the fear of being sued continue to have a substantial negative influence on physicians and the practice of medicine. This finding is consistent with the Society’s previous Workforce Studies and its first-of-a-kind Investigation of Defensive Medicine in Massachusetts, released in November of 2008, which showed that the fear of being sued is a serious burden on health care. Findings from the 2009 Workforce Study:

• 46% of physicians surveyed said their practice is being altered or limited because of the fear of being sued, an increase of 2% from the year before.
• More than half of physicians in nine specialties, two more than last year, said they have altered or limited their practice because of the fear of being sued: orthopedics (71%), urology (64%), neurosurgery (62%), gastroenterology (62%), obstetrics-gynecology (60%), emergency medicine (59%), cardiology (53%), family medicine (51%), and internal medicine (51%).
• 21% of physicians reported that professional liability fees were more than 15% of their total operating costs. The top specialties reporting these high ratios for liability fees in 2009 were obstetrics/gynecology (77%), general surgery (59%), neurosurgery (57%), and emergency medicine (40%).

Regional findings across the state show recruitment remains difficult

The 2009 study examined physician workforce issues across four regions in Massachusetts: Boston metropolitan area, New Bedford/Fall River/Barnstable County (Cape Cod), Springfield, and Worcester for all physicians and primary care specialties. (A limited sample response from primary care physicians in the Pittsfield/Berkshire County area, normally included in the annual study, precluded an analysis of that region for this year’s report.)

A key finding from the regional data is that recruitment of physicians remains difficult. The percentages of practicing physicians reporting difficulty in filling vacancies were 65% in Boston; 68% in Worcester; 71% in Springfield; 76% in Bedford/Fall River/Barnstable County.

Additional findings

• Residents pursuing careers out of state More than one-half (56%) of medical residents pursue the next step of their careers outside of Massachusetts, another reason for physician shortages. This figure is consistent with previous studies.
• International Medical School Graduates Massachusetts employs a large number of international medical graduates (IMGs) and is highly dependent on IMGs to fill its physician labor market needs. The percentage of IMGs as new hires at teaching hospitals has risen from 19% in 2005 to 26% in 2008. 
• Dissatisfaction with practice environment Eighty-five percent (85%) of physicians surveyed find their careers rewarding, but 42% say they are dissatisfied with the practice environment in Massachusetts. Since 2002, nearly one-half of physicians surveyed have responded that they are dissatisfied with the practice environment. Nearly one out of four physicians currently practicing in Massachusetts indicated they are contemplating a career change because of the practice environment in the state.
• Dissatisfaction with administrative hassles Forty-four percent (44%) of physicians say they are dissatisfied with the number of hours spent on patient care versus administrative tasks. The figure rises substantially for the primary care specialties of family medicine (59%) and internal medicine (56%), and for orthopedic surgeons (56%).

About the Physician Workforce Study

The Massachusetts Medical Society’s annual Physician Workforce Study examines the state’s physician workforce through surveys of practicing physicians, medical staff presidents of community hospitals, department chiefs in teaching hospitals, medical groups, residency and fellowship program directors, and public opinion surveys. The 2009 study is the Society’s eighth annual comprehensive look at multiple aspects of the physician workforce. The study was conducted in collaboration with economist James Howell, Ph.D., of The Howell Group and Andrew Sum, Director of the Center for Labor Market Studies at Northeastern University, who served as consultants. The complete report and an executive summary are available at www.massmed.org/workforce.  

About the Massachusetts Medical Society

The Massachusetts Medical Society, with some 22,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society publishes the New England Journal of Medicine, a leading global medical journal and web site, and Journal Watch alerts and newsletters covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country. For more information please visit www.massmed.org, www.nejm.org, www.journalwatch.org.