Massachusetts Medical Society: 2010 Physician Workforce Study Shows 5 Consecutive Years of Primary Care Shortages

2010 Physician Workforce Study Shows 5 Consecutive Years of Primary Care Shortages

Fragile state of access to care requires careful and deliberate steps in cost control and payment reform efforts

Contact: Richard Gulla
rgulla@mms.org
(781) 434-7101

Waltham, Mass. - October 20, 2010 - The Massachusetts Medical Society today released its annual Physician Workforce Study, showing a fifth consecutive year of  shortages of primary care physicians, half of primary care practices closed to new patients, shortages in 10 of 18 physician specialties across the state, and community hospitals continuing to be the most affected by persistent physician shortages.

 Physician Workforce Study
Download
The 2010 study is the Society's ninth annual look at multiple aspects of the physician workforce and builds on the previous eight years of data. The study surveys teaching hospitals, community hospitals, practicing physicians, medical directors of medical groups, and resident and fellow programs throughout the state. It is the most comprehensive examination of the physician workforce in the state done on an annual basis.

The report's key findings include:  

  • The primary care specialties of family medicine and internal medicine are in critically short supply, the fifth consecutive year of shortages for these specialties.
  • 10 of 18 specialties studied have been found in short supply, 3 more than last year.
  • High percentages of primary care practices are closed to new patients: 54 percent of family medicine physicians and 49 percent of internal medicine physicians are not accepting new patients.
  • Wait times for new patients for primary care continue to be long, with an average wait time of 29 days for family physicians and 53 days for internists.
  • With the exception of Boston, physician shortages exist in all regional labor markets across the state.
  • Community hospitals continue to be the most seriously affected by the physician shortages, with difficulty filling vacancies and retaining physicians, resulting in the need to alter services and change staffing patterns. 
  • The fear of being sued remains a substantial negative influence on the practice of medicine, affecting access to and availability of physician services.

"The findings from this latest analysis," said Alice Coombs, M.D., president of the Massachusetts Medical Society, "clearly show how fragile access to care for patients is across the entire Commonwealth.

"The state's universal health care plan has improved access to care," said Dr. Coombs, "but universal coverage can only be sustained with a strong physician workforce. As we continue to look at reforming the health care system, we must do so carefully and deliberately in all aspects, and that includes the next steps for cost control, particularly with respect to establishing a fair system of payment reform."

"A strong physician workforce is critical to delivering top quality and cost effective care. If physicians think that the viability of their practices is threatened or unsustainable under a new payment system, Massachusetts may encounter further problems with recruitment and retention. And that, certainly, will affect patient care," Dr. Coombs said. 
 
Dr. Coombs said the physician workforce in Massachusetts continues to be affected by 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 0.8 percent in 2009 and has fallen in 16 of the past 18 years. Since 1992, the Massachusetts Index has declined by 26.4 percent, significantly more than the 21.3 percent decline in the comparable national index. 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 

Specialties Classified in Short Supply
The Medical Society's 2010 analysis found 10 of 18 specialties studied in short supply: dermatology, emergency medicine, family medicine, general surgery, internal medicine, neurology, orthopedics, psychiatry, urology, and vascular surgery. 

Over the last three years (2008-2010), six specialties have been operating within tight labor market conditions in each of those years: family medicine, internal medicine, vascular surgery, urology, dermatology, and neurology.

A trend analysis over a five-year period (2006-2010) shows that 11 specialties have been in short supply in at least three of those five years: family medicine, internal medicine, vascular surgery, urology, dermatology, neurology, psychiatry, general surgery, orthopedics, emergency medicine, and neurosurgery.
 
Access to Primary Care
Primary care practices closed to new patients; long waits

The primary care specialties of internal medicine and family medicine continue to be under intense pressure following the establishment in 2006 of the state's health care reform law, which resulted in some 440,000 residents being added to the insurance rolls.

High percentages of primary care practices are closed to new patients.  A survey of physician practices showed that approximately half of primary care physicians are not accepting new patients. The percentage of family medicine physicians who are not accepting new patients has increased from 30 percent in 2007 to 54 percent in 2010 - the highest it has been in four years. The percentage of internal medicine physicians no longer accepting new patients decreased slightly from the previous year to 49 percent in 2010 - the same level it was in 2007.

Wait times for new patients: Long wait times for appointments for new patients continue. For internal medicine, the average wait time increased to 53 days, nine days longer than last year's figure of 44 days and the highest it has been in six years. For family medicine, the average wait time is 29 days, 15 days shorter than last year's figure of 44 days.

Regional Analysis Shows Shortages across the State
A regional analysis of the 18 specialties for the five Metropolitan Statistical Areas in the state (Boston, Worcester, Springfield, New Bedford/Barnstable, and Pittsfield/Western Massachusetts) found that, with the exception of Boston, all regional labor markets were experiencing shortages of physicians. Critical shortages exist in Pittsfield/Western Massachusetts and Worcester.

In an analysis of the 18 specialties examined by the study, the percentage of practicing physicians in the four labor markets of New Bedford/Barnstable, Pittsfield/Western Massachusetts, Springfield, and Worcester who responded that they were dealing with an inadequate pool of physicians, had difficulty in filling vacancies, needed to alter services, and needed to adjust staffing exceeded the percentage of physicians in the Boston market by at least nine percentage points.

In the four labor markets outside of Boston, more than two-thirds of the practicing physicians said there was an inadequate pool of physicians for recruiting. This characteristic was especially acute in New Bedford/Barnstable and Pittsfield/Western Massachusetts, where more than 8 out of 10 said the pool was inadequate.

Community Hospitals Most Affected By Shortages
Community hospitals continue to be the most affected by the consequences of physician shortages. All - 100 percent - of the medical staff presidents of community hospitals reported they are experiencing difficulty filling vacancies, and 82 percent reported that the amount of time to recruit as physician has increased, an increase of 5 percent over the average of the previous eight years of the studies.

Community hospitals are also reporting the most difficulty with retaining physicians, with 64 percent saying retention has become harder over the last three years. However, this is an improvement from the average of the previous seven-year period, when 79 percent reported difficulty in retaining physicians.

Sixty-four percent of community hospitals reported that physician shortages required them to alter the services they provide, a substantial increase from 43 percent in last year's study.

Eighty-two percent of medical staff presidents responded that physician supply problems required adjustments in their staffing patterns, a substantial increase from 64 percent last year and the average ratio of 56 percent for the years 2003-2009.

Professional Liability: A Negative Influence on the Practice Of Medicine 
The 2010 study once again found that 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 2010 Workforce Study:

  • Forty-six percent of practicing physicians surveyed said their practice has been altered or limited because of the fear of being sued, the same percentage as last year.
  • More than half of physicians in five specialties, said they have altered or limited their practice because of the fear of being sued: neurosurgery (82%); urology (74%), emergency medicine (70%), orthopedics (70%), and obstetrics/gynecology (60%). 40% or more of physicians in nine other specialties have changed their practice for the same reason: cardiology, neurology, gastroenterology, general surgery, dermatology, psychiatry, radiology, internal medicine, and family medicine.

Additional findings

  • Satisfaction with practice environment: For the first time, more physicians (43%) expressed satisfaction with the practice environment than not (41%). 
  • Dissatisfaction with administrative hassles: More physicians expressed displeasure with the tradeoff between patient care and administrative tasks. More than half (51%, up from 44% last year) of all practicing physician regardless of specialty expressed displeasure with the abundance of administrative measures. Among primary care physicians, 59 percent expressed displeasure.  

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 directors of medical groups, residency and fellowship program directors, and a physician office survey. The 2010 study is the Society's ninth 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, Ph.D., 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 http://www.massmed.org/workforce.

About the Massachusetts Medical Society

The Massachusetts Medical Society, with some 23,000 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.

Share on Facebook

New: A Call to Action on Physician Burnout

We’ve published our findings on physician burnout and our directives on ways to mitigate its effect.

Read More »

New: Advertise With MMS

Increase your brand awareness and visibility to physicians and the general public through advertising space on the MMS website and several MMS email newsletters.

Read More »

Subscribe to e-Newsletters

Stay on the cutting edge of medicine by subscribing to free MMS e-newsletters. Choose from up to ten subject areas including physician and patient advocacy, public health, CME, daily health care news, and more. 

Sign Up »

NEJM Resident 360  Ad
FacebookTwitterLinkedInYouTube

Copyright © 2019. Massachusetts Medical Society, 860 Winter Street, Waltham Woods Corporate Center, Waltham, MA 02451-1411

(781) 893-4610 | (781) 893-3800 | Member Information Hotline: (800) 322-2303 x7311