Vital Signs September 2013
Access to Primary Care Still a Statewide Problem
Despite the healthy supply of physicians in Massachusetts, some patients must still wait as long as four months for a first-time visit with a primary care physician.
A new MMS study shows that new patients seeking an appointment with an internist in the New Bedford area can expect to wait an average of 128 days. Typical waits for family physicians in Berkshire County can reach 102 days.
These numbers are much higher than those in other parts of Massachusetts, but the average wait times statewide for adult primary care are still too long, said MMS President Ronald Dunlap, M.D.
“The fact that even in a high-supply state, we have a 50-day wait for internal medicine and a 39-day wait for family medicine is reflective of the depth of the problem,” said Dr. Dunlap. “And the regional data shows significant variation in access and physician supply from county to county.”
Now in its ninth year, the MMS’s Patient Access to Care study asked 1,137 physician offices (e.g., internists, family physicians, OB/GYNs, gastroenterologists, cardiologists, pediatricians, and orthopedic surgeons) the following:
- How long do new patients wait for non-emergency appointments with a physician?
- Do they accept new patients?
- Do they accept Medicare and MassHealth?
Year after year, the headline for the wait times study has remained stubbornly consistent: primary care doctors are in short supply. And it’s hardly just a Massachusetts story. Nationally, 16,000 primary care providers are needed to meet today’s need and an estimated 52,000 primary care physicians by 2025, according to a 2013 report, Primary Care Access, authored by the U.S. Senate Committee on Health, Education, Labor, and Pensions.
Primary Care Waits
Richard Dupee, M.D., an internist and geriatrician with Wellesley Hills PCMH, attributes the long waits for internists — the average jumped by six days since last year — to a couple of factors: first, state and federal health care reform continues to add new patients to the rolls of the insured. Second, with Medicaid rates rising to Medicare levels for certain primary care services this year, it’s likely that some internists are accepting Medicaid patients for the first time, making their panels even larger, he said.
Yet for every internist who accepts new patients, another internist does not: 55% turn away new patients. And Dr. Dupee, who has practiced for 39 years, attributes that partially to the greying of internal medicine.
“Many primary care practices have been around for a long time and the physicians are not interested in taking on new patients,” said Dr. Dupee, who still accepts new patients. “They’re maxed out. They want to go home at a decent hour.” And for salaried internists working for hospital-owned practices, the incentive to squeeze in that new patient just isn’t there, he said.
The PCP Pipeline
It’s pretty much the same story — shortage-wise — when it comes to family physicians, according to the 2013 MMS survey. And judging by the lack of new family physicians in the Massachusetts pipeline, it’s unlikely to get much better, according to Joseph Gravel, M.D., chief medical officer and residency program director at Greater Lawrence Family Health Center.
“We like to think in Massachusetts that we’re progressive and leading the curve,” said Dr. Gravel. “But the fact is 8.5% of residents are in family medicine nationally, but only 3.5% in Massachusetts. We shouldn’t be so far below in terms of primary care physicians.” Dr. Gravel attributed the paucity of family physicians largely to the dominance of tertiary medical centers in the state.
Other Specialties
While wait times for other specialties haven’t changed much since last year, the one exception — and bright spot — was gastroenterology, where average wait times fell by 11 days to the lowest level since the study began — 33 days (although in Franklin County, patients wait on average 213 days, the longest wait time for any specialty anywhere in the state). Douglas Pleskow, M.D., a gastroenterologist with Beth Israel Deaconess Medical Center, said his colleagues recognized that long waits have been a problem in the past. “The shorter waiting time is the response by the GI community to the demands of our patients,” said Dr. Pleskow. As is the case every year, orthopedic surgery had the shortest average wait time (22 days), followed by pediatrics (25 days) and cardiology (28 days).
Medicare and MassHealth Acceptance
The vast majority of Massachusetts physicians accept Medicare, and while internists are the least likely to, 85% still do. MassHealth is also commonly accepted, although a sizable number of family physicians and internist are saying no — 30% and 34% respectively.
“When you get just 60 cents on the dollar, why would you join?” asked Dr. Dupee, the Wellesley internist and geriatrician. “[For PCPs], many studies show that Medicaid fees just pay the overhead. Most practices that do accept Medicaid are downtown clinics that receive city or state help.”
Dr. Dunlap believes that Massachusetts will have won the universal care battle when access is improved in even the most underserved areas of the state.
“That’s the frontier that needs to be crossed,” he said. “And those regional differences in access in turn affect quality.”
The complete study can be found at massmed.org/patientaccess.
– Vicki Ritterband
