Contact: Richard P. Gulla
(781) 434-7101
rgulla@mms.org
Waltham, Mass. - Oct. 2, 2012 - The Massachusetts Medical Society today released its annual study of the state's physician workforce, once again showing shortages in several specialties and continuing difficulty in recruitment and retention of physicians, especially at community hospitals and in areas outside of Boston.
The study also noted some positive trends: more physicians say they are familiar with payment reform initiatives such as accountable care organizations and global payments and more indicated a willingness to participate in one or both of these new models of care. Additionally, slightly fewer physicians said they have altered or limited the scope of their practice for fear of being sued.
The 2012 Physician Workforce Study is the Society's 11th annual comprehensive look at the physician workforce in Massachusetts and includes surveys of practicing physicians, department chiefs of teaching hospitals, and medical staff presidents of community hospitals. Among the topics surveyed were the labor supply of physicians; recruitment and retention; satisfaction with the profession and practice environment; willingness to participate in global payment programs and accountable care organizations; opinions of the U.S. health care system; and the impact of professional liability concerns on the practice of medicine.
"This year's study has mixed results," said Richard Aghababian, M.D., President of the Massachusetts Medical Society. "We still have shortages of physicians in key specialties, especially primary care, and, despite some positive trends, physician recruitment is problematic, particularly for community hospitals."
"Yet we also see some positives, with more physicians willing to participate in accountable care organizations and global payments, and that bodes well as health reform continues to evolve."
Dr. Aghababian also cautioned that physicians face new challenges ahead. "The payment reform bill signed in August has many provisions pertaining to physicians and the practice of medicine. While we are heartened by the law's provisions for medical liability reforms and preventive care, just how the law will affect our physician workforce and to what degree is unknown at this time. It is something we will be watching carefully, particularly as it affects physician practices and patient care. "
Key Findings From 2012 Workforce Study: 7 Specialties in Short Supply
The Medical Society's 2012 analysis found seven of 18 specialties, one fewer than in 2011, to be in critical or severe shortages: family medicine, internal medicine, general surgery, neurosurgery, dermatology, psychiatry, and urology.
Four specialties - internal medicine, psychiatry, urology, and neurosurgery - met the criteria to be classified as facing "critical" shortages. Three were classified as "severe" - family medicine, dermatology, and general surgery.
Primary Care: The 2012 study records both family medicine and internal medicine with shortages for the seventh consecutive year.
Year-to-year trends: Of the five non-primary care specialties in short supply, four are seeing particularly tight labor markets. Urology is experiencing six consecutive years of shortages, and dermatology has seen five consecutive years. Psychiatry has been in short supply for six of the last seven years, and neurosurgery, the specialty having shortages more frequently than any other, has been in short supply in nine of the eleven years of the Society's studies.
A trend analysis over a five-year period (2008-2012) shows that 10 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, and neurosurgery.
Recruitment and Retention of Physicians: Some Improvement, but Community Hospitals Lag
The 2012 Physician Workforce Study found mixed results regarding the recruitment and retention of physicians in the state.
While 2012 marked the fifth consecutive year that saw a decrease in both the recruiting time to hire physicians and in the number of physicians reporting difficulty in retaining physician staff, recruitment still remains difficult for those seven specialties seeing critical and severe shortages and in areas outside of Boston, and it remains particularly hard for community hospitals.
More than 94% of community hospitals report significant difficulty in filling vacancies (compared to 7.3% of teaching hospitals and 22% of practicing physicians) and 87% report increased recruiting time (compared to 30% of teaching hospitals and 39% of practicing physicians). As a result, 50% of community hospitals report it has been necessary to alter services, and 87% report it has been necessary to adjust staffing.
Among the reasons reported by community hospitals for this disparity are that a limited number of physicians are interested in working for a small community hospital, Massachusetts offers lower compensation and has a higher cost of living than other states, and smaller hospitals are often unable to offer competitive salaries. The specialties community hospitals find the most difficult to hire include: neurosurgery, dermatology, cardiology, vascular surgery, orthopedic surgery, obstetrics and gynecology, and the primary care specialties of internal medicine and family practice.
Regional Labor Markets in Massachusetts: Tougher than Boston
With few exceptions, recruitment and retention in the areas outside of Boston are even more difficult. For the four labor markets of Worcester, Springfield, New Bedford/Barnstable, and Pittsfield/Western Massachusetts, physicians indicated it was more difficult to fill vacancies, more difficult to retain staff, and took more time to recruit than last year. The needs to alter services and adjust staffing were also greater in the regional markets.
Physician Satisfaction with Practice Environment is Low
For the second year in a row, the percentage of physicians (40%) who say they are satisfied with the practice environment in Massachusetts equals the percentage (40%) who say they are dissatisfied, though both percentages showed decreases from the previous year (42%-42%).
MMS officials say that the fact that less than half of all physicians are satisfied with the practice environment reflects the findings of the annual MMS Physician Practice Environment Index, a statistical compilation of nine selected factors that influence the overall practice climate for physicians in the state. While the index rose fractionally (0.4%) in 2011, it was only the third increase in the index in the 20 years that it has been compiled.
Patient Care v. Administrative Tasks
Most physicians (78%) find their careers rewarding, but more than half (53%) are dissatisfied with the division between patient care and administrative tasks. This is especially pronounced among primary care physicians (family medicine, internal medicine); with 62% expressing dissatisfaction with the tradeoff between patient care and the administrative tasks they are required to perform.
Views of Massachusetts Payment Reform Initiatives
For the second year in row, the study asked physicians about payment reform initiatives being undertaken in the Commonwealth, specifically global payments and accountable care organizations (ACOs). Responses to questions in 2012 showed an increased familiarity with both global payments and ACOs and an increased willingness to participate in either or both.
Findings on Global Payment Systems
- Familiarity with global payments is high, with 65% of physicians saying they were familiar with global payments, up from 57% last year.
- 48.7% said they were likely (up from 42% last year), and 51.3% (down from 58%) said they were not likely to participate in a voluntary global payment system.
- Employed physicians (61.6%) are more likely to participate in global payments than self-employed physicians (43.4%)
Findings on Accountable Care Organizations (ACO)
- Familiarity with ACOs is high, with 73.5% of physicians saying they were familiar with ACOs, an increase from 58% last year.
- 60% percent said they were likely, and 40% said they were not likely to participate in a voluntary ACO.
- Pediatricians (72.7%) and primary care physicians (71.2%) are more likely to participate voluntarily in an ACO than specialists (60.9%).
- Physicians working in practices of 250 or more physicians (84.3%), in practices between 26-100 physicians (70.8%), and in practices of 11-25 physicians (68.9%) are more likely to participate in a voluntary ACO than those working in smaller or solo practices.
Impact of Professional Liability on the Practice of Medicine
The 2012 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, though somewhat less than in previous years. This finding is consistent with the Society's previous Workforce Studies and its first-of-a-kind Investigation of Defensive Medicine in Massachusetts of November 2008, which showed that the fear of being sued is a serious burden on health care. Findings from the 2012 Workforce Study:
- 41% of physicians said they have altered or limited the scope of their practice because of the fear of being sued - 5% fewer than in each of the last three years.
- More than 40% of physicians in 12 specialties said they have altered or limited their practice because of the fear of being sued: orthopedics (63%), urology (63%), neurosurgery (60%), emergency medicine (57%), family medicine (50%), obstetrics/gynecology (48%), neurology (44%), general surgery (43%), internal medicine (42%), cardiology (41%), gastroenterology (40%), and radiology (40%).
The Medical Society pointed out that the research in the 2012 Physician Workforce Study on professional liability was gathered before the new health care payment reform law was signed in August. The new law includes reforms to the state's medical liability system, including provisions for a six-month, pre-litigation resolution period that affords the time to go through a disclosure, apology and offer process with sharing of all pertinent medical records by the patient, full disclosure by providers, and for statements of apology by providers to be inadmissible in court.
Opinions of U.S. Health Care System
For the second year, physicians were asked their opinions on the best option for the U.S. health care system. While 38% of physicians support a single-payer system, 62% prefer other options. The responses from the 2012 study:
- 22% (versus 23% in 2011) preferred both public and private plans with a public buy-in option for businesses and individuals
- 18% (v. 15% in 2011) said keep the existing mix of public and private plans, but allow insurers to sell plans with limited benefits and high deductibles to keep premiums low
- 19% (v.17% in 2011) preferred the current Affordable Care Act
- 38% (v. 41% in 2011) preferred a single-payer national health care system
- 4% (v. 4% in 2011) other
Patient Access to Care
The Medical Society's 2012 Patient Access to Care Study, released in August and containing the results of a survey of physician offices and a public opinion poll of residents, examined wait times for new patient appointments, physician acceptance of Medicare and Medicaid, and patient experience and satisfaction with health care in the Commonwealth. Details from that study are available at qa.massmed.org/patientaccess
About the Physician Workforce Study
The Massachusetts Medical Society's annual Physician Workforce Study was conducted in collaboration with economist James Howell, Ph.D., of The Howell Group. The complete report is available at http://qa.massmed.org/workforce
About the Massachusetts Medical Society
The Massachusetts Medical Society, with more than 24,000 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.
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