Primary care doctors in short supply, survey says

By Elizabeth Cooney, Globe Correspondent

Just when the new healthcare law in Massachusetts is expected to send more people to doctors’ offices, the state’s shortage of primary care physicians continues to be critical, according to a physician workforce study released today.

For the second year in a row, family practice and internal medicine doctors are harder to find, both for patients seeking appointments and for hospitals and group practices trying to recruit them, according to the sixth annual survey conducted by the Massachusetts Medical Society.

“Supply and demand are both going in the wrong direction,” Dr. B. Dale Magee, the society’s president, said in an interview. “With the new healthcare reform law, we anticipate that the demand for physician services is going to increase, not only across the board, but especially for primary care physicians.”

As of July 1, residents of Massachusetts were required to have health insurance. New coverage will mean new patient visits, health experts believe.

“We would anticipate in the earlier stages of the law that a disproportionate number of people with more advanced diseases will require care than later on,” Magee said. “If you aren’t seeing the doctor, you don’t know you have high blood pressure or you may not know you have kidney disease. A lot comes to light with good preventive medicine.”

Psychiatry also appeared on the list of critical shortages for the second year. Vascular surgery jumped to critical this year, up from its first ranking on the severe list last year.

Anesthesiology, cardiology, gastroenterology and neurosurgery are continuing a six-year trend of severe or critical shortages. Urology was added to the severe shortage list this year.

The study polled physicians, hospital presidents, residency and fellowship program directors, physician offices, and patients.

Internal medicine appointments are harder to get this year, the office survey found. A little over half (51 percent) are accepting new patients, down from 64 percent last year. The average time a new patient waits to see an internist with openings is 52 days, compared with 33 days last year.

Last year, 53 percent of patients reported they could see their primary care physician within a week of calling, but that fell to 42 percent this year.

Among hospitals, 68 percent of teaching hospitals and 83 percent of community hospitals are having trouble filling their physician vacancies. For 72 percent of community hospitals and 38 percent of teaching hospitals, that meant changing the provision of services.

Seventy percent of medical directors at group practices said the average amount of time to recruit a doctor had gone up over the last three years.

The medical society is trying to get state and federal government programs to consider some form of loan forgiveness for doctors who leave medical school deep in debt as a way to encourage them to choose the less lucrative primary care specialty, Magee said.

The society is also working with the American College of Physicians to bring more nurse practitioners and physician assistants into primary care offices to ease the crunch. Medical schools are being encouraged to highlight the need for primary care physicians. Fewer than 30 percent of medical school graduates in Massachusetts choose primary care, while 50 percent or more would be ideal, Magee said.

A separate Physician Practice Environment Index published by the medical society last year has shown a 13-year decline. Rising costs of doing business, including liability payments, and declining income account for much of the deterioration, the society said.

Today’s survey said that 86 percent of doctors believe that over the next five years their salaries will either decline or remain the same. About a quarter (24 percent) said they are planning or considering a move out of Massachusetts.

If given the chance, just over half (51 percent) said they would choose medicine again as their profession.
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