By Andy Metzger
State House News Service
---- — BOSTON — While the number of uninsured Massachusetts residents has fallen since 2006 and the number who have visited a doctor has increased, the state’s shortage of physicians continues, with “critical” levels in a few specialties.
This year, neurosurgery joined internal medicine, urology and psychiatry as fields where there is a critical shortage, according to the Massachusetts Medical Society Physician Workforce Study released yesterday. Other fields in the slightly less drastic “severe” rating include family medicine, dermatology and general surgery.
According to the study, the most “in-demand” fields of medicine are the ones where patients have the most difficulty finding a doctor, and the shortages will be exacerbated by the Affordable Care Act as they were by the 2006 state-level reform.
“In Massachusetts, the percentage of insured residents has increased to 97 percent over the past five years; however 32.8 percent of insured patients indicated a problem obtaining health care in the past year,” the study says. “On a national scale, a similar problem will likely surface, given the number of physicians.”
In the period immediately following the 2006 law, patients around Boston and in the western part of the state were unable to see doctors because they were not accepting new patients, a development that may have added to more emergency room visits.
“[T]he challenges faced by Massachusetts residents in obtaining medical care are reminders that universal insurance coverage does not always guarantee access to health care,” the study said.
The shortage has been somewhat alleviated since 2006, when the number of specialties with critical or severe shortages shot up from six in 2005 to 11 in 2006. That figure peaked in 2008 at 12. This year’s total of seven specialties listed as critical or severe is down from last year’s total of eight.
Orthopedics was listed as in a severe shortage last year but not this year. Internal medicine has been at a critical shortage for the past three years.
The survey also measured doctor satisfaction, and found that the percentage of satisfied doctors and dissatisfied doctors was equal at 40 percent each. In 2010, the number of satisfied doctors edged the number dissatisfied but dating back to 2002, dissatisfaction has reigned among Massachusetts physicians. In 2003, 60 percent of doctors were dissatisfied or very dissatisfied.
“This year’s study has mixed results,” said Massachusetts Medical Society President Dr. Richard Aghababian, M.D., in a statement. “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.”
Community hospitals have been significantly more affected by the shortage than teaching hospitals. Teaching hospitals reported a 7.3 percent rate of “significant difficulty to fill vacancies” compared to 94.1 percent at community hospitals and a rate of 21.7 from 8,052 physicians surveyed.
Executives at the community hospitals listed lower salaries, high cost of living and lack of interest as reasons contributing to the difficulty in recruiting. Asked which specialty was most difficult to fill, the community hospital executives listed family practice, neurosurgery and internal medicine as the top three.
Western Massachusetts is more affected by the shortage than other areas of the state. The western region reported a 47.8 percent rate of “significant difficulty to fill vacancies” compared to 17.4 percent in Boston and 29.3 percent in Worcester.
A growing and aging population will live longer than previous generations and will develop more chronic diseases, contributing to the demand, according to the study.
Medical schools will aim to keep up with the increasing demand, the study says. In 2005, the Association of American Medical Colleges recommended medical schools increase enrollment by 30 percent by 2015. The Bureau of Labor Statistics predicts the number of physicians nationwide will climb by 168,300, or 24 percent, from 2010 to 2020. The AAMC predicts a nationwide shortage of 124,000 full-time physicians by 2025.