1. Bruce S. Auerbach, MD, FACEP President Massachusetts Medical Society
Will the Shortage of Primary Care Physicians in Massachusetts Derail Reform Efforts?
Bruce S. Auerbach, MD, FACEP
President
Massachusetts Medical Society

2. Commonwealth Care (30% pay monthly premium)
Enrollment through July 2008
110,740*
91,031
83,276
Almost 300,000 people who didn’t have health insurance previously, now have health insurance.
About two-thirds of them get their insurance for free, courtesy of the state and federal governments. 29% pay something towards their premium.
These numbers have been relatively steady for a number of months – clearly the biggest room for growth is in category of middle-class residents.
18,132
Commonwealth Care (30% pay monthly premium)
Commonwealth
Choice
May 1 data
Source: Commonwealth Connector reports 2 2 2

3. But … Will They Have a Doctor
But … Will They Have a Doctor? Massachusetts Physician Workforce Study: 2007
Internal Medicine
Critical
Vascular Surgery
Family Practice
Severe
Neurosurgery
Anesthesiology
Cardiology
Gastroenterology
Psychiatry
Urology
Every year we have identified specialties where the labor shortage is in severe or in critical condition.
Labor economists have looked closely at our data, and say that without question, the physician labor market in Massachusetts is under remarkable stress.
But even among those specialties in trouble, a handful of specialties stand out as worse than the rest.
In our 2007 study, four were placed in the critical category – and many of these have persisted over the time we have conducted the study.
These categories were based on responses to six key questions
[It‘s a national problem: in the last decade, a 22% drop in the number of medical school graduates who choose to become primary care physicians]

4. But …When Will They See a Doctor?
Another symptom of stress – long wait times for appointments
Merritt Hawkins annual survey in Mass:
Researchers posed as a new patient calling for a routine (non-emergent) appointment in several specialties
Number of days between date of call and the date of appointment.

5. Appointment Wait Times: 2007
Merritt Hawkins employees anonymously called physician offices in six specialties and tried to schedule a routine appointment.
What you see here is the number of days in each specialty, from the time of the phone call, that they could get in the see the doctor.
In almost every instance, these numbers are significantly higher than other major cities around the country.
High, low, and average number of days between scheduling the appointment and the date of the appointment, per specialty (statewide).
Cardiology - The shortest average wait time is 13 days in Berkshire, while the longest average wait time is 54 days in Worcester County.
Gastroenterology - The shortest average wait time is 12 days in Hampshire County, while the longest average wait time is 53 days in Middlesex County.
Internal Medicine - The shortest average wait time is 21 days in Hampden County, while the longest average wait time is 109 days in Bristol County.
Obstetrics/Gynecology - The shortest average wait time is 33 days in Hampshire County, while the longest average wait time is 119 days in Berkshire County.
Orthopedic Surgery - The shortest average wait time is 11 days in Franklin County, while the longest average wait time is 47 days in Suffolk County.
Family Practice/General Practitioner - The shortest average wait time is 12 days in Berkshire County, while the longest average wait time is 66 days in Bristol County.
Trend
N/A
Range and average for each specialty

6. Patients Feel the Strain
Only 42% who made an appointment to see a primary care physician could be seen within a week
Down from 53% in 2005 and 2006
21% were forced to wait for necessary medical care
The most commonly cited reason for delays
Overcrowded doctors’ offices (23%) up 13% from last year
Scheduling problems (16%)
A lack of insurance (12%)
The need to wait for a referral (10%)
Patients are starting to notice.
And the reasons they believe for the long wait times is very accurate.

7. Practices Accepting New Patients
Trend
N/A

8. Fixing the Supply Imbalance
New incentive programs
Loan forgiveness programs
Partners Healthcare and community health centers
State Health Care Workforce Center
Advanced medical home pilots
State program under Medicaid
ACP pilot
Mass. Blue Cross Blue Shield
Expanded primary care training at UMass Medical School

9. Other considerations Reducing administrative burdens Payment reform
Patient engagement
Wellness programs
Chronic disease management
Lifestyle changes
Care must be comprehensive and integrated