Are physicians overworked and underpaid?
A Massachusetts Medical Society (MMS) report released this week
answers in the affirmative, but health plans think differently.
The MMS report shows that 12 physician specialties are operating under
severe labor market conditions. Not surprisingly, internal medicine
and family practice are listed as critical shortages. Long wait times
continue to plague the primary care system; the average wait time for
internal medicine is 50 days, and the average wait for family practice
is 36 days, according to the report.
Twelve of 18 specialties surveyed were deemed to be operating under
shortage conditions, including three—dermatology, neurology, and
oncology—that were added to the shortage list for the first time. The
number of shortage specialties in the state has doubled in just three
years, according to researchers.
Although compensation is often cited as a causal factor in shortage
conditions for lower-paying specialties (such as primary care), the
newer additions to the list are some of the highest-compensated
specialties in medicine (such as dermatology). Shortages in those
areas reflect a growing disparity between patient demand and physician
supply being seen nationwide, says Bruce Auerbach, MD, MMS, president
of the Massachusetts Medical Society.
Auerbach attributes the broader causes of the shortage to trends that
are being seen across the country: retention and recruitment
challenges, the threat of malpractice lawsuits, high malpractice
premiums, and rising medical school debt—issues that would affect the
state regardless of its health insurance system.
"Clearly there is a link to the health insurance system we have, both
in terms of administrative burden as well as the reimbursement levels
it provides to physicians that live in high-cost states like ours,"
Auerbach says.
Massachusetts physicians complained about increased workload and low
payments in the report, but Marylou Buyse, MD, president and CEO of
the Massachusetts Association of Health Plans, says those are
misperceptions. Physicians are not seeing more patients, and health
plans increased physician payments by 10% each year between 2002 and
2006 and the healthcare reform law increased Medicaid payments for
physicians and hospitals, she says.
"Doctors are charging more for their care, they are not seeing more
patients, and their payments are going up 10% a year," says Buyse.
Auerbach mentioned that decreasing administrative burdens is one
immediate step the state could take. That charge rings hallow for
Buyse.
"If anything, these administrative requirements are not new. They have
been around for at least a decade. And if anything, the health plans
have reduced them, not increased them," she says, mentioning fewer
prior authorizations as an example. Healthcare law consultant David
Harlow, principal of the Harlow Group in Newton, MA, who writes Health
Blawg, says the question is: How can Massachusetts create a more
attractive environment for physicians immediately?
Harlow says even if residencies are increased that won't help in the
near term. "It's not an immediate quick fix," he says.
Recruiting new physicians and helping prospective doctors pay for
their college are long-term solutions, but there are ways to deal with
the problems now, such as revamping malpractice environment and
allowing for retail pharmacies. CVS/pharmacy recently opened its first
MinuteClinic in Massachusetts and hopes to have 28 retail clinics in
its stores by the end of the year.
Greater use of physician assistants and nurse practioners to provide
basic healthcare services would free up physicians to work on more
complex cases, Harlow and Buyse say.
"To a great extent, that can be a reliever of pressure of primary care
physicians, emergency rooms in hospitals, etc. If those service
settings are used properly, they can be helpful escape valves," Harlow
says.
What about the 433,000 newly insured in Massachusetts thanks to the
recent healthcare reforms? That must be contributing to overwhelmed
physicians, right? Maybe not. A recent article showed that many of the
newly insured are using emergency rooms for routine care rather than
visiting primary care physicians.
If average wait time for internal medicine is 50 days and family
practice is 36 days, no wonder why people are rushing to the emergency
room for routine care. Massachusetts has made great strides through
its healthcare reforms, but educating patients and removing barriers
to primary care are still major hurdles.
State leaders will need to clear those barriers before they can
contain healthcare costs. But what will all of those newly insured do
to a healthcare system that MMS already suggests is in severe trouble?
Les Masterson is senior editor of Health Plan Insider. He can be
reached at lmasterson@healthleadersmedia.com.
Elyas Bakhtiari contributed to this report. Note: You can sign up to
receive Health Plan Insider, a free weekly e-newsletter designed to
bring breaking news and analysis of important developments at health
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