The 2012 Physician Workforce Study released by the Massachusetts Medical Society reports that of 18 medical specialties selected from a random sample, those core specialties that serve as gateways to preventive treatment remain among seven labeled as “critically” or “severely” lacking.
Baystate Medical Center and Mercy Medical Center, both in Springfield, and Holyoke Medical Center, clockwise from top left, are among the hospitals in Massachusetts suffering from a lack of new primary care doctors.As primary care doctors emerge as a more critical part of the healthcare landscape statewide and nationally, experts on the physician workforce say new doctors in those fields remain hard to come by - and hard to afford in small Massachusetts hospitals.
The 2012 Physician Workforce Study released by the Massachusetts Medical Society reports that of 18 medical specialties selected from a random sample, those core specialties that serve as gateways to preventive treatment remain among seven labeled as “critically” or “severely” lacking.
Based on a survey mailed to 8,052 doctors in Massachusetts in January, the study offers a forecast of physician labor shortages that could affect wait times for doctor’s appointments; patient services and turnaround times for recruitment.
In addition to internal medicine, specialists in psychiatry, urology and neurosurgery were ranked in the critical shortage category. Dermatologists, family practitioners and general surgeons were deemed in severe shortage.
The study also said community hospitals in Western Massachusetts will be most affected by these trends. Local physicians and recruitment specialists attribute this to several factors – including the state’s 2006 universal health care law, its high penetration of managed care and new doctors’ tendencies to be attracted to large urban hospital networks.
"It's expensive to hire physicians," said Dr. Karen M. Ferroni, medical director at Holyoke Medical Center. "Physicians in Massachusetts in some specialties do not earn enough money in their offices to cover their salaries. But these days new doctors leave medical school carrying the equivalent of a mortgage home (in medical school loans)."
Whereas freshly minted physicians easily sought a bank loan to open a solo practice once upon a time, not so these days, Ferroni said, prompting the financial arms of hospitals to scramble for ways to make hiring sorely needed doctors cost-effective. Ancillary services including labs, x-rays and other procedures through doctor referrals often factor in, she said.
According to the study, respondents in the Pittsfield/Western region reported a 47.8 percent rate of “significant difficulty to fill vacancies” compared to 33.7 percent in Springfield, 29.3 percent in Worcester and 17.4 percent in Boston.
Most area hospitals have their eyes on the future and have upped their recruitment efforts. Some are sharing recruiters, wooing new doctors long before they complete training and placing an emphasis on the region’s best quality-of-life features.
All health care providers have in mind the sweeping health care control act signed by Gov. Deval L. Patrick in August, which goes into effect in November. The bill aims to save up to $200 billion in health care costs and offers incentives for providers that push primary care as opposed to a strong fee-for-service approach. “Primary care is number one, two and three,” said Daniel P. Moen, CEO of the Sisters of Providence Health System in Springfield, of its physician recruitment priorities.
Moen said that health system, Noble Hospital in Westfield and Hampden County Physician Associates are pooling their resources with a common recruiter to act as a booster for the three entities.
“We do well with people who have family here .¤.¤. maybe people like to ski,” Moen said, half-jokingly. “The people we recruit we expect to raise families here and to stay here for their careers. In Massachusetts we train so many residents and fellows, we’ve got to do a better job at keeping them here.”
At Noble Hospital, Chief Executive Officer Ronald P. Bryant said they often woo recruits with Westfield's idyllic neighborhoods and school systems and those of even more pastoral nearby towns.
"What we can offer is a community-based practice in a non-urban area," Bryant said, noting that their key patient bases of Westfield and Southwick comprise about 45,000. "What you create is an environment for primary care physicians that's attractive and the other specialties will follow. Specialties cannot thrive without a referral base from primary care doctors."
Moen and others said universal health care decreased the number of uninsured (to 97 percent) statewide, but also overwhelmed many general practitioners who closed their practices, sending emergency room visits skyward. He said Mercy Medical Center saw approximately 75,000 emergency room visits last year.
Baystate Medical Center, the region’s largest and only teaching hospital, saw around 110,000, an official there said.
Moen said that health system recently added two orthopedic surgeons and is in the process of recruiting a thoracic surgeon and boosting its general surgery staff.
Sisters of Providence has 600 physicians including staff and private physicians who practice there.
Fittingly, the study says the greatest shortages in medicine are the ones where most new patients struggle to find a doctor. It also contends the shortages will be exacerbated by the federal Affordable Care Act as they were in 2006 through state reforms as the uninsured gap closes further. Though, it will ultimately serve to level the reimbursement playing field for Massachusetts.
Baystate Health has three hospitals including its flagship Baystate Medical Center in Springfield and community hospitals in Greenfield and Ware. It has about 450 staff physicians among the various entities and approximately 500 more private doctors who practice in the system, according to Dr. Mark Keroack, president of Baystate Medical Practices.
“We’re a little bit different in that we’re a large physician group,” plus a system that earlier this year unveiled a new, state-of-the-art hospital in Springfield. Keroack said. “We’ve recruited 42 doctors in the last year but are facing some of the same challenges in family medicine and internal medicine.”
Other areas where Keroack said the health system was “short,” but not reflected in the study, are gynecological oncology and plastic surgery.
“It’s not unusual for us to be in the market for a position for 100-plus days,” even using up-to-the minute networking tools including Monster.com and Facebook. “We compete with people across the region and the country.”
A major factor barrier to physician recruiting in Massachusetts is the fact that the 2006 healthcare reform has led to no growth in physician reimbursement over the past three years.
This is a challenge facing the biggest hospitals to the smallest, most specialized groups. Dr. Stephen J. Sweet, of Western New England Renal and Transplant Associates, said kidney specialists frequently won’t meet the threshold for sampling in the workforce survey because their numbers are so small. However, the barriers to recruitment are still the same.
“Our fee schedule is still the same, but my malpractice insurance and office expenses and computer expenses have all gone up, so you’re losing ground to inflation within the office,” Sweet said.
But, the group of about a dozen renal specialists in Springfield typically has not had an opening for too long and patients have relatively short waits to get an appointment: an average of two weeks, he said.
Many hospitals and health systems also are mindful of the retiring age of their physicians. Cooley-Dickinson Hospital in Northampton, for example, says it has a three-year physician recruitment plan with that in mind. That hospital counts 351 staff and private physicians, a spokeswoman said.
Josh Maybar, recruitment manager at the hospital, said it is most heavily recruiting adult primary care physicians, endocrinologists, neurologists and inpatient psychiatrists.
Maybar said he could not put a finite number on the quotas of doctors the hospital is seeking in each specialty because the figures are speculative and based on a complicated formula of the over health of the population, average wait times at various practices, physician interest and other factors.
“If we were to flood specialty areas all at once, physicians would have a hard time building a patient panel,” Maybar said of the delicate balance, adding that they have begun recruiting physicians more than a year out, depending on the need.