Annual survey lists physician shortages in four specialties, regional difficulties in recruitment and retention, physician satisfaction, knowledge of state health reform initiatives
Contact: Richard P. Gulla
Tel: 781-434-7101
Email:
rgulla@mms.org
Waltham, Mass. -- September 18 -- The Massachusetts Medical Society today released its annual study of the state’s physician workforce, showing an eighth consecutive year of shortages of primary care physicians; stark differences in recruitment and retention among the state’s five regional labor markets; and high levels of knowledge by physicians with state reform initiatives and emerging care models.
The 2013 Physician Workforce Study is the Society’s 12th annual comprehensive look at the physician workforce in Massachusetts and is based on a survey of practicing physicians across the state. Among the topics examined are the supply of physicians; recruitment and retention; satisfaction with the profession and practice environment; familiarity with health reform efforts; the impact of professional liability concerns on the practice of medicine; and knowledge of and willingness to participate in global payment programs and accountable care organizations. The study also included a smaller survey of medical residents and fellows and their willingness to practice in Massachusetts after completion of training.
Massachusetts Medical Society President Ronald Dunlap, M.D. said the 2013 study revealed continuing difficulties as well as improvements within the physician labor force.
“The supply of physicians in the state remains under stress, notably with primary care,” Dr. Dunlap said, “and recruitment and retention continue to be difficult, especially for less populated areas of the state. Those factors affect patient access to care.”
“On the plus side, physician satisfaction with the profession remains high, more physicians are becoming familiar with reform initiatives, such as global payments and accountable care organizations, and more physicians indicated they are likely to move to global payments to reduce health care costs.”
Key Findings From 2013 Workforce Study
Specialties Found in Short Supply
The Medical Society’s 2013 analysis found four specialties to be in critical or severe shortage: family medicine, internal medicine, neurology, and gastroenterology. The primary care specialties of family medicine and internal medicine were recorded with shortages for the eighth consecutive year. A trend analysis over the last five years (2009-2013) shows that seven specialties have been in short supply in at least three of those five years: family medicine, internal medicine, psychiatry, dermatology, general surgery, neurology, and urology.
Recruitment and Retention: Big Regional Differences
In an analysis of six key categories, the study showed striking differences in physician recruitment and retention among the state’s five regional labor markets: Boston/Greater Boston, New Bedford/Barnstable, Worcester, Springfield, and Pittsfield/Western Massachusetts. (See individual sections below for geography of labor markets.)
With the Boston/Greater Boston market as a baseline for comparison, the study shows that it is three times as difficult to fill physician vacancies in the Pittsfield/Western Massachusetts market, twice as difficult in the Springfield market, and more than one-and-a-half times as difficult for the Worcester and New Bedford/Barnstable regions than it is for the Boston/Greater Boston region.
In every region of the state, 50% or more of the physicians said the pool of physicians from which to recruit was inadequate. Specifics for each labor market in descending order of difficulty:
Pittsfield/Western Massachusetts:
Recruitment and retention appear most difficult in this region, as physicians in this market reported more difficulty than the other regions in four of the six categories examined. Nearly eight in ten physicians (78%) said the pool of physicians from which to recruit was inadequate, 47% reported it is more difficult to retain staff, 43% said it was difficult to fill vacancies, 63% reported the need to adjust staffing, and 57% reported the need to alter services. The Pittsfield/Western Massachusetts labor market includes Berkshire County.
Springfield:
This labor market was the second most difficult. Three-quarters (75%) of physicians responding said the pool of physicians was inadequate, 50% said it was difficult to retain staff; 40% said it was difficult to fill vacancies, 61% reported the need to adjust staffing, and 49% reported the need to alter services. The Springfield labor market includes Hampden, Hampshire, and Franklin counties.
Worcester:
The Worcester market was judged third most difficult for recruitment and retention, with 57% of physicians reporting an inadequate pool of physicians, 43% reporting it was more difficult to retain staff, 30% saying it was significantly difficult to fill vacancies, 39% reporting the need to alter services, and 49% reporting the need to adjust staffing. The Worcester labor market includes Worcester County.
New Bedford/Barnstable:
Physicians in this part of the state reported the fewest problems with recruitment and retention other than the Boston/Greater Boston region. Twenty-seven percent (27%) said they had significant difficulty in filling vacancies; 32% reported the need to alter services; 39% reported the need to adjust staffing; 40% said it was more difficult to retain staff, and 64% said the pool of physicians for hiring was inadequate. The New Bedford/Barnstable labor market includes Bristol, Barnstable, Nantucket, and Dukes counties.
Boston/Greater Boston:
Physicians in this region reported the fewest challenges of the five labor markets in physician recruitment and retention. Only 18% reported difficulty in filling vacancies, and less than one–third saw the need to alter services (27%) or adjust staffing (30%). Still, nearly one-third (32%) said it was more difficult to retain staff and one-half (50%) said the pool of physicians for hiring was inadequate. The Boston/Greater Boston labor market includes Suffolk, Middlesex, Essex, Norfolk, and Plymouth counties.
Knowledge of and Participation in Health Care Payment Reform Initiatives
For the second year in row, the study asked physicians about their knowledge of state health care reform and payment reform initiatives being undertaken in the Commonwealth, including global payments and accountable care organizations (ACOs).
Familiarity with Chapter 224, the state’s cost containment law
Just under half (49%) of respondents said they were familiar with Chapter 224, the state’s health reform law on cost containment passed in 2012; 24% said they were not familiar; and 27% indicated they were unsure.
Familiarity with and participation in Global Payment System
- Familiarity with global payments remains high, with 59% of respondents indicating they are either very or somewhat familiar with global payments.
- More physicians (54%, up 5% from last year) said they were likely, and fewer (46% down 5%) said they were not likely, to participate in a voluntary global payment system.
- Employed physicians (61%) are more likely to participate in global payments than self-employed physicians (44%)
Familiarity and Participation with Accountable Care Organizations (ACO)
- Familiarity with ACOs remains high, with 71% of physicians saying they were either very or somewhat familiar with ACOs.
- Of those physician practices that were familiar with ACOs, 42% are currently part of an ACO.
- Of those physician practices that were familiar with ACOs, more primary care physicians (49%) were part of an ACO than specialists (38%).
Physician Satisfaction
The 2013 study recorded physician satisfaction with the profession of medicine, the practice environment in Massachusetts, and time spent on patient care versus administrative tasks.
Physician satisfaction with the profession of medicine
More than three-quarters (77%) of Massachusetts physicians find their careers in medicine rewarding. Despite a slight drop (1%) from the previous year, this figure has remained relatively constant over the last four years.
Physician satisfaction with the practice environment in Massachusetts
Less than half (43%) of physicians expressed satisfaction with the practice environment in the state, with 39% saying they are dissatisfied. MMS officials say that the fact that less than half of all physicians are satisfied with the practice environment reflects the findings of the annual
MMS Physician Practice Environment Index, a statistical compilation of nine selected factors that influence the overall practice climate for physicians in the state. While the index rose slightly (up 0.6%) in 2013, it has declined by more than 25% since its peak in 1993.
Physician satisfaction with patient care v. administrative tasks
More than half (53%) of physicians are dissatisfied with the division between patient care and administrative tasks. This percentage has remained constant over the last three years and is especially pronounced among primary care physicians (family medicine, internal medicine), with 59% expressing dissatisfaction with the tradeoff between patient care and the administrative tasks they are required to perform.
Impact of Professional Liability (Medical Malpractice) on Practice of Medicine
The 2013 study again found that the fear of being sued continues to have a negative influence on physicians and the practice of medicine, though less than in previous years. This finding is consistent with the Society’s previous workforce studies.
- 36% of physicians said they have altered or limited the scope of their practice because of the fear of being sued – a drop of 5% from 2012.
- A third or more of physicians in eight specialties said they have altered or limited their practice because of the fear of being sued: general surgery (64%), emergency medicine (61%), orthopedics (50%), urology (63%), neurology (45%), cardiology (41%), radiology (39%), oncology (38%), and obstetrics/gynecology (33%).
Survey of Residents and Fellows
The 2013 Physician Workforce Study included a survey of medical residents and fellows (physicians who are continuing their training), with particular emphasis on post-training employment decisions, whether they would seek to stay in Massachusetts to practice, and how they rated Massachusetts as a place to practice medicine. Among the key findings from this part of the study:
- 61% of respondents said they would choose Massachusetts to begin their practice.
- Respondents indicated that both professional factors, such as the practice environment and research and clinical opportunities, and personal factors, such as work/family balance, are less favorable for staying in Massachusetts to practice compared to 2011, when the last survey of residents and fellows was taken.
About the Physician Workforce Study
The Massachusetts Medical Society’s 2013 Physician Workforce Study was conducted in collaboration with economist James Howell, Ph.D., of The Howell Group. The complete report is available at
www.massmed.org/workforce2013.
Additional studies by the Massachusetts Medical Society
The 2013 Physician Workforce Study is one of three studies conducted by the Massachusetts Medical Society this year as part of its continuing effort to gauge the healthcare landscape in Massachusetts.
The 2013 Patient Access to Care Study, released in July, examined three areas of access to care: (1) wait times for new patients getting non-emergency appointments with a physician; (2) percentages of physicians accepting new patients; and (3) physician acceptance of the government insurance programs of Medicare and MassHealth. Details from that study are available at
www.massmed.org/patientaccess
The 2013 Public Opinion Survey of Health Care in the Commonwealth has been conducted periodically since 2003 as part of the Society’s continuing effort to gauge patient opinions of health care in the state. The 2013 survey was conducted by telephone May 14-16 and included 417 randomly selected interviews with adults 21 and over. The complete 2013 Massachusetts Medical Society Public Opinion Survey is available at
www.massmed.org/poll2013
About the Massachusetts Medical Society
The Massachusetts Medical Society, with more than 24,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society, under the auspices of NEJM Group, publishes the New England Journal of Medicine, a leading global medical journal and web site, and NEJM Journal Watch alerts and publications covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country.
