Work force studies find scattered physician shortages

In Massachusetts, there is a shortage of family physicians, internal medicine specialists and psychiatrists for the first time. Nationwide, there is a shortage of child and adolescent psychiatrists, with rural areas reporting the greatest shortfalls.

Massachusetts

Primary care physicians are in short supply in Massachusetts, and several specialties there are having an increasingly difficult time retaining doctors, according to a new Massachusetts Medical Society work force study.

MMS has monitored the state's physician work force for five years, with the 2006 evaluation noting severe to critical shortages, for the first time, in family medicine, psychiatry and internal medicine.

"The shortage of primary care physicians is especially disturbing," MMS President Kenneth R. Peelle, MD, said in a statement. "The results of these studies should carry a strong message to health care officials and policy-makers alike: It is imperative that we improve the practice environment for our physicians."

Anesthesiology and neurosurgery remain stressed, according to the "2006 Physician Workforce Study," with severe to critical shortages noted for the fifth consecutive year. Gastroenterology, orthopedics, general surgery and radiology had severe to critical shortages for the fourth time. Meanwhile, cardiology moved out of the severe to critical category for the first time since the study began.

"It's ironic and troubling that in a state known for its leadership in health care, the physician work force is so much under stress," Dr. Peelle said. "We need to improve the viability of our physician practices, improve our recruitment and retention, and reduce the shortages in key specialties."

The MMS 2006 study found community hospitals were feeling the deficit most keenly, with 92% of them reporting recruiting problems overall and 54% of them reporting shortages of family physicians.

Others also were feeling the pinch, with 65% of the state's practicing physicians reporting problems filling physician vacancies in their practices and 67% of teaching hospitals reporting recruiting problems.

Access to care also was a concern, according to the report. Existing patients waited an average of 15 days for an office visit and new patients waited an average 26 days.

Child and adolescent psychiatrists

A new study in the Journal of the American Academy of Child & Adolescent Psychiatry shows that the national shortage of child and adolescent psychiatrists hits poor children and adolescents living in rural areas the hardest. With little relief in sight, the study's authors recommend that use of telepsychiatry be expanded and that primary care offices offer more mental health services. At the same time, recruitment efforts need to be improved and training opportunities expanded, the authors said.

There is no definitive number on how many psychiatrists are enough, but one managed care model estimates 14.38 child and adolescent psychiatrists per 100,000 youth would be ideal. Only six states meet or exceed that standard: Connecticut, Hawaii, Maryland, Massachusetts, New York and Rhode Island. Five states, Alaska, Alabama, Nevada, Oklahoma and Wyoming, have fewer than four child and adolescent psychiatrists per 100,000 youth, the study said.

According to the study, 35 states fall below the national average of 8.67 child and adolescent psychiatrists per 100,000 children and adolescents. Some 190 metropolitan counties -- those encompassing cities or metropolitan areas -- do not have a child and adolescent psychiatrist.

At the same time, one in five youths are likely to develop a mental disorder; children living in poverty are at an even higher risk for mental disorders.

The overall number of these physicians is expected to increase gradually. However, a growing population and a doubling in demand may leave patients in 2020 with the same access to care that was available in 1995, the study shows.

The research, scheduled to appear in the journal's September issue, is available in an online advance publication (link).