State societies warn of primary care shortages

Groups in Wisconsin, Massachusetts and Connecticut are the latest to say more doctors are needed to meet patient needs, with primary care physicians in especially high demand.

The state-level findings echo those in national November reports from The Physicians' Foundation and the American College of Physicians that project escalating primary care physician shortages. Fewer medical residents are choosing primary care specialties, contributing to the strain on patient access to primary care. Aging baby boomers are among the reasons work force experts project shortfalls to worsen in many specialties.

Physicians in Wisconsin, Massachusetts and Connecticut hope that the findings will be a springboard to find ways to improve each state's -- and the nation's -- doctor supply.

"The demands are high, and the report reflects we are short," said family physician Tim Bartholow, MD, the Wisconsin Medical Society's senior vice president of member services, policy planning and physician professional development. "The number of primary caregivers in Wisconsin -- and nationally -- is far, far short to effectively get the job done."

Wisconsin's study, issued in November, found that the state is short 374 primary care physicians across 31 counties. By 2030, there likely will be a small shortfall for all physicians, with a worse-case scenario of a 44% overall shortfall. Among primary care physicians, a 14% shortfall is expected by 2030.

The study offered recommendations to turn the situation around, including expanding tuition reimbursement for graduates who stay in Wisconsin and preserving the state's favorable professional liability climate. To attract physicians to Wisconsin and fill vacancies, the Wisconsin Council on Medical Education and Workforce in October created a Web site that lists physician openings in Wisconsin clinics, hospitals and academic medicine (link). It has posted about 500 positions in 61 specialties.

East Coast shortages

The Massachusetts Medical Society's 2008 Physician Workforce Study found that 12 of 18 specialties evaluated are in short supply, double the number three years ago.

Internal and family medicine doctors are in critically short supply, experiencing the highest degree of stress. Oncology, neurology and dermatology, studied for the first time this year, made the severe shortage list, meaning they are seeing a high degree of stress.

The result is that some patient wait times are up, according to the seventh annual report, released in October. The wait time for a new patient to see a family physician was two days longer this year, rising to 36 days.

Contributing to the shortages is that 52% of Massachusetts' medical residents move elsewhere once they've completed training. Another contributor: state health reforms that led to more insured patients.

"It definitely was a factor. We had a shortage for the population that had coverage [before the reforms], and then we added an additional 440,000 new individuals who now have coverage," said MMS President Bruce Auerbach, MD.

In July, Massachusetts' Legislature approved measures to increase the number of primary care doctors, including boosting the University of Massachusetts Medical School's class size, and waiving tuition and fees for students who agree to work as primary care physicians in the state for four years after graduation.

If the issue is not addressed, newly insured people won't have access to care because there won't be enough doctors to treat them, Dr. Auerbach said.

In Connecticut, the Connecticut State Medical Society in September issued its first state work force study. Based on answers from 1,077 physicians, 19% of doctors are considering a career change, and 10% plan to leave the state because of the practice environment.

"What was interesting about the survey was that the dissatisfaction was spread across the specialties," said CSMS President William A. Handelman, MD.

Forty-seven percent of physicians increased their hours. Still, patients waited an average 17 days for an office visit, with waits higher in Hartford, Middlesex, New Haven and Windham counties, according to the Connecticut Physician Workforce Survey 2008.

Like other states, Connecticut faces an aging physician population, and doctors are finding it difficult to recruit young physicians to take their spots. Demands are increasing as baby boomers age and require more medical care. Dr. Handelman said solutions include finding ways to attract new doctors through loan forgiveness programs and improving the professional liability climate.

"The Legislature has to understand doctors are a small business and under a lot of stress," he said.