Evidence of Family Medicine Shortage Grows With New Report

By Leslie Champlin
7/25/2006

Further data indicating that Massachusetts is struggling with a "severe shortage" of family physicians have joined a series of surveys confirming the need for policies that support primary care medicine, according to the Massachusetts Medical Society, or MMS.

The data, part of the MMS 2006 Physician Workforce Study, show a severe shortage of family physicians in Massachusetts. Community hospitals reported that family physicians constituted their "most critical shortage," according to the study's executive summary. Of community hospitals that responded, 54 percent -- "a sharp increase from the 21 percent average response for the 2003-2005 survey years" -- reported they were experiencing shortages in family medicine, the study said.

"This workforce study for Massachusetts is a validation of recent predictions of a substantial and significant shortage of primary care providers, especially for adults," said Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education.

Moreover, because some family medicine residency programs have reduced their class sizes or have closed, the shift away from primary care professions "is only beginning to make its mark and will likely become more obvious," the study authors predicted.

Pugno agreed. "It is the herald for the potential that patients will find it hard to get access to primary care in the future unless the nation becomes proactive and does what's necessary to promote primary care, especially family medicine," he said.

Evidence of Shortage Builds

The MMS survey is the latest indication that serious shortages loom for family medicine and the patients FPs serve. Previous reports that demonstrate rising demand and greater difficulty finding family physicians to recruit include

the Merritt, Hawkins & Associates 2005 Review of Physician Recruitment Incentives (PDF file: 12 pages / 199 KB. More about PDFs.), which said family physicians ranked as the fifth most recruited specialty, an indication of "a steady resurgence in two areas of primary care recruitment";
recommendations from a recent AMA Council on Medical Education Report (MS Word document, 25 pages / 142 KB. More information on downloading files.), that decried the escalation of subspecialization and the growing shortage of generalist physicians, including family physicians, and called for policies to encourage specialization in primary care; and
the article "Shortages of Medical Personnel at Community Health Centers," in the March 1 issue of the Journal of the American Medical Association, which stated "CHCs face substantial challenges in recruitment of clinical staff. … The largest numbers of unfilled positions were for family physicians at a time of declining interest in family medicine among graduating U.S. medical students. The success of the current US national policy to expand CHCs may be challenged by these workforce issues."

Poor Environment, Liability Contribute

The MMS survey attributes much of the overall physician shortage to dissatisfaction with the practice environment. Although 84 percent of respondents said the practice of medicine was rewarding or very rewarding, 42 percent said they were dissatisfied or very dissatisfied with the current practice environment, and about 47 percent said they probably would not choose medicine as their profession again.

Among the top factors contributing to this dissatisfaction were skyrocketing medical liability premiums.

In 2006, the AAFP launched a concerted effort to persuade the U.S. Senate to pass the House of Representatives' comprehensive medical liability reform package. Despite that effort, the Senate failed to bring the legislation to the floor for a vote.

Equally oppressive for physicians, said MMS survey respondents, are the administrative burdens that impinge on patient care time. Their complaint was confirmed by a recent Medical Group Management Association study, which found that, on average, a 10-physician practice spent more than $247,500 per year on administrative costs.

The MMS study notes that at the same time physicians are dealing with more administrative burdens, they also are facing new demands for quality and cost measurements. "Many physician labor markets in Massachusetts continue to be under extreme stress and will need significant system reform and collaboration from stakeholders to avert a future health care crisis," says the report.

As possible ways to avert the potential crisis, the study authors recommend