Is There A Doctor In The House?

In Massachusetts, in particular.  A subscription-only article in today's Wall Street Journal touches on the difficulty some of Massachusetts' mandatory insurance enrollees are having in locating a primary care MD.  It turns out that, go figure, a state with very restrictive financial conditions for physicians doesn't have enough physicians for the population.

BOSTON -- Tamar Lewis runs a makeshift hair salon out of her one-bedroom apartment in Roxbury, a low-income neighborhood here. She's 24 years old and has been cutting hair since she dropped out of high school in 2002. Until recently, she never had health insurance.

"Good thing I never snipped one of these off," Ms. Lewis jokes, wiggling 10 fingers. Earlier this month, she signed up for state-subsidized insurance under a new Massachusetts law that aspires to universal coverage. The plan costs her $80 a month.

But it takes a lot more than an insurance card to see a doctor in this state.

On the day Ms. Lewis signed up, she said she called more than two dozen primary-care doctors approved by her insurer looking for a checkup. All of them turned her away.

Her experience stands to be common among the 550,000 people whom Massachusetts hopes to rescue from the ranks of the uninsured. They will be seeking care in a state with a "critical shortage" of primary-care physicians, according to a study by the Massachusetts Medical Society released yesterday, which found that 49% of internists aren't accepting new patients. Boston's top three teaching hospitals say that 95% of their 270 doctors in general practice have halted enrollment.

For those residents who can get an appointment with their primary-care doctor, the average wait is more than seven weeks, according to the medical society, a 57% leap from last year's survey.

[...]

As it happens, primary-care doctors, including internists, family physicians, and pediatricians, are in short supply across the country. Their numbers dropped 6% relative to the general population from 2001 to 2005, according to the Center for Studying Health System Change in Washington. The proportion of third-year internal medicine residents choosing to practice primary care fell to 20% in 2005, from 54% in 1998.

A principal reason: too little money for too much work. Median income for primary-care doctors was $162,000 in 2004, the lowest of any physician type, according to a study by the Medical Group Management Association in Englewood, Colo. Specialists earned a median of $297,000, with cardiologists and radiologists exceeding $400,000.

At the same time, the workweek for primary-care doctors has lengthened, and they are seeing more patients.

It isn't only the primary care doctors that are in short supply here. Specialists are hard to recruit to Massachusetts, as my group has noted, as the best candidates can make much more going elsewhere.  The Mass Medical Society survey gives the gloomy details.

Seven of 14 physician specialties studied by the Society have been listed as in severe or critical shortage for at least four of the six years of studies: anesthesiology, cardiology, gastroenterology, general surgery, neurosurgery, orthopedics, and radiology. Urology was examined for the first time in the 2007 study.

The shortage is particularly stark outside of the Boston teaching hospitals.  One of the problems of looking at the macroeconomics of healthcare is clearly shown.  Sure, costs of health care are rising.  Sure, America already spends a large chunk of GDP on health care, much more than is typical in other nations.  But reimbursements for individual diagnoses and procedures, at least in Massachusetts, have been squeezed down, with roughly 90% of patients here in government programs or HMO's, and physicians find themselves caught between a rock and a hard place.  If you try to make up the loss with volume and efficiency then you end up providing less personal care in shorter visits - which patients hate - and you open yourself to mistakes, missed diagnoses and malpractice.  So you watch your income fall as your overhead rises, or you can just work longer and longer hours.

My group of well-trained orthopaedic surgeons, three trained in Boston and one in Philadelphia, made a decision about 18 months ago, and we'll be moving our practice to southern New Hampshire around the end of the year.  There are several reasons for it, but suffice it to say that we finally realized that we had to move when, after five years, we were unable to recruit a surgeon to join us.  We needed to find ways to improve our group's finances in order to be able to make an attractive offer to a recruit.  And the economics of medicine in New Hampshire, while not comparable to most of the country, is a significant step up from Massachusetts.

 

Comments

[Kevin]

Great piece, and I applaud your conclusions. You might be interested in the article I wrote about such health care systems at Heritage.org:

http://www.heritage.org/Research/HealthCare/bg1973.cfm
High-Priced Pain: What to Expect from a Single-Payer Health Care System
by Kevin C. Fleming, M.D.
Backgrounder #1973

[Emerson]

Don't worry, The State will provide!

[nbpundit]

So, when is the great state of Taxaholicks going to
start frog marching you guys to jail for leaving? :)
The irony of the situation is just too rich.

[Giacomo]

Thanks for visiting, all. And thanks to Jay Tea for the Wizbang link.

Dr. Fleming: Excellent paper at Heritage. The holy grail of "equal-for-all, universally available" healthcare - which of course would not be equal - is being pursued without regard for the future consequences, which include less innovation, long waiting lines, and fewer doctors.

NBP: I doubt Taxachusetts will drag us back to the state. The officials in charge seem blithely unaware of the problem.