Why is it so hard to find a doctor in Massachusetts?

Half of primary care physicians in our state are not accepting new patients. A prescription for the problem.

By Michael Fitzgerald, The Boston Globe Magazine, October 2013

KATHRYN QUIRK THOUGHT it would be easy to find a new doctor when she moved from Boston to Newton in 2009, just like it was when she arrived in Boston in 1996. Back then, she walked across the street to a doctor’s office and got an appointment.

It isn’t 1996 anymore. Quirk still hasn’t found a primary care doctor she feels comfortable with. Her quest sounds a lot like dating; in four years she’s had three doctors and has sometimes preferred to get care from physician’s assistants and nurse practitioners who work in those doctors’ offices. With three kids, a husband, and a job, Quirk doesn’t have endless time to look. She’s frustrated that it took her four months to find her first doctor in Newton. When she didn’t connect with that physician, she was able to switch to one she liked. But his practice stopped taking her insurance, and Quirk has needed a good chunk of this year to land a replacement doctor. She felt relief in September when she found one who was accepting new patients, but that was only the first hurdle. She won’t find out whether she likes this new doctor for a while; she couldn’t get an appointment until April 2014.

Quirk’s woes reflect a broader problem in the Boston area: It’s hard to get a doctor. Entire practices are booked. Even if she wanted to go back to her old doctor in Boston, he probably wouldn’t be able to take her. His practice is part of Massachusetts General Hospital, and primary care openings at MGH are like snowflakes in September.

Across Massachusetts, about half of primary care doctors aren’t taking new patients, according to the Massachusetts Medical Society’s 2013 Patient Access to Care Study. The rate for internal medicine specialists, or internists, who often also serve as primary care doctors, is 55 percent. If you’ve found a new doctor and want to schedule a routine visit, be prepared to wait. It takes an average of 39 days for new patients to get an appointment with a family physician and 50 days to see an internist. That’s better than last year, when the average wait was a whopping 45 days, but up from 29 days in 2010.

The wait could get longer. The Association of American Medical Colleges projects that nationwide 13,700 more doctors of all types were needed than were available in 2010, and that the gap will hit 130,600 by 2025, with about half of the shortfall in primary care. Are doctors becoming two-headed calves? No, but they are getting scarcer, for lots of reasons.

Nationwide, 13,700 more doctors of all types were needed than were available in 2010, and that gap will hit 130,600 by 2025

For one, we’re all living longer, on average, and we need more care as we age. Baby boomers, the oldest of whom are now in their mid-60s, will swell demand for doctors’ time over the next two decades. Doctors are baby boomers, too, meaning many of them are nearing retirement age; about a third of the nation’s doctors, including specialists, are older than 55. Meanwhile, when the state reformed health care in 2006, it expanded insurance coverage, increasing access to care without boosting the supply of doctors.

Nationwide, there simply aren’t enough residency training programs to go around — more than 1,700 newly minted MDs were frozen out of residency programs, primary care and otherwise, in 2013 alone. Add to those factors an acute lack of interest in primary care by young doctors. A study published in 2012 in The Journal of the American Medical Association found that only 1 in 5 third-year residents planned to go into general internal medicine.

Why? One big reason is money. While primary care doctors’ pay averages over $220,000 a year, good money to most of us, doctors who specialize average close to $400,000 a year.

Daniel Ginsburg, a health consultant who was the chief operating officer of the Massachusetts General Physicians Organization from 1994 to 2008, says it’s hard for up-and-coming physicians to resist the lucrative specialties, especially since medical students average more than $166,000 in debt. “I went to business school and not medical school, and if you look at where doctors are going, the decision-making process is disappointingly similar,” Ginsburg says.

Primary care is as demanding as (some say more demanding than) many traditionally higher paying specialties, including what’s called “the ROAD” specialties — radiology, oncology, anesthesiology, and dermatology. Doctors in those professions, however, tend to work fewer nights and weekends than many other doctors. Medicine has also become more specialized in the last 50 years, and prestige and pay went to those who were most specialized. In the 1990s, “the internists felt like second-class citizens,” says Ginsburg, “and were paid that way.”

Ginsburg also says Boston hospitals often paid primary care doctors at about the national average, despite the higher-than-average cost of living in this area.

Quirk was lucky back in 1996 to walk into a Mass. General practice and get a primary care doctor. Ginsburg remembers a time in the early to mid 2000s when a friend asked him for help getting a male primary care doctor at MGH. “I couldn’t get him anybody,” he says.

Some things have changed since the 1990s to help address the pay disparities. Notably, some insurance payouts were restructured so that primary care physicians became the source for referrals to specialists. Hospitals and health care systems, nervous about being cut off by primary care doctors, started buying physician practices to ease access to referrals.

Though that has helped with pay disparities, in the 2013 Massachusetts Medical Society Physician Workforce Study, 45.6 percent of primary care doctors in the Bay State said their salaries were uncompetitive or very uncompetitive compared with MDs in other states (53.2 percent of specialists in Massachusetts said the same).

By requiring patients to visit a primary care doctor before seeing a specialist, the referral system has probably also slowed access. And the rise of the concierge doctor is having an impact on doctors’ availability. Concierge practices demand a retainer from patients, often more than $1,500 a year, limiting participation to patients who can afford the fees. In exchange, patients get quick access to their doctors.

Bill and Joan Sawyer of Bedford switched to different doctors when their old one went to a concierge practice that carries a yearly fee. Now Bill’s new doctor is going concierge, too, forcing him to look for a physician again.

ALEX GAGNE

Bill and Joan Sawyer of Bedford switched to different doctors when their old one went to a concierge practice that carries a yearly fee. Now Bill’s new doctor is going concierge, too, forcing him to look for a physician again.

Bill and Joan Sawyer’s longtime doctor at a practice affiliated with Newton-Wellesley Hospital decided a few years ago to join a concierge practice, MDVIP, which has 19 doctors in Massachusetts. The Sawyers, who live in Bedford, would have had to pay $1,800 a year each to follow him. They decided to switch to different physicians in their doctor’s practice at Newton-Wellesley. That hasn’t worked out so well for Bill Sawyer — he got a letter telling him his replacement doctor was joining the same concierge practice. “Now I have to go looking for a new doctor again,” says Sawyer, a retired lawyer.

“What’s difficult here is to establish a relationship with a doctor; you need to do it over time,” Sawyer says. “If the physician is only going to be available to you for a year or two, what are you going to accomplish?”

READ FULL STORY to see how the Affordable Care Act plays into the picture.

About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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