Longer patient wait times, continued difficult access to primary care physicians,and gaps in physician acceptance of government coverage
May 9, 2011
Contact: Richard Gulla
E-mail: [email protected]
Waltham, Mass. -- May 9, 2011 -- A 2011 survey about patient access to health care in the Commonwealth shows more than half of primary care practices closed to new patients, longer wait times to get appointments with primary and specialty physicians, and significant variations in physician acceptance of government and government-related insurance products.
The survey of physicians by the Massachusetts Medical Society is part of the Society's annual Physician Workforce Study and is being released today as hundreds of physicians gather on Beacon Hill to meet with legislators at Doctors Day at the State House.
The survey included seven physician specialties and examined three areas:
- wait times for new patients getting non-emergency appointments with a physician;
- percentages of physicians accepting new patients; and
- physician acceptance of Medicare, MassHealth (Medicaid), and Commonwealth Care and Commonwealth Choice, the latter two offered by The Health Connector, an independent state agency that helps Massachusetts residents find health care coverage and which was established as part of the state's health care reform five years ago.
The specialties surveyed included internal medicine, family medicine, cardiology, gastroenterology, orthopedic surgery, obstetrics and gynecology, and pediatrics.
Alice Coombs, M.D., President of the Massachusetts Medical Society, said the survey results point out a critical characteristic of health care in the Commonwealth, one that physicians have known for some time.
"Massachusetts has made great strides in securing insurance coverage for its citizens," said Dr. Coombs, "but insurance coverage doesn't equal access to care. We still have much work to do to reduce wait times and widen access. This has important implications for health care cost control, as difficulty or delay with routine access to care leads people to seek other options, such as the emergency room, which is much more costly."
Dr. Coombs cited a recent survey released in April by the American College of Emergency Physicians that showed emergency room usage in the state has risen, due in part to physician shortages.
In addition to data for the state as a whole, the survey includes data for each of the 14 counties in the Commonwealth, five-year trend data for six of the specialties, and two-year trend data for pediatricians.
ACCESS TO PRIMARY CARE PHYSICIANS
Access to primary care physicians is becoming more restricted, as more than half of primary care practices - 51% of internists and 53% of family physicians - are not accepting new patients. These figures remain close to those of last year's survey which showed 49% of internists and 54% of family physicians not accepting new patients.
Medical Society officials say the percentage of practices closed to new patients reflects the persistent shortages of primary care physicians in the Commonwealth. For five consecutive years, the Medical Society has recorded critical and severe shortages of both internists and family physicians.
WAIT TIMES FOR NEW PATIENTS
Primary Care Long wait times continue for the primary care physicians of internal medicine and family medicine who are accepting new patients. The average wait time for an appointment for internal medicine is 48 days, five days shorter than last year, and the average wait time for family medicine is 36 days, up 7 days. Internal medicine was the only specialty reporting a shorter wait time, yet at 48 days it has the longest wait time of any of the seven specialties surveyed.
The average wait time for pediatricians - primary care for youngsters up to age 18 - was 24 days, the same as last year. Seventy-three percent of pediatricians are accepting new patients.
Specialty Care All four specialties reported longer wait times: gastroenterologists, 43 days, up from 36 days; obstetricians/gynecologists, 41 days, up from 34 days; orthopedic surgeons, 26 days, up from 17 days; and cardiology, 28 days, up from 26 days.
Access to specialists is easier than primary care, with 82% of cardiologists, 85% of obstetricians/ gynecologists, 95% of gastroenterologists, and 97% of orthopedic surgeons, accepting new patients.
ACCEPTANCE OF GOVERNMENT and GOVERNMENT-RELATED INSURANCE
Physician acceptance of government and government-related insurance products varies widely, within primary care and between primary care and specialties.
Primary Care The gap between primary care physicians accepting Medicare and MassHealth is striking. While most internists (85%) and family physicians (87%) accept Medicare, significantly fewer of both (53% of internists) and (62% of family physicians) accept MassHealth.
Even fewer accept Commonwealth Care (43% of internists; 56% of family physicians) and Commonwealth Choice (35% of internists; 44% of family physicians).
Similar differences were found for pediatrics: 89% accept MassHealth, but only 50% accept Commonwealth Care and only 45% accept Commonwealth Choice.
Specialty Care The overwhelming majority of specialists accept Medicare and MassHealth, but significant gaps exist between those plans and Commonwealth Care and Commonwealth Choice.
Accepting Medicare are 96% of cardiologists, 97% of gastroenterologists, 94% of obstetricians/gynecologists, and 98% of orthopedic surgeons.
Accepting MassHealth are 92% of cardiologists, 85% of gastroenterologists, 89% of obstetricians/gynecologists, and 82% of orthopedic surgeons.
Accepting Commonwealth Care/Commonwealth Choice: cardiologists, 78%/76%; gastroenterologists, 68%/60%; obstetricians/gynecologists, 82%/71%; and orthopedic surgery, 59%/42%.
The survey was conducted between February 16 and March 8 of this year, and included 838 telephone interviews. The complete study is available at www.massmed.org/patientaccess
Practice Environment Continues to Decline
The Society also released its latest MMS Practice Environment Index, a statistical compilation of nine factors that influence the practice climate for physicians in the Commonwealth. For 2010, the index declined 0.9 percent, representing a continued deterioration of the practice environment for physicians in Massachusetts. The index has declined in 17 of the 19 years the Society has been compiling such data.
The index is available at www.massmed.org/mmsindex
The Massachusetts Medical Society, with nearly 23,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society publishes the New England Journal of Medicine, a leading global medical journal and web site, and Journal Watch alerts and newsletters covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country. For more information please visit www.massmed.org, www.nejm.org, or www.jwatch.org.
Definitions of Insurance Plans:
Medicare is the U. S. government sponsored health insurance program for people age 65 or older or under age 65 with certain disabilities. www.medicare.gov
MassHealth is a public health insurance program for eligible low and medium-income residents of Massachusetts. MassHealth is the name used in Massachusetts for Medicaid and the Children's Health Insurance Program (CHIP), combined in one program. www.massresources.org
Commonwealth Care is a health insurance program for low and moderate-income Massachusetts adults 19 and older who don't have health insurance and who are ineligible for Medicaid. Members get free or low-cost health services through managed care health plans. www.mahealthconnector.org
Commonwealth Choice is a health insurance program for uninsured adult Massachusetts residents. The program offers unsubsidized health insurance to people who are not eligible for Medicaid or Commonwealth Care. www.mahealthconnector.org