Bruce S. Auerbach, MD, FACEP President Massachusetts Medical Society Will the Shortage of Primary Care Physicians in Massachusetts Derail Reform Efforts? Bruce S. Auerbach, MD, FACEP President Massachusetts Medical Society

Commonwealth Care (30% pay monthly premium) Enrollment through July 2008 110,740* 91,031 83,276 Almost 300,000 people who didn’t have health insurance previously, now have health insurance. About two-thirds of them get their insurance for free, courtesy of the state and federal governments. 29% pay something towards their premium. These numbers have been relatively steady for a number of months – clearly the biggest room for growth is in category of middle-class residents. 18,132 Commonwealth Care (30% pay monthly premium) Commonwealth Choice May 1 data Source: Commonwealth Connector reports 2 2 2

But … Will They Have a Doctor But … Will They Have a Doctor? Massachusetts Physician Workforce Study: 2007 Internal Medicine Critical Vascular Surgery Family Practice Severe Neurosurgery Anesthesiology Cardiology Gastroenterology Psychiatry Urology Every year we have identified specialties where the labor shortage is in severe or in critical condition. Labor economists have looked closely at our data, and say that without question, the physician labor market in Massachusetts is under remarkable stress. But even among those specialties in trouble, a handful of specialties stand out as worse than the rest. In our 2007 study, four were placed in the critical category – and many of these have persisted over the time we have conducted the study. These categories were based on responses to six key questions [It‘s a national problem: in the last decade, a 22% drop in the number of medical school graduates who choose to become primary care physicians]

But …When Will They See a Doctor? Another symptom of stress – long wait times for appointments Merritt Hawkins annual survey in Mass: Researchers posed as a new patient calling for a routine (non-emergent) appointment in several specialties Number of days between date of call and the date of appointment.

Appointment Wait Times: 2007 Merritt Hawkins employees anonymously called physician offices in six specialties and tried to schedule a routine appointment. What you see here is the number of days in each specialty, from the time of the phone call, that they could get in the see the doctor. In almost every instance, these numbers are significantly higher than other major cities around the country. High, low, and average number of days between scheduling the appointment and the date of the appointment, per specialty (statewide). Cardiology - The shortest average wait time is 13 days in Berkshire, while the longest average wait time is 54 days in Worcester County. Gastroenterology - The shortest average wait time is 12 days in Hampshire County, while the longest average wait time is 53 days in Middlesex County. Internal Medicine - The shortest average wait time is 21 days in Hampden County, while the longest average wait time is 109 days in Bristol County. Obstetrics/Gynecology - The shortest average wait time is 33 days in Hampshire County, while the longest average wait time is 119 days in Berkshire County. Orthopedic Surgery - The shortest average wait time is 11 days in Franklin County, while the longest average wait time is 47 days in Suffolk County. Family Practice/General Practitioner - The shortest average wait time is 12 days in Berkshire County, while the longest average wait time is 66 days in Bristol County. Trend N/A Range and average for each specialty

Patients Feel the Strain Only 42% who made an appointment to see a primary care physician could be seen within a week Down from 53% in 2005 and 2006 21% were forced to wait for necessary medical care The most commonly cited reason for delays Overcrowded doctors’ offices (23%) up 13% from last year Scheduling problems (16%) A lack of insurance (12%) The need to wait for a referral (10%) Patients are starting to notice. And the reasons they believe for the long wait times is very accurate.

Practices Accepting New Patients Trend N/A

Fixing the Supply Imbalance New incentive programs Loan forgiveness programs Partners Healthcare and community health centers State Health Care Workforce Center Advanced medical home pilots State program under Medicaid ACP pilot Mass. Blue Cross Blue Shield Expanded primary care training at UMass Medical School

Other considerations Reducing administrative burdens Payment reform Patient engagement Wellness programs Chronic disease management Lifestyle changes Care must be comprehensive and integrated