The Massachusetts Medical Society released a report this week — the Physician Workforce Study — highlighting physician shortages including — but also well beyond — primary care. This issue was picked up by Les Masterson in the current issue of HCPro's Health Plan Insider; I spoke with him about the myriad factors influencing physician shortages and perceptions of physicians and payors about them.
Much of the literature on this subject looks at physicians per 1,000 population. By contrast, the MMS annual survey is based on the experience and perceptions of physicians and related professionals (i.e., folks hiring physicians). While clearly the Massachusetts health insurance experiment has added pressure by adding many patients to the rolls of the insured looking for PCPs (see recent Boston Globe story re: ED volume), there is something else at work here. Payors seem to think that physicians could take on a little more volume to ease the pressure. Physicians rail against the administrative costs of running a practice (including malpractice insurance and dealing with payors). It's possible that malpractice insurance reform could relieve some of the pressure (cf. Pennsylvania), but even that is not certain.
Some would say we need more medical school slots — or even more medical schools. Unless the federal cap on residency slots is lifted, however, the effect would simply be to replace international medical graduates with US med school graduates, without increasing the overall supply. Furthermore, any monkeying with supply in that fashion will have an actual effect only many years in the future (reminds me, in that respect, of the offshore drilling debate: too remote in time and in likelihood of having a real impact on the issue at hand.)
A thorny issue; it is important to look at all possible avenues available to expand the supply of physicians — as well as the supply of alternatives: nurse practitioners and physician assistants, and also retail clinics. While these providers won't replace the neurosurgeons, they can alleviate some of the pressure on PCPs and EDs.
For further perspective, see John Iglehart's piece in NEJM earlier this year.
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
