The Doctor Is In – But Patients Must Wait and Wait

A shortage of primary-care physicians in Massachusetts means that some patients must wait up to 48 days for an appointment. A poll of 838 Massachusetts physicians called the “Patient Access To Health Care Study found that Bay State residents often have to wait weeks — in some cases as long as a month and a half — for non-urgent appointments with primary care physicians and certain specialists.  The Massachusetts Medical Society (MMS) called doctors’ offices in February and March and asked when they could come in for routine care.  They asked for a new patient appointment with internists, family practitioners, and pediatricians; an appointment for heartburn with gastroenterologists; a heart check-up with cardiologists; an appointment for knee pain with orthopedic surgeons; and a routine exam with obstetrician/gynecologists.  The typical waiting period ranged from 24 days for an appointment with a pediatrician to 48 days to see an internist.  The wait for an internist was less than the 53 days in a 2010 survey, but the waits for family doctors, gastroenterologists, orthopedists, and ob/gyns rose.

Additionally, 50 percent of Massachusetts’ primary-care physicians are not accepting new patients.  The report has serious repercussions on the cost of healthcare in the state.  Patients with no access to a primary-care physician are more likely to visit the far more costly emergency room when they are sick.  “Massachusetts has made great strides in securing insurance coverage for its citizens,” said Dr. Alice Coombs, MMS president, in reference to the state’s ground-breaking 2006 universal health insurance law.  “But insurance coverage doesn’t equal access to care.”  Dr. Lynda Young, a Worcester, MA-based physician, counters, noting that “There’s only so many patients you can see in a day.”  The situation is especially dire in rural areas.  Dr. Joseph Viadero, whose Turner Falls, MA-based four-physician, three nurse-practitioner practice includes 12,000 patients, says “We’re overwhelmed and just have difficulty taking care of our own patients.”  As a result, more people don’t get the preventative care they need.

Dr. Richard Dupee, a geriatrician, says he sees poor, sick and elderly people traveling from Boston to the suburbs, just to see a doctor.  Because relatively few Boston-area doctors are willing to see new patients who pay with government-subsidized insurance, “people are always taking the T from Boston, to get to my office.”  Although Massachusetts’ healthcare law was written to get moderately ill people out of costly hospital emergency rooms and into less expensive doctors’ offices, the report finds that difficulty accessing care is sending some people back to the emergency room.  “These people are insured, but they end up in the ER anyway, because they can’t find a doctor to treat them,” Dupee said.

The study also examined the types of insurance accepted by each specialty.  Medicare acceptance ranged from 98 percent in orthopedic surgery to 85 percent for internal medicine.  While 92 percent of cardiology practices accepted MassHealth and Medicaid, that fell to 62 percent for family medicine and 53 percent for internal medicine.  Two additional insurance types were included: Commonwealth Care, which serves low- and moderate-income adults lacking coverage and ineligible for Medicaid, and Commonwealth Choice, which is offered through an unsubsidized exchange run by the Commonwealth Connector.  Acceptance ranged from 82 percent for ob/gyn to 43 percent for internal medicine with Commonwealth Care, and from 76 percent for cardiology to 35 percent for internal medicine with Commonwealth Choice.

The Association of American Medical Colleges estimates that the nation will be short of 91,500 physicians over the next 10 years.  “Physicians are very heavily loaded with patients that have been in their practice for a long time,” said Dr. Robin Richman, executive vice president of medical affairs and chief medical officer at Fallon Clinic.  “Over time, as we all age, we develop a complexity of care issues, and those take more time and management skills for physicians.”

“We still have much work to do to reduce wait times and widen access,” Coombs said.  “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.”

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