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Massachusetts health care — wonky, with a healthy dose of reality

Will More Physicians Cure the Physician Shortage? Maybe Not...

Will More Physicians Cure the Physician Shortage? Maybe Not...

April 20, 2008

Important article in this past week's New England Journal of Medicine on the physician shortage and what to do about it -- "Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription" by Drs. David Goodman and Elliott Fisher from the Center for Health Policy Research at Dartmouth:

The situation in Massachusetts reflects the problem with focusing narrowly on the physician workforce. Massachusetts has seen its supply of physicians per capita more than double since 1976, and it now has the highest physician-to-population ratio of any state, in primary care as well as overall. Yet the Massachusetts Medical Society has issued several annual reports asserting that there is a severe physician shortage, and patients report that the availability of primary care continues to decline.5

We believe that the perception of a physician shortage, both nationally and in Massachusetts, is just one symptom of the underlying problems in our health care system. The current delivery and payment systems often make it more "efficient" for primary care physicians to see patients they already know (diminishing others' access to primary care) and for all physicians to narrow their scope of practice (increasing referrals to specialists) and to admit patients to the hospital (where hospitalists manage their care). Data showing that physicians in high-supply regions are more likely to report difficulty gaining both hospital admissions and specialist referrals are consistent with this hypothesis.1 In the absence of reform of the delivery system, additional growth will lead to further fragmentation of care that will exacerbate the problem of access and worsen the apparent scarcity it is intended to remedy.

Of special note: see Table 1 showing imperceptible difference in patient satisfaction between regions with high vs. low numbers of physicians.