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Health Workforce challenges -- Massachusetts and US

Posted by John McDonough  November 5, 2013 10:25 PM

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I've been hearing this charge since 2006.  U.S. health reform is going to cause a huge shortage of physicians, and Massachusetts is Exhibit A that this will happen -- case closed.

First, I'll address some unrecognized issues about the Massachusetts physician shortage. Second, I'll discuss the U.S. shortage.

First, Massachusetts, egged on by the annual physician satisfaction survey conducted by the Massachusetts Medical Society. Here is their own description of their most recent results from the survey this past September:

"The Medical Society's 2013 analysis found four specialties to be in critical or severe shortage: family medicine, internal medicine, neurology, and gastroenterology. The primary care specialties of family medicine and internal medicine were recorded with shortages for the eighth consecutive year. A trend analysis over the last five years (2009-2013) shows that seven specialties have been in short supply in at least three of those five years: family medicine, internal medicine, psychiatry, dermatology, general surgery, neurology, and urology."

Full disclosure:  I have many friends in the MA Medical Society and am a big admirer of their work. But, regarding their study, which gets avidly reported all over the country as evidence of terrible physician shortages in Massachusetts, consider this from the report's methodology section on page 9:

"A survey was mailed to 7,212 practicing physicians in January 2013. The survey was mailed to those physicians licensed through the Commonwealth of Massachusetts Board of Registration in Medicine who have a full and active license and a primary business address in Massachusetts. The survey mailing included both MMS members and nonmembers who were randomly selected from 18 specialties (anesthesiology, cardiology, dermatology, emergency medicine, gastroenterology, general surgery, internal medicine and family medicine (primary care), neurology, neurosurgery, OB/GYN, oncology, orthopedics, pediatrics, psychiatry, radiology, urology and vascular surgery). Each survey was sent with a cover letter and a postage-paid return envelope. The surveys were serial numbered, and a second follow-up mailing to non-responders occurred in late January 2013. Of the surveys that were mailed out, 748 were completed and returned for a response rate of 10.4%."

So, 9 out of 10 physicians surveyed did not respond. Residents and Fellows were also surveyed and their response rate was 3.25%. And this is Exhibit A for national media stories about the physician workforce debacle in Massachusetts.

Give ... me ... a ... break.

Yes, the United States has serious workforce challenges facing physicians and many other health professionals. Though we pay our physicians far more than physicians in any other nation, we have a supply of physicians only around the median of advanced industrialized nations.  It's a problem, just not so much in Massachusetts. In just about any professional category you can name, Massachusetts has the most robust supply on a population basis, either number one or one of the top five states. We're not the problem -- get over it.

The rest of the nation has much more severe shortages than does Massachusetts, every single state. Big problems. And the Affordable Care Act contains an approach to address this by creating a National Workforce Commission to study and recommend policies to expand and enhance the U.S. health care workforce. No one, I man no one, opposed this during the legislative process leading to passage of the ACA. After President Obama signed the ACA, the U.S. Comptroller General responded to the ACA's directive by nominating a stellar panel of health workforce experts to compose the Commission. And then?

Nothing.

Three years, and the Commission has been unable to form because the Republican controlled U.S. House of Representatives has refused to appropriate the $2-3 million needed so that the Commission can begin meeting and operating.

Why? Because the Commission is part of Obamacare, and Republicans cannot support anything that is part of Obamacare.

Advocates for America's medical colleges like to suggest that the solution to our health care workforce challenges is to produce more physicians. Important to note, not all workforce experts share that conclusion. Consider this article -- New Systems of Care Can Leverage the Health Care Workforce: How Many Doctors Do We Really Need? -- from Dr. Arthur Garson from the University of Virginia:

"There are shortages of physicians and nurses, and these will worsen, with increasing geographic maldistribution. However, the shortages may not be as serious as projected if the systems in which practitioners work can be changed to promote integration, with different payment models and leveraging every member of the workforce to perform at his or her maximum competency."

The simple solution: let's just produce more physicians.  It is not as simple as it sounds. In spite of the rhetoric about physician shortages, the Congressional Republican agenda means less financial support for graduate medical education. And Democrats are not likely to prioritize funding for a massive increase either.

The solution, as Garson suggests, is not more physicians; it is using our health care workforce at its best. That makes sense, and it's doable.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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