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Primary care doctors harder to find, report says

E-mail | Print | Comments () Posted by Elizabeth Cooney July 19, 2010 06:04 PM

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Massachusetts has the highest ratio of doctors per population in the country, but that doesn’t mean its residents can find a primary care physician who is accepting new patients. It got harder to secure a slot after 2006, according to one of three reports on health care released by the state today.

Last year 60 percent of family medicine doctors’ offices were accepting new patients, down from 70 percent in 2007, the first full year after passage of a state law mandating near-universal health insurance coverage. Last year only 44 percent of internal medicine practices were accepting new patients, down from 66 percent in 2005. The figures come from data analyzed by the Division of Health Care Finance and Policy.

Not all the news is bad. Fewer residents -- 11 percent in 2008 compared to 12.2 percent in 2006 -- had no primary care doctor. But last year 22 percent of residents said they had trouble obtaining health care, despite statewide gains in insurance coverage.

Part of the primary care problem is the high percentage of doctors who are specialists, the report said. In Massachusetts 68 percent of active physicians are specialists, compared to 64 percent nationally. Another issue is where the doctors are located. Physicians -- including 1 in 3 specialists -- are concentrated in Boston and Suffolk County, which has less than one-tenth of the state’s population but almost one-quarter of the primary care doctors. In the rest of the state, 14 percent of residents live in areas that met federal criteria as primary care health professional shortage areas last year. It would take 214 primary care doctors to fill the gap, the report said.

The primary care shortage may be related to an increase in preventable trips to hospital emergency departments, another report from the state said. In 2008, nearly half of outpatient emergency visits were considered avoidable, at a cost on $514 million. An emergency department visit is considered avoidable if it could have been treated in a doctor’s office, if treatment wasn’t necessary within 12 hours, and if proper care could have prevented a condition, like asthma, from getting bad enough to warrant emergency treatment.

Outpatient emergency visits went up 9 percent from 2004 to 2008, but preventable emergency visits went up more -- by 13 percent. Uninsured people are not responsible, the report says. Expanded health care coverage and the primary care shortage may explain why.

“Reliance on the ED may instead be due to outpatient capacity constraints that may be exacerbated by the newly insured who have not yet established primary care relationships,” it said.

The third report measures preventable hospitalizations. In 2008 they accounted for 13 percent of inpatient admissions among Massachusetts adults and cost $639 million. Overall, rates declined 7 percent from 2004 through 2008.

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About white coat notes

White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at cconaboy@boston.com. Follow her on Twitter: @cconaboy.

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