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Waits to see Hub doctors grow longer

Busiest practices have no openings for a year

By Liz Kowalczyk
Globe Staff / May 15, 2009
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Despite Boston's abundance of top-notch medical specialists, the waits to see dermatologists, obstetrician-gynecologists, and orthopedic surgeons for routine care have grown longer - to as much as a year for the busiest doctors.

A study of five specialties shows that the wait for a nonurgent appointment in the Boston area has increased in the past five years, and now averages 50 days - more than three weeks longer than in any other city studied.

Patients in Boston and other areas of Massachusetts for years have faced notoriously long delays, according to earlier surveys of physicians' offices. A number of factors contribute, doctors said, but the 2006 health insurance law, which has required hundreds of thousands of state residents to obtain coverage, probably has worsened the waits.

"We had a bus that was pretty full, and then we invited more people on the bus," said Dr. Gene Lindsey, president of Harvard Vanguard Medical Associates, a large physicians group. "Now people are standing in the aisles."

Merritt, Hawkins & Associates, a Texas-based consulting and physician recruiting firm, surveyed 1,162 doctors' offices in 15 metropolitan areas, trying to replicate what new patients would experience if they were searching for a doctor for a nonurgent appointment, including a heart checkup, a skin exam to detect possible cancer, knee injury or pain, a gynecological exam, and a complete physical exam.

Boston had the longest delays to see dermatologists, obstetrician-gynecologists, and family practitioners, and was second after Dallas in delays to see orthopedic surgeons. Waits increased since 2004 for appointments with dermatologists, obstetrician-gynecologists, and orthopedic surgeons, but patients can get in faster now to see cardiologists; Boston ranked fourth in waits for heart doctors, behind Minneapolis, Miami, and San Diego. The company did not survey family practitioners in 2004.

Average times to get appointments with doctors in Boston ranged from 21 days for cardiologists to 70 days for obstetrician-gynecologists. But when surveyers called, some dermatology and family practice offices said they couldn't get an appointment for a year.

The survey did not address whether delays hurt patients, or why Boston is generally worse than other cities.

But the authors also pointed to the more than 400,000 newly insured residents flooding doctors' offices, and said the long waits in Boston "may signal what could happen nationally in the event that access to healthcare is expanded through healthcare reform."

A major goal of the Massachusetts law is to provide care for more people in physicians' offices rather than in emergency rooms.

Brian Rossman, research director for Health Care for All, a Boston-based patient advocacy group, said that the law has increased concern about physician shortages in Massachusetts, but that the reasons for the area's long waits - and the increase - are complex. Many specialists in the city work for large academic medical centers and don't see patients full-time, fitting them in around teaching and other responsibilities.

"We have an enormous emphasis on research in Massachusetts," Rossman said. "And that influences the amount of time doctors have for patient care."

At Harvard Vanguard, Lindsey said that waits for new patients generally are somewhat shorter in his organization than in the Merritt Hawkins survey. But that's because Harvard Vanguard has focused heavily on hiring more doctors - bringing on 73 last year, a 12 percent increase - enough to accommodate 30,000 new patients. "We knew the tsunami of need was coming," he said.

Dr. Mario Motta, a cardiologist and the president of the Massachusetts Medical Society, agreed that the new law probably has contributed to longer waits. "You have 10 percent more patients to see with the same number of doctors," he said. "And we already had a shortage before."

The survey did not address how long patients wait to see doctors for urgent conditions. But Motta said most practices get these patients in immediately, that day or the following day.

"If someone calls with chest pain, their doctor is not going to say, 'Come back in three weeks.' That is not going to happen," he said. "But naturally, the patients who want a routine evaluation are going to go to the bottom of the list."

Legislators hope a law passed in July to control the cost and improve the quality of healthcare will draw more primary care doctors into the workforce. The state is spending $1.7 million this year to repay medical school loans of doctors who agree to work in community health centers, but Rossman said that funding is in jeopardy.

Kurt Mosley, vice president of Merritt Hawkins and a member of the Council on Physician and Nurse Supply, a national group of academics and industry professionals, said the council is recommending to Congress and the Obama administration that it increase government funding to expand physician training slots by 30 percent to ease the shortage. He said this will become even more urgent if a national health insurance overhaul passes and dramatically expands coverage.

Liz Kowalczyk can be reached at kowalczyk@globe.com.