State's patients endure long wait

Patients in Massachusetts must wait more than six weeks on average to visit primary care physicians, nearly three times the recommended wait, according to new research detailing the costs of the state's doctor shortage.

The researchers blamed the long wait times on the state's inability to attract and retain specialists and primary care doctors because of low salaries and high living costs compared with other states.

''People can't get access to their family doctor," said Dr. Alan M. Harvey, president of the Massachusetts Medical Society, which commissioned the research. ''It signifies that there are smaller number of doctors taking care of more patients."

Six medical specialties in Massachusetts, the researchers found, were facing particularly acute physician shortages: neurosurgery, anesthesiology, radiology, gastroenterology, cardiology, and orthopedics.

Doctors avoid Massachusetts, and medical students flee the state after training here, because they can earn more in other states, the researchers concluded.

Harvey, who works as an anesthesiologist at Brigham and Women's Hospital, said shortages in his speciality were running him and his colleagues ragged.

''We have to work longer hours. People are saying it's not a balanced lifestyle. Looking elsewhere, they see the environment is better, and they leave Massachusetts," he said. ''That places more pressure on those remaining here. It's almost a downward spiral."

Longer wait times and doctor burnout were not the only consequences of physician shortages. Dr. Kenneth Peelle, a radiologist at Saints Memorial Medical Center in Lowell, said the situation puts considerable pressure on his staff, which scrutinizes MRIs and CAT scans for signs of disease.

''The push is to read them faster and get them done quicker, and that may lead to more misses" of disease markers, said Peelle.

The new research came from two studies both released yesterday, one a survey of state doctors, the other a survey of patients.

The patient poll, conducted by the Opinion Dynamics, found that 15 percent of 400 Massachusetts patients surveyed found it ''extremely difficult" to obtain medical care, more than double the figure from a similar poll taken two years ago. Cost and trouble getting an appointment were the leading impediments cited by patients.

The survey of physicians, conducted by health care consultants at the MHA Group/Merritt, Hawkins & Associates, revealed long wait times for patients seeking five types of medical care, including basic primary care.

In addition, it found that six medical specialties were suffering physician shortages so severe that doctor's offices and hospitals had to alter work schedules, increase wait times, or enact other operational changes in their practices.

In addition to the average six-week wait for primary care, Bay State patients faced average 32-day waits for cardiology care, 44 days for gastroenterology care, 39 days for obstetrics and gynecology care, and 18 days for orthopedic surgery, the survey found.

Physicians consider waits of more than 14 days, to be the sign of a busy and burdened practice. The Massachusetts Medical Society recommends not exceeding the two-week threshold. The researchers said that in most of the specialties studied, national average wait times were lower than the Massachusetts averages.

The researchers said those surveyed linked the long wait times to physician shortages.

Anesthesiologists, neurosurgeons and radiologists were found to be in ''critical" shortage, meaning about half of physicians surveyed in those fields reported considerable difficulty in recruiting and retaining staff. In addition, gastroenterologists, cardiologists, and orthopedic specialists were in ''severe" shortage, meaning their recruitment and retention problems were slightly less challenging though still problematic by Massachusetts Medical Society standards.

The research found the problems most intense in community hospitals, which typically serve suburbs and small towns. While 62 percent of physician practices and 60 percent of academic hospitals reported problems filling doctor vacancies, 87 percent of community hospitals had this difficulty.

Suburban and rural wait times were also higher than in urban centers. For instance, in Essex County in northeastern Massachusetts, patients had to wait an average 104 days for primary care visits, while in Hampshire County in Western Massachusetts, the average wait for gastroenterology services was 92 days.

The Massachusetts Medical Society blames the problems on high medical malpractice insurance rates, which cut into salaries -- a problem that is cited by doctors in other states as well. Also, several specialists said the state's high housing prices may be driving doctors away.

In a previous study, the medical society found that New England physicians earned $177,500 on average in 2003, but the homes here cost twice as much. Nationally, the average house costs just 1.2 times more than doctors' salaries.

Others said Massachusetts' insurance companies, as well as state medical programs, reimburse doctors less generously than in many other states.

''The rate of reimbursement to do the work we do is so low in this state, coupled with the fact the malpractice insurance in this state is so high," said Dr. Peter Dempsey, vice-chairman of neurosurgery at the Lahey Clinic. ''We're not getting paid at the rate we used to get paid."

He said a shortage of neurosurgeons has forced his staff to pick up the treatment of emergency strokes, brain injuries, and spinal traumas at Emerson Hospital as well as at Lahey.

''It just spreads us a little thin," Dempsey said.