Does Massachusetts represent the country's future?

The Massachusetts Medical Society last week released its annual Physician Workforce Study, revealing a fifth straight year of primary-care shortages in the state. Four years after requiring all residents to have health insurance, more than half of the state's primary-care doctors have stopped accepting new patients.

"The state's universal healthcare plan has improved access to care," said Alice Coombs, MD, President of the Massachusetts Medical Society, in a press release. "But universal coverage and access can only be sustained with a strong physician workforce.

And although the average time a patient has to wait to see a family medicine physician in Massachusetts has decreased to 29 days from 44 days last year, the number of PCPs no longer accepting new patients rose dramatically to 54 percent versus 40 percent in 2009.

"Massachusetts may be ahead of the rest of the country in covering more residents with health insurance, but this report reminds us that we need in Massachusetts and the rest of the U.S. to focus on cost-effective care, and that is impossible without a strong primary-care workforce," Fred Ralston, MD, president of the American College of Physicians, told MedPage Today.

So, what is the rest of the country to glean from the Massachusetts experience with a national insurance mandate just a few years away? That was a key question raised at Monday's panel discussion at the Medical Group Management Association annual conference by moderator and MGMA president Bill Jessee, MD.

According to James Rohack, MD, immediate past president of the American Medical Association, the country is not necessarily fated to have the same access crisis as the pioneer state. "In Massachusetts, in one year, eight percent of the uninsured population got insurance--and the state didn't have the surge capacity," he said.

But the Patient Care and Affordability Act doesn't require the health system to merely "flip the switch" overnight, Rohack explained. Between now and 2013, the law also builds in financial incentives for primary care, rearranges graduate medical education and provides for the creation of the patient-centered medical home. "The bill gives four years to innovate delivery to deal with the surge," he said.

However, Charles "Chip" Kahn III, president of the Federation of American Hospitals, wasn't quite so optimistic, pointing out that Massachusetts' demographic doesn't match the rest of the country, with several states standing to add double-digit percentages of uninsured residents to health plans.

Likewise, Michael McCallister, president/CEO of Humana Inc., stated that physician demand would soon be "off the clock" and that providers would have no choice but to increase productivity, leverage more technology and increase use of all kinds of nurses and physician extenders.

"Regardless of reform, we still have a problem," he said.

To learn more:
- see the study
- check out the article from MedPage Today

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