s******n
发帖数: 2279 | 1 By Emily P. Walker, Washington Correspondent,
MedPage Today
October 20, 2010
WASHINGTON -- Massachusetts experienced a shortage of primary care
physicians for the fifth year in a row in 2010 and half of primary care
doctors in the state stopped accepting new patients, according to a study
released Wednesday by the Massachusetts Medical Society.
Massachusetts has, in some ways, been a model for healthcare reform for the
nation.
While overall access to care has improved since the state passed a universal
healthcare law in 2006 requiring all residents to have insurance, state-
wide insurance coverage can only be sustained if there are enough physicians
to meet the needs of patients, wrote the study authors, James Howell, PhD
and Andrew Sum, PhD.
"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.
The Massachusetts Medical Society's annual Physician Workforce Study surveys
teaching hospitals, community hospitals, practicing physicians, medical
directors of medical groups, and resident and fellow programs throughout the
state to examine a number of physician trends -- including workforce
shortages, physician retention, patient access to care, and physician
satisfaction.
This year's study found "severe" shortages in 10 of the 18 medical
specialities studied in 2010 -- three more specialities with fewer
practitioners than last year. Emergency medicine, general surgery,
orthopedics, and psychiatry made it to the "severe" shortage list this year.
Mirroring findings from previous years, internists and family medicine
physicians made it to the "critical" list as being scarcest specialties in
the state -- reporting the fewest available slots for new patient
appointments.
As well, the study found that a greater percentage of family doctors said
they were not accepting new patients in 2010, compared with last year (54%
versus 40%).
The average time patients must wait to see a family doctor actually
decreased among those physicians who are accepting new patients. Last year,
patients waited an average of 44 days to see a family medicine physician;
this year the average wait time was 29 days.
At the same time, patients waited nine fewer days to see an internist this
year compared with 2009, according to the study.
"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.
"If we do not increase the number of internists and family physicians then
wait times should be expected to lengthen and it will be difficult to
accomplish many aspects of the health reform implementation," Ralston said.
While the shortages were greatest among internists and family doctors, a
number of specialties in Massachusetts were classified as having "severe"
shortages, including dermatologists, emergency medicine doctors, general
surgeons, neurologists, orthopedic surgeons, psychiatrists, urologists, and
vascular surgeons.
However, most specialists, including gastroenterologists, pediatricians, and
ob/gyns, are accepting new patients, the study found.
The report's findings have implications for national healthcare reform, said
Steffie Woolhandler, MD, professor of medicine at Harvard Medical School,
and a member of the group Physicians for a National Health Program.
Woolhandler was not involved in the study and said she had not yet read the
report.
"There is a primary care shortage in Massachusetts and it will no doubt be
worse in the rest of the country, because Massachusetts has more primary
care physicians per capita than the rest of the country," she told MedPage
Today.
However, Woolhandler said she's not convinced that there is a shortage of
specialists.
She said that in order to produce enough primary care doctors to treat the
number of current patients -- and those that will come into the medical
system come 2019 when everyone will be required to have health insurance --
fees for primary care doctors and specialists must become more comparable.
"There is a huge power imbalance with speciality care commanding much more
than primary care," she said. "You can't have a dermatologist earning four
times as much as a geriatric specialist and expect people to go into
geriatrics. You just need to make the salary more similar," Woolhandler said.
Despite the reported doctor shortages in the state, findings from the survey
of resident and fellow program directors show that Massachusetts is doing
well in attracting medical school graduates to its residency and fellowship
programs.
While the state appears to be doing well in training doctors, 62% of
practicing physicians feel that the current pool of physician applicants is
inadequate to fill vacant positions. One-third of department chiefs at
teaching hospitals believe the current applicant pool is inadequate.
Community hospitals seem to struggle the most in finding enough qualified
doctors: Among the medical staff presidents surveyed at community hospitals,
91% believe the current applicant pool is inadequate to fill existing
physician vacancies.
Despite the feeling that there aren't enough doctors to fill positions, the
reliance on international medical graduates at teaching hospitals actually
decreased in 2010 to 18% -- down from 26% in 2009.
While reported physician satisfaction in Massachusetts improved this year, a
large number of doctors are still dissatisfied because of uncompetitive
incomes, too much paperwork, and the fear of being sued.
The Workforce Study survey, which has been conducted annually for nine years
, added a new question this year: Doctors were asked what should be included
in national healthcare reform.
One-third of doctors said they prefer a single-payer system; one-third
preferred a mix of public and private plans with a public buy-in option; 17%
would prefer to keep the current system but allow insurers to sell plans
with limited benefits and high deductibles; and 14% prefer modeling reform
after the Massachusetts health law, which was passed in 2006.
The study authors suggest a number of key changes needed to bolster the
Massachusetts physician workforce:
•Healthcare stakeholders must advocate for a fair payment system, and
address medical malpractice costs as well.
•Simplify administrative tasks and record-keeping in order to ease the
burden on physician hours.
•Addressing the growing concern of medical student debt, perhaps by
requiring doctors to practice for a number of years in medically underserved
areas, or to practice primary care.
Primary source: Massachusetts Medical Society
Source reference:
Massachusetts Medical Society "Physician workforce study" 2010. | k*****e
发帖数: 372 | 2 看来showdown兄很关注这个问题，给个zt的Review如何？ | s******n
发帖数: 2279 | 3 呵呵，我喜欢看英文新闻，不光是这个话题，政治的体育的科技的都喜欢，多看看有好处
美国医疗体制面临着即将到来的不得不进行的改革，未来医师短缺是未来几年必须解决
的问题，卡住瓶颈的是住院医师名额，缺乏经费是必须有创造性的办法来解决，个人的
结论就是，CMG考出证书，耐心等待，盯住内科家庭儿科等PCP专业，早晚会有MATCH机
会大增的一天 | b*****u
发帖数: 289 | 4 明年，后年在不增加名额，我等叫要废了。今年的形式就很严峻。您看明年后年有望增
加住院医名额么？ | s******n
发帖数: 2279 | 5 国会不想办法增加住院医生名额的话，最近几年会非常困难，因为一些家伙搞的美国医
学院扩招已经轰轰烈烈开始了，增加的AMG进一步挤压FMG本来就有限的机会，但经济好
转，不见得扩招能够继续进行下去，同时，也会有更多资金来源支撑增加住院医师名额
，最近国会两个共和党参议员医生对OBAMACARE严厉批评，其实真没说错，如果真的放
开保险，几千万新增加的都要看病，PCP哪里来？增加住院医师培训的经费哪里来？中
期选举共和党肯定赢，很大可能是维持现状，但如何应对共和党选民居多的老龄化，也
必须得有办法，把扩大化医保的钱拿来扩大原有体制的住院医师培训，应该是最现实的
做法了 | e*****a
发帖数: 1334 | 6 The number of residency positions will be increased eventually. The question
is when and by how many.
Since last year, several proposals have been discussed.
Senate Majority Leader Harry Reid (Democrat) co-sponsored a bill to fund for
15,000 more slots for graduate medical residencies in primary care and
general surgery (roughly 4,500 per year). This didn't come out from the
committee because it carries a high price tag - an estimated $10 billion to
$15 billion cost over a decade.
Sen. Charles Schumer of New York (Democrat) introduced an amendment that
would add about 2,000 residency spots (roughly 600 per year). However, this
didn't get into the final version of the healthcare reform bill.
Current option is to redistribute any unfilled residency positions to
primary care and general surgery in rural/underserved areas. | k**e
发帖数: 2728 | 7 Compared to the growth of US medical school students, how much of this pie
of residency positions will eventually be left for our FMGs?This is a
discouranging question, however, I think it will also help to shape our
strategy :) in terms of where and when to apply, perhaps?
question
for
to
this
【在 e*****a 的大作中提到】
: The number of residency positions will be increased eventually. The question
: is when and by how many.
: Since last year, several proposals have been discussed.
: Senate Majority Leader Harry Reid (Democrat) co-sponsored a bill to fund for
: 15,000 more slots for graduate medical residencies in primary care and
: general surgery (roughly 4,500 per year). This didn't come out from the
: committee because it carries a high price tag - an estimated $10 billion to
: $15 billion cost over a decade.
: Sen. Charles Schumer of New York (Democrat) introduced an amendment that
: would add about 2,000 residency spots (roughly 600 per year). However, this
| e*****a
发帖数: 1334 | 8 发信人: ericusa (eric), 信区: MedicalCareer
标 题: Re: Mass. Primary Care Shortage: Lesson for National Reform?
发信站: BBS 未名空间站 (Wed Oct 27 11:34:03 2010, 美东)
From 2004 to 2009 the number of Non-U.S. FMGs enrolled in PGY-1 positions
was about 4,700 per year (including the Main Match and pre-match). This
number dropped to ~4,200 in the 2010 match.
About 500 more of U.S. MD/DO graduates will enter the race each year, and
the residency positions will be increased about 1% per year (~200). So even
in the worst case there will be some opportunities for FMGs in the next
several years.
【在 k**e 的大作中提到】
: Compared to the growth of US medical school students, how much of this pie
: of residency positions will eventually be left for our FMGs?This is a
: discouranging question, however, I think it will also help to shape our
: strategy :) in terms of where and when to apply, perhaps?
:
: question
: for
: to
: this
| k**e
发帖数: 2728 | 9 thanks for reposting! i must have missed it this morning when reading the
posts.
even
【在 e*****a 的大作中提到】
: 发信人: ericusa (eric), 信区: MedicalCareer
: 标 题: Re: Mass. Primary Care Shortage: Lesson for National Reform?
: 发信站: BBS 未名空间站 (Wed Oct 27 11:34:03 2010, 美东)
: From 2004 to 2009 the number of Non-U.S. FMGs enrolled in PGY-1 positions
: was about 4,700 per year (including the Main Match and pre-match). This
: number dropped to ~4,200 in the 2010 match.
: About 500 more of U.S. MD/DO graduates will enter the race each year, and
: the residency positions will be increased about 1% per year (~200). So even
: in the worst case there will be some opportunities for FMGs in the next
: several years.
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