workforce

The President’s Podium: “Physicians Really Are Different”

Posted in Annual Meeting 2015, Leadership, workforce on May 8th, 2015 by MMS Communications – Comments Off on The President’s Podium: “Physicians Really Are Different”

Dr. Dennis Dimitri 300 ppiBy Dennis Dimitri, M.D., President, Massachusetts Medical Society

Editor’s Note: On Friday, May 1, 2015, Dennis Dimitri, M.D. was installed as the 133rd president of the Massachusetts Medical Society. His inauguration address, while reflecting on personal experiences and acknowledging the help and support of those closest to him, also carried an important message for physicians, as they practice in a dramatically changing and increasingly burdensome health care system. Here are excerpts of his inauguration speech.

“There is really no other career that for most of us could have brought so much personal reward while doing so much professional good.

“We’re very privileged in the sense that our patients come to us, sharing openly all of their own difficult circumstances, be they medical, personal, social, or economic issues that created their difficulties. They look to us to help them overcome these problems, yet over and over lately, we hear about physician burnout and the loss the joy in practice.

“Yes, it can be stressful and overwhelming to be faced by our professional demands at times. Often, the healthcare delivery system seems to add more roadblocks rather than make it easier for us.

“Yet we must not lose sight of the privilege we are afforded in return for our willingness and our professional mandate to put our patients’ interests before ours. Many of us often decry the loss of some types of physician autonomy, as well as the sense of the loss of respect for the profession, yet, over and over, polls of the public indicate that they want a physician to be the provider of their health care, and that medicine remains at the top of the list of respected professions.

“So, yes, we now practice more and more often as part of a team or in an integrated system, but the unique role of physician leadership of that team and physician impact on those systems remains fundamental to our patients’ well-being.

“And as to that loss of joy in practice…. Well, recent studies of physicians indicate, not surprisingly, that what gives us the greatest satisfaction is providing good care to our patients.

“When we feel burned out by dealing with our EMR’s, the prior authorization forms, and the delays in payments from insurers … when we have to stop to check the prescription monitoring program, or search for a course to fulfill our risk management CME’s, we should try to remember this: We helped some patients today.

“We should think for a moment about the impact we have on our patients’ lives, how much we become a part of their families, often without even realizing it.

“My point is that physicians really are different. Every day we have the potential to be involved in awesome life-and-death decision-making. We do our best to make those decisions, based not just on the whimsy of the day, but on scientific evidence, and then we take the feedback of the outcome of those decisions and use it to improve the quality of our next decision, be it for the current patient or the one we might see the next time.

“It’s what our patients expect, it’s what we like to be able to do, and it’s what we should remember on those days when the frustration mounts.

“So in this coming year, I plan to try to remember we are here to take care of patients, to improve the quality of care we deliver, to husband the resources needed to provide that quality of care, and to pay attention to … improving the work life of physicians and their staffs.

“I believe such an effort is reflected in the time-honored mission statement of the Medical Society: Maintaining the highest professional and ethical standards, while promoting medical institutions that are formed on liberal principles for the health, benefit, and welfare of the citizens of the Commonwealth. I shall endeavor to continue to make it so with the help of all of you.”

Watch Dr. Dimitri’s remarks here:

The President’s Podium: Opinions of our Profession

Posted in Leadership, workforce on December 2nd, 2014 by MMS Communications – Comments Off on The President’s Podium: Opinions of our Profession

By Richard Pieters, M.D., President, Massachusetts Medical Society

My President’s Message in the November issue of Vital Signs, our monthly publication for MMS members, cited encouraging findings from The Physicians Foundation 2014 survey. The survey, which received  responses from more than 20,000 physicians across the U.S., found that 49 percent of us feel positive about the future of the medical profession. While that’s still below half, it’s a huge 26 percent increase from TPF’s 2012 survey.

Despite the trend, however, pessimism and negativity are growing, even from some colleagues within the profession. In an August 29 essay in The Wall Street Journal headlined Why Doctors Are Sick of their Profession, cardiologist Dr. Sandeep Jauhar writes:

“Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future …. The growing discontent has serious consequences for patients.”

Other physicians have expressed similar dissatisfaction with the profession, whether it stems from administrative overload, more legislative or regulatory requirements, or intrusion into the physician-patient relationship.

This kind of perspective is reaching patients. An essay entitled Doctors Tell All – and It’s Bad in the November edition of The Atlantic by Meghan O’Rourke – a self-described “patient and the daughter of a patient” – states:

“A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments…. Few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades.”

Medicine has indeed changed dramatically. But is our profession deteriorating as fast as some suggest? Are patients being negatively affected?

Many of us may bristle at the increasing administrative hassles, the interference in the physician-patient relationship, and the loss of independence.

I do not, however, believe medicine is “just another profession.” And I don’t think our patients do either.

Consider these assessments: a Gallup poll ranks doctors fourth among professions in honesty and ethics, and a Harris poll shows doctors to be regarded as the most prestigious occupation in America. The Harris poll also found that 91 percent of respondents would encourage a child to become a doctor.

Consider also an October 23 Perspective article in the New England Journal of Medicine, which seems to paint a different picture.

A review of polls on public trust in U.S. physicians and medical leaders from 1966 through 2014, as well as a survey of 29 countries, reveals that “public trust in the leaders of the U.S. medical profession has declined sharply over the past half century and that “the level of public trust in physicians as a group in the United States ranks near the bottom of trust levels in a survey of 29 industrialized countries.”

The authors of the article cite a Gallup poll of June 2014 indicating that only 23 percent of the public has confidence in the U.S. health care system. “We believe,” the authors write, “that the medical profession and its leaders are seen as a contributing factor.” Yet another Gallup poll released in November shows that 66 percent of Americans are satisfied with how the health care system works.

But here’s the key finding from the NEJM article: the decline in trust is not reflected in patient satisfaction with medical care. While the U.S. may rank near the bottom internationally in the public trust in physicians, it ranks near the top in patient satisfaction with medical treatment.

Our own public opinion poll of last year found a similar result. The overwhelming majority of Massachusetts residents (84 percent) remains as satisfied with the health care they receive as they were before reform began in 2006. The biggest reason: the “quality of care.” That reflects the work we’re doing as physicians.

So as the polls continue, and the pessimism persists, let’s take both in stride. Most of all, let’s listen, to our patients. They are, in the end, the best judges of our performance as physicians, and they’re telling us we’re doing well.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine.

Mass. Still Short in Key Medical Specialties; Physicians Hard to Recruit and Retain

Posted in workforce on October 2nd, 2012 by Erica Noonan – Comments Off on Mass. Still Short in Key Medical Specialties; Physicians Hard to Recruit and Retain

The Massachusetts Medical Society today released its annual study of the state’s physician workforce – once again showing shortages in several specialties and continuing difficulty in recruitment and retention of physicians.

The 2012 Physician Workforce Study is the Society’s 11th annual comprehensive look at the physician workforce in Massachusetts.  The study also noted some positive trends: more physicians say they are willing to participate in new models of care such as accountable care organizations and global payments.

Additionally, slightly fewer physicians said they have altered or limited the scope of their practice for fear of being sued.

“This year’s study has mixed results,” said MMS President Richard Aghababian, M.D.  “We still have shortages of physicians in key specialties, especially primary care, and, despite some positive trends, physician recruitment is problematic, particularly for community hospitals.”

Key findings of the study included:

  • Seven of 18 specialties were found to be in critical or severe shortages: family medicine, internal medicine, general surgery, neurosurgery, dermatology, psychiatry, and urology.
  • While 2012 marked the fifth consecutive year that saw a decrease in both the recruiting time to hire physicians and in the number of physicians reporting difficulty in retaining physician staff, recruitment remains difficult for those seven specialties, and in areas outside of Boston.  More than 94% of community hospitals report significant difficulty in filling vacancies, compared to 7.3% of teaching hospitals.
  • For the second year in a row, the percentage of physicians (40%) who say they are satisfied with the practice environment in Massachusetts equals the percentage (40%) who say they are dissatisfied.
  • Most physicians (78%) find their careers rewarding, but more than half (53%) are dissatisfied with the division between patient care and administrative tasks. This is especially pronounced among primary care physicians (family medicine, internal medicine); with 62% expressing dissatisfaction with the tradeoff between patient care and the administrative tasks they are required to perform.
  • 41% of physicians said they have altered or limited the scope of their practice because of the fear of being sued – but that is a decrease of 5% fewer than in each of the last three years.
  • For the second year, physicians were asked their opinions on the best option for the U.S. health care system. While 38% of physicians support a single-payer system, 62% prefer other options.

The complete report is available at http://www.massmed.org/workforce

  –– Erica Noonan

 

Physicians and ACOs: Skepticism Abounds

Posted in Payment Reform, workforce on October 7th, 2011 by MMS – 1 Comment

Last in a series of five articles on the 2011 MMS Physician Workforce Study

With global payment contracts and accountable care organizations becoming more prevalent in Massachusetts, we thought it would be important to ask physicians what they thought of these new practice arrangements.

About 57 percent of physicians said they were familiar with global payment contracts and 58 percent said they were familiar with ACOs. Forty two percent said they were willing to enter into a global payment contract, and 49 percent said they would join an ACO. Physicians who were familiar with the terms were only slightly more willing to participate than those were not familiar.

There is a strong divide between specialists and primary care physicians. Almost 72 percent primary care physicians said they were likely to join an ACO, compared to 50 percent of specialists. This correlates strongly to specialists’ long-stated worries that their referral patterns – the lifeblood of their practices – would be disrupted or diminished by ACOs.

The survey didn’t ask for the reasons behind their answers, but preliminary results from research that the Harvard School of Public Health is conducting for us may shed a light on that.

In that study, only 7 percent of all respondents said their practice has access to computer systems to manage clinical information, and only 29 percent said their group is ready to enter into a global payment contract. These are important preconditions to succeeding in a global payment environment.

Will implement global payment system achieve what its sponsors hope? Physicians are skeptical.

Fewer than half (44%) believe that medical spending will decrease. Even fewer, 19 percent, believe that quality will improve. Most believe that that global payments will reduce physician incentives to work (59%) and reduce the numbers of physicians willing to work in Massachusetts (76%).

Sponsors of a global payment system need two groups to believe it will work – physicians and patients. We don’t have data yet on patients, but the evidence suggests that physicians aren’t there yet.

Read the workforce study at www.massmed.org/workforce

End of series. Read the other posts in this series here.

Does Where Doctors Practice Determine Their Professional Satisfaction?

Posted in workforce on October 6th, 2011 by MMS – Comments Off on Does Where Doctors Practice Determine Their Professional Satisfaction?

Fourth in a series of five articles on the 2011 MMS Physician Workforce Study

Physicians generally love being doctors. It’s the practice of medicine that troubles them.

Our 2011 Physician Workforce Study again asked physicians for their opinions on the practice environment, and well as the professional rewards of being a doctor.

It’s interesting that the percentage of physicians expressing dissatisfaction with the practice environment has declined significantly since we began asking the question in 2002.

Sixty percent said they were dissatisfied in 2003. That percentage has fallen steadily over the year to 42 percent in the current survey. Those are satisfied rose at a similar rate, 29 percent in 2003 to 42 percent today. So now there’s an exact split between those are satisfied and those who are not.

Why do more doctors today say they’re happier?

One possible factor: Dramatic changes over the last decade in where physicians work. Slightly more than half of physicians who are employed or work in a community health center said they are satisfied, while only 29 percent of self-employed physicians said they were satisfied. We know from other research that the numbers of employed physicians have grown sharply in the last decade.

There is no difference between the answers of specialists or primary care physicians. Women were somewhat more likely than men to express satisfaction with the environment (47% to 40%) and since more women are practicing medicine than in 2003, that could explain some of the change, too.

But let’s not forget: When nearly half of physicians are unhappy with the practice environment something’s not right – these demographic shifts notwithstanding.

If there’s any comfort to be derived from the survey, it’s that physicians still love the profession itself. Eighty-one percent (81%) said they find the profession rewarding or very rewarding. That percentage has held very steady since 2002. There’s no difference in this area between specialists and primary care physicians.

One interesting note: On almost every question, pediatricians were significantly more satisfied with the practice environment. How would you interpret this?

Read the workforce study at www.massmed.org/workforce

Coming tomorrow: Physicians and ACOs. Read the other posts in this series here.

Physicians’ Fear of Being Sued is Pervasive

Posted in Malpractice, medical liability reform, workforce on October 5th, 2011 by MMS – Comments Off on Physicians’ Fear of Being Sued is Pervasive

Third in a series of five articles on the 2011 MMS Physician Workforce Study

Our 10th annual workforce study suggests that while medical malpractice insurance costs in Massachusetts tend to be higher than national averages, the fear of being sued has a much more dramatic impact on physicians than the actual cost of the insurance.

The survey found that 12.5 percent of physicians have limited the scope of their practice because of malpractice insurance costs. Specialists were only slightly more likely to respond yes, at 14.6 percent.

But when asked whether the fear of being sued has prompted them to alter or limit their scope of practice, that number jumps to 46 percent. There’s only a slight difference between primary care physicians and specialists (46 and 49 percent, respectively).

But within specific specialties we see some interesting numbers, especially when comparing their answers to the same question in the 2008 survey.

In 2008, about half of orthopedic surgeons, gastroenterologists and dermatologists said they had altered their practice for fear of being sued. In 2010, that numbers jumps to almost three in four.

Conversely, we see the reverse dynamic among neurosurgeons and urologists. In 2008, three quarters of these doctors said they had altered their practice. In this year’s survey the number was much closer to 50 percent.

The percentage of obstetrician-gynecologists (who have the highest premiums of any specialty) who responded yes to that question remained relatively steady at 56 percent, compared to 57 in 2008.

Why the differences over the years? It’s hard to say, and the study didn’t delve into the question. But as the survey notes, “the threat of a malpractice suit has an extraordinary pervasive impact on all specialties.”

Read the workforce study at www.massmed.org/workforce

Coming tomorrow: Physicians and Their Professional Satisfaction. Read the other posts in this series here.

Why Do Medical Residents Stay in Massachusetts – Or Leave?

Posted in workforce on October 4th, 2011 by MMS – Comments Off on Why Do Medical Residents Stay in Massachusetts – Or Leave?

Second in a series of five articles on the 2011 MMS Physician Workforce Study

When the MMS began publishing its physician workforce studies a decade ago, one of the more unsettling findings was the broad reluctance of medical residents to start their careers in Massachusetts. To be sure, there wouldn’t be room for all residents training in Massachusetts to work here, but many believed that more residents should want to stay after completing their training.

That phenomenon was observed again in our 10th annual workforce study released last month. About 40 percent of residents said they had already accepted a position outside Massachusetts, or didn’t plan to stay. Sixty percent said they planned to stay here, compared to 52% in the 2005 survey.

That’s a little higher than six years ago. Is that reason to be optimistic? Given the size of the sample, it may be a stretch to call it a trend, let alone a statistically significant difference.

What’s affecting their decision? The survey asked residents to rank the favorability of professional and personal issued that factored into their decision of where to practice.

Professional factors ranked favorably

Intellectual stimulation: 98%
Professional development: 95%
Research opportunities: 94%
Diverse patient demographics: 74%
Clinical opportunities: 72%
Practice environment: 60%
On call schedule/work hours: 47%
Malpractice premiums: 13%

Personal factors ranked favorably

Local amenities: 89%
Geographic location: 77%
Children’s educational opportunities: 70%
Partner’s job: 63%
Work/family balance: 48%
Proximity to extended family: 43%
Tax environment in Massachusetts: 20%
Salary level: 19%
Salary arrangement: 15%
Cost of living: 10%
Housing costs: 8%

Clearly, family ties matter to those who stay. What can we do to keep those who don’t have family nearby? The results above may provide some insight.

Read the workforce study at www.massmed.org/workforce

Coming tomorrow: Physicians’ Fear of Being Sued is Pervasive. Read the other posts in this series here.

Eight Specialty Shortages in a Land of Plenty

Posted in workforce on October 3rd, 2011 by MMS – Comments Off on Eight Specialty Shortages in a Land of Plenty

First in a series of five articles on the 2011 MMS Physician Workforce Study.

In a state with 4 medical schools, 2,700 medical students,  398 residency programs and almost 5,500 residents, it might seem logical to conclude that there is no shortage of doctors in Massachusetts.

But for the tenth straight year, our physician workforce study has uncovered critical shortages in this land of plenty. On the basis of responses to a series of six questions, eight specialties are in short supply in Massachusetts this year:

  • Dermatology
  • Family medicine
  • General surgery
  • Internal medicine
  • Neurosurgery
  • Orthopedics
  • Psychiatry
  • Urology

But not all regions in the state are equal. In the immediate Boston area, there’s a relatively adequate supply of physicians. But the southeastern, central and western parts of the state are having much more difficulty recruiting new physicians. Even many urban labor markets are feeling the squeeze:

  • Cambridge/Somerville/Arlington/Medford
  • Salem/Beverly/Lynn/Saugus
  • Newton/Wellesley/Needham
  • Quincy/Braintree/Plymouth

While there is some agreement about the causes of these shortages, there’s a lively debate about how to resolve them. The workforce study says that natural labor market dynamics seems to work well enough in Boston, but “labor markets often do not function as efficiently as one would like.”

The prospects for the future are not entirely comforting. A large cohort of late-career physicians is nearing retirement, and there aren’t enough younger physicians in [place to succeed them. Moreover, the thousands of young people who train in Massachusetts remain hesitant to establish roots here. More about that in tomorrow’s post.

Read the workforce study at www.massmed.org/workforce

Coming tomorrow: Why Do Residents Stay in Massachusetts?

Despite Travails, Internist’s Practice Stays Open to New Patients

Posted in Global Payments, Primary Care, workforce on June 8th, 2011 by Rebecca McDade – Comments Off on Despite Travails, Internist’s Practice Stays Open to New Patients

Richard Dupee, M.D., a Wellesley-based internist and geriatrician whose practice has about 10,000 patients, is among a dwindling segment of primary care physicians accepting new patients.

“It’s a matter of business survival,” explained Dr. Dupee, whose practice accepts several new patients every week, including MassHealth enrollees. “I need to keep [patient] volume up to stay in practice.”

Dr. Dupee also thinks closing a practice to new patients sends the wrong message to existing ones. “If you close a practice to new patients, some existing patients might wonder if you’re too busy to see them,” he said.

Of the many primary care physicians who have closed their practices to new patients (see the 2011 Patient Access to Health Care Study), Dr. Dupee said, “I think they’re interested in maintaining a more 9-to-5 lifestyle.” The same preferences motivate young physicians coming out of residency, “so they become employees, with guaranteed salaries, no nights, and no weekends,” he said.

Dr. Dupee is also an associate professor at Tufts University School of Medicine, where he teaches, among other courses, a small medical ethics seminar. “Most of those students are interested in primary care, but they get discouraged by the attitudes of the primary care doctors they work with who don’t love what they do…I love what I do.”

Having said that, Dr. Dupee is quick to itemize the daily travails of a small primary care practice: time wasted on paperwork and prior authorizations and low reimbursements. Increased pay for primary care may eventually come from savings due to better-coordinated care and stricter adherence to clinical guidelines. But in the short term, Dr. Dupee sees no solution to the pay disparity other than to rob Peter to pay Paul. “At some point, subspecialists may have to realize that some of those dollars will be maneuvered to primary care,” he said.

Dr. Dupee’s practice belongs to the New England Quality Care Alliance, a network of autonomous solo and group practices, IPAs, and academic physicians affiliated with Tufts Medical Center. His experience with payers as part of that alliance has convinced him that “global pay for Medicare patients makes sense.” What about the rationing that global-payment critics warn against? Dr. Dupee said that no matter what the payment or delivery system is, “doctors do not and will not deny appropriate care.”

Hefty Numbers: The Economic Impact of Physician Practices

Posted in Medicine, workforce on March 24th, 2011 by MMS Communications – Comments Off on Hefty Numbers: The Economic Impact of Physician Practices

Here’s a different, but important, look at the impact of physician practices: Massachusetts office-based physicians contribute $31.7 billion in economic output to the state and support 112,000 jobs. Those were some of the findings from a first-of-its-kind analysis done for the American Medical Association by The Lewin Group, a national healthcare policy research and management consulting group based in Virginia. The study reported on the economic impact of nearly 20,000 office-based physicians in the Commonwealth for the year 2009.

The study also found that Massachusetts office-based physicians support $23.5 billion in total wages and benefits and generate $1.5 billion in total state and local tax revenues.  

Reacting to the findings, MMS President Alice Coombs, M.D. said the report clearly shows the economic significance of the physician workforce as part of the state’s number one industry, as well as the critical need to improve the physician practice environment in the state, which, according to MMS annual evaluations, has been in a continual state of decline.

“A good physician practice environment produces many benefits,” Dr. Coombs said. “Patients will have more and better access to care, the state will have a stronger economy, and we will be better able to recruit and retain physicians to enhance our health care delivery.”

Additional key findings from The Lewin Group’s research: in comparison to other industries, office-based physicians almost always contribute more to local economies than the hospital, legal, nursing home, home health, or legal industries, and physicians provided an estimated $24.4 billion in charity care nationwide in 2008.

The complete report on Massachusetts is available here. AMA commissioned a national report, as well as individual reports for each state, and those are available from the AMA’s website.