OP-ED | No Evidence To Back Up Claim of Physician Shortage
by Neil Ferstand | Sep 24, 2012 5:59am
(3) Comments | Commenting has expired
Posted to: Opinion
It’s simple, there is no evidence.
If you’ve read some of the recent opinion pages you may come to believe that Connecticut is again fast approaching another physician shortage or, more precisely, the threat of one. As threats go this one is getting a little stale, although the focus has changed now to primary care physicians.
Fact is, there isn’t much Connecticut-based empirical evidence to make this case, primary care physicians or not. What do exist are proprietary, self-administered surveys conducted by the organized medical community and cited by the editorial pages as Connecticut “statistics.”
In 2003, the General Accountability Office (GAO), which was studying access to healthcare, condemned these surveys as extremely unreliable.
The Department of Public Health (DPH), the agency tasked with the responsibility of licensing and profiling physicians, should receive some credit for its lengthy attempt to convert a 2005 law requiring a host of new data to be collected into a workable application. Doing so would have put the state on track to begin collecting accurate information regarding how many Connecticut physicians are indeed “actively” practicing medicine and in what field — data that does not now exist.
For a number of reasons, the DPH has been unable to meet the requirements of PA 05-275, in part because the law did not specifically require that physicians renew their licenses online, a sure way to capture this valuable information. Currently, a little over half of physicians renew in this fashion.
In 2012, to their credit, the DPH introduced SB 186 An Act Concerning the Licensing, Investigations and Disciplinary Processes for Physicians and Nurses. The bill included a requirement for physicians to process their license renewals online. Alice Pritchard, executive director of the Connecticut Women’s Education and Legal Fund, summed up the value and need for this information in her written testimony, stating, “One key challenge is the lack of adequate data for forecasting our workforce shortages. The mandatory electronic licensing called for in SB 186 would provide important data in the state’s efforts to ensure an adequately trained healthcare workforce.”
The provision never made it out of the Public Health Committee. A rather large and somewhat indecipherable fiscal note appeared and the language was gone. An interesting side note: during committee testimony the organized physician community opposed the provision because it contained a $5 electronic processing fee. To be fair, Connecticut physicians pay hefty annual licensing fees while their neighbors in bordering states pay biennially. However, paying a $5 fee seems a small price to pay for the state to finally begin collecting some reliable data that ultimately may benefit physicians. In other words – we’d be forced, out of necessity, to base policy decisions on sketchy, unreliable, and mostly partisan data.
I digress. Let’s return to the opinion pages.
The editorial boards are all atwitter, as they were in 2003 when similar editorial predictions of a physician shortage surfaced. Much as they were in 2003, they are thoroughly convinced that these dire predictions of a shortage or possible physician flight have been proven by “statistics” appearing in a 2009 (often cited as 2010) Physician Satisfaction, Supply and Patient Access report published by the Connecticut State Medical Society (CSMS). This time the survey targeted primary care physicians.
Editors seemed to have a missed one of the more important qualifiers contained on the last page of the survey report. As if channeling the GAO’s findings, the authors state, ”This study is based entirely on self-report measures which, although used previously in surveys of Massachusetts and Connecticut physicians, have not been subjected to rigorous quantitative tests of their validity and reliability.” I suppose one might call them “sur-real” statistics.
In a different study conducted in 2008 by the University of Connecticut, the Center for Public Health and Health Policy completed an “Assessment of Primary Care Capacity in Connecticut.” This study, not recently cited in any editorial, is a bit more circumspect in its findings — in fact, a lot more: “Based on the current population, number of primary care providers with unexpired licenses, estimated productivity norms, and estimated primary care provider capacity, it appears that Connecticut, like much of the Northeast, currently has an adequate supply of licensed primary care physicians.”
The report acknowledges however, that these conditions of primary care capacity may not be the case “in 10 to 15 years.”
In addition, the report continues, “The count of unexpired primary care provider licenses issued by DPH most certainly overestimates the current supply of practicing primary care providers in Connecticut.” To their credit the authors reveal one of the key elements of this argument. In order to complete their study, they used DPH licensing data reflecting only the number of “unexpired” licenses. Not the profiles for “actively” practicing physicians and their specialties.
This data does not exist.
Neil Ferstand has been managing organizations for the last 38 years – 17 of those years has been spent as the Executive Director of the Connecticut Trial Lawyers Association
Tags: physician shortage, Neil Ferstand, Department of Public Health, primary care, licenses, dh
(3) Comments
posted by: travelling medicine dog | September 24, 2012 9:37pm
The flat earth society also claimed that there was no evidence and that it was simple common sense.
Ever tried to get an appointment within a week with a sub specialist? call back and say that you have no insurance…it will be another insured lifetime when you get your appointment. Then try it in the rural part of the state.
Why is there a 10 year life expectancy gap between whites and minorities?
Do you even know what the average age of a physician is in the state? what happens when they all retire?
do you know how many are trained in the state and are retained in the state? Do you know that a woman dies every minute from heart disease? Do you know of the Psychiatric needs that go unmet for patients because there are few providers?
Perhaps the facts do not connect the dots sufficiently for you, but the new ignorance is to discount global warming and then be conscientiously unaware.
I hope that you will never have to care for a loved one and be the one responsible to access the healthcare system for them.
posted by: edvolpintesta md | September 24, 2012 10:29pm
Mr. Neil Fernstand’s OP-Ed piece “No Evidence to Back Up Claim of Physician Shortage” in the September 24 issue is important because it demonstrates the complexity of the issue and how difficult it is to get information that is accepted by all sides.
In this context it is understandable that he questions the methodology used to collect the data that maintains that a shortage of primary care physicians exists in Connecticut, My response, however, is not intended to refute his opinions but to broaden the outlook that he brings to this important issue.
Because of insurance companies’ tight and unfair regulation of the compensation paid to primary care physicians for their labors and because of the inordinate amount of administrative chores that insurers expect them to deal with, many primary care physicians not only that their noble calling has been devalued, but many feel powerless to improve their situation because of the immense power wielded by insurance companies.
In order to survive, many primary care doctors see more patients than they normally would if they were compensated fairly.
Working in “overdrive” so to speak, leads to false conclusions regarding the adequacy of the primary care workforce. Working harder and seeing more patients gives the erroneous impression that there is no shortage of primary care physicians. This crucial understanding is impossible to demonstrate with statistical analysis.
Furthermore, working in the overdrive mode leaves primary care little time to talk with their patients. This detracts from the quality of care. In fact the biggest complaint that many patients have is that their physicians do not spend enough time talking to them.
A demoralized primary care workforce eventually burns out. And since it takes about 11 years to produce a primary care physician, the citizens of Connecticut may be forced to undergo a dry spell when the number of primary care physicians is insufficient to fulfill the needs of our citizens.
At that time we may see many nurse practitioners and physician assistants providing primary care because their training period is significantly shorter.
The point, and I think I may have strayed from it, is that it is misleading to rely on statistical data alone when drawing conclusions about whether a sufficient number of primary care physician exists in Connecticut.
Statistics are important but they represent only one facet of this many-sided problem of great public concern. And because statistics may lend themselves to different interpretations, it is critical that the factors I mentioned be brought into the discussion.
posted by: edvolpintesta md | September 25, 2012 7:49am
I forgot to mention in my previous letter that one of the dangerous side-effects of primary care doctors having to work harder, that is, to see more patients in order to survive (because of insurers’ unfair regulation of their fees) is that it increases their chances of missing diagnoses. Needless to say the consequences can be serious medically and legally.
It should be obvious to all that seeing more patients than is appropriate is a risk factor for physicians and for their patients. And insurers’ distractions and intrusions (getting clearance for tests and medications, among others) accentuates the problem.
The serious ramifications that follow in the wake of working too hard to see more patients in order to survive is one of those factors that is difficult if not impossible to represent statistically.
Yet it is every bit as important as any statistical date that supports or refutes whether the number of primary care physicians in Connecticut is adequate.