In Massachusetts, long waits for doctor visits

BOSTON (Reuters) - Almost everyone in Massachusetts has health insurance under a state mandate, but many doctors do not accept the subsidized insurance programs available to low-income residents, a new study shows.

Residents in some areas also face long waits in getting doctors' appointments, or find that overstretched primary care practices are not taking on new patients.

"Insurance coverage doesn't equal access to care," said Dr. Alice Coombs, president of the Massachusetts Medical Society (MMS) and an emergency room physician,

Massachusetts' healthcare program was introduced five years ago by then-governor Mitt Romney, a Republican now expected to run for president in 2012 after falling short in 2008.

The state's program is often regarded as a model for President Barack Obama's 2010 healthcare reforms. Conservatives have criticized Romney for his support of the state's plan, although he has said it was designed for Massachusetts and would not work as a national plan.

The medical society on Monday issued its annual Physician Workforce survey, which was conducted in February and March. More than 23,000 doctors and students are members of MMS, which publishes the New England Journal of Medicine.

Coombs said that despite its problems, Massachusetts has done "an incredible job" with healthcare. Issues such as a shortage of doctors in poorer communities are not unique to the state, she noted.

"It's a success in terms of the number of patients who have seen a doctor in the past few years, but the physician workforce has been strained," Coombs said.

Massachusetts, like much of the nation, has a severe shortage of doctors in primary care - internists and family physicians - because those fields are less lucrative.

"We need more doctors in primary care. There's no getting around that fact," said Coombs.

Many primary care doctors do not accept MassHealth, the state's version of Medicaid, and even less accept Commonwealth Care and Commonwealth Choice, programs for low- and moderate-income residents.

More than half of primary care practices are not taking new patients, especially patients for whose treatment they will be paid at a much lower level than for those carrying private health insurance.

Long wait times are common - almost seven weeks, on average, for a non-emergency appointment for internal medicine. The average wait time for pediatricians, primary care for children, was 24 days, the MMS study showed.

New patient wait times in Massachusetts jumped between 2006 and 2007 after the initial implementation of the state health care reform law, and have remained high. As a result, the rate of emergency room visits to receive care has also stayed high.

More lucrative specialist practices - gastroenterology, cardiology, obstetrics/gynecology and orthopedics - were in most instances taking new patients, although long wait times were still seen, MMS said.

"There really is a maldistribution of medical workforce resources," said Coombs.

The complete report, "2011 Patient Access to Health Care Survey," can be viewed on the Massachusetts Medical Society website at bit.ly/mqZno4.