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.
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