More than 340,000 Massachusetts residents have gained health insurance since 2006 under the state's landmark health care reform law. But residents are now waiting longer for appointments. Doctors and consumer advocates report growing difficulties among patients vying for care, and for physicians trying to squeeze them in. Some doctors are shutting their doors to new patients.

In its annual physician survey, the Massachusetts Medical Society, the state's largest physicians group, found that among 100 internists the average wait time for an appointment for a new patient is now 50 days, with some waits up to 100 days. In 2004, the average wait time was 47 days and the longest wait was 87 days. The medical society also found that fewer primary care doctors are taking on new patients; 42 percent of internists surveyed have closed their practices to them, compared with 33 percent in 2004. The waits for appointments with obstetrician/gynecologists and family practitioners also have generally increased.

Access to internists and family practitioners is especially difficult in western Massachusetts and on Cape Cod, but Boston, too, is feeling the squeeze, according to the Boston Globe. Bay State physician shortages illustrate the law of unintended consequences in action: The state's reform law now extends coverage to more residents, as intended, but getting it through a state-imposed guaranteed issue market hardly guarantees access to timely medical care from practitioners who are truly capable of handling substantial increases in their patient rolls.

In the meantime, Governor Deval Patrick (D) announced on September 30 that the federal government will extend the Commonwealth's Medicaid waiver, allowing the state to continue to extend access to coverage under its reform law through a three-year, $21.2 billion agreement. The pact, expected to be formalized in the coming weeks, commits federal taxpayers to $11 billion in subsidies to state residents who earn up to 300 percent of the federal poverty level, or $63,600 annually.