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The shortage of doctors in critical specialties is worsening even as the state's mandatory health insurance law has spread medical insurance coverage to unprecedented numbers of citizens.

A report released today by the Massachusetts Medical Society said the number of medical specialties facing shortages of doctors has doubled in the past three years with three - oncology, neurology and dermatology - added this year, alone.

Altogether, two-thirds of the 18 medical specialties are "stressed," some critically, the report said.

The report said patient demand has outstripped the supply of doctors because of the increased numbers of patients doctors and hospitals are seeing.

"Our latest analysis raises serious questions about our ability to efficiently handle the increased demand for health services for both primary and specialty care," said Dr. Bruce Auerbach, vice president and chief of emergency and ambulatory care at Sturdy Memorial Hospital in Attleboro and president of the Massachusetts Medical Society. Two specialties, internal medicine and family practice, face "critical" conditions, the study said, with a quarter to a third of physicians in those specialties saying that they plan to change careers.

The results were based on surveys of doctors and health care providers.

Ironically, the doctor shortage is tied to the state's health care reform initiative, which requires all residents to get health insurance.

Mandatory insurance has provided coverage for an increased number of residents, but does not guarantee equal access to doctors. The shortage means longer waits for new patients looking for doctors and greater difficulty in filling vacancies at hospitals and practices, the report said.

"The success of health care reform in insuring hundreds of thousands more people is a great step forward," Auerbach said. "But it has put enormous pressure on primary care, and we now know that insurance without access to care will not result in true health care reform and that universal coverage does not equal universal access."

"With more patients, an aging population and rising rates of obesity and chronic disease, demand is overwhelming supply, and our physician workforce is coming under more stress and strain," he said.

The shortage has also been felt in the Attleboro area, Auerbach said, although not as acutely as in some other parts of Massachusetts. He said it has been more difficult to recruit doctors lately and that some patients looking for doctors, other than those with pressing medical problems, are having to wait longer.

The doctor shortage has been felt particularly among family physicians and internal medicine doctors.

According to the survey, the number of family doctors who are no longer accepting new patients increased from 25 percent in 2006 to 35 percent this year, while internal medicine practices no longer accepting new patients jumped from 31 percent to 48 percent.

The time needed to recruit doctors for vacancies has increased to a year or more in many specialties. The medical society's study also found that primary care physicians are some of the most critical scarcities facing community hospitals. Fifty-six percent of community hospitals report shortages in internal medicine, and 44 percent report shortages in family medicine.

Doctors surveyed said low pay and adverse working conditions are also affecting the way they practice.

About 44 percent of physicians surveyed said their practice is being altered or limited because of the fear of being sued. From 2004 to 2008, about one of every four physicians said that professional libability insurance amounted to more than 15 percent of operating costs.

About 62 percent of Bay State physicians say their current incomes are uncompetitive with doctor salaries in other states, and 42 percent are considering changing their profession because of the current environment.

Nonetheless, Auerbach said he sees a number of opportunities to change things for the better.

"Decreasing administrative burdens, fixing our liability system and reducing barriers to recruitment and retention, such as lowering medical school debt are just a few of the immediate steps we can take now to improve the practice environment," he said. "Working together to improve chronic disease management and encourage healthy lifestyles will also reduce demand and improve our general health."