Physician Practice Environment Index Slips Again

WALTHAM — According to the Mass. Medical Society (MMS), a continuously deteriorating practice environment in the Commonwealth is causing physician shortages in specialty and primary care, creating difficulties in recruiting and retaining physicians, and reducing patient access to care. And those conditions, the organization says, should raise concerns as the state implements universal insurance coverage.The society issued those comments in making public its 2006 MMS Physician Practice Environment Index, an annual statistical compilation of nine selected factors that shape the overall practice climate for physicians in the state. The index declined for the 13th straight year, reflecting a practice environment for Massachusetts physicians that continues to erode.For 2006, the MMS Index dropped 1.6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 73.4, reaching yet another all-time low since its first year of measurement in 1992. The Society also released a comparable index for the U.S., providing a reference point to judge the changes in Massachusetts. For 2006, the U.S. index dropped 0.2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, its 11th consecutive drop.

“The persistent decline of the practice environment for physicians in Massachusetts should raise alarms with policymakers, health care officials, and government and legislative leaders alike,” said Dr. Kenneth R. Peelle, MMS president, noting that the deterioration of the state environment has occurred at a rate 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} faster than the U.S. He also noted that the 2006 rate of decline in Massachusetts was three times faster than 2005, when medical liability premium increases, one of the major driving forces of the index, were relatively modest.

“A deteriorating practice environment has led to persistent difficulty in physician recruitment and retention,” Peelle said, “as well as physician shortages in specialty and primary care. These conditions are negatively affecting patient access to care and should raise concerns as we implement our health care reform law.

“Having insurance doesn’t guarantee access to care,” he continued, “and if patients have trouble finding a specialty or primary care physician, or if they have to wait months to get an appointment, are we really delivering on the promise of universal coverage?”

He said the situation reflects a disconnect between reputation and reality in Massachusetts health care and highlights the fragile viability of physician practices, many of which are struggling as businesses. “It doesn’t make Massachusetts very competitive in trying to attract and keep a skilled physician workforce.”

Peelle said physicians in Massachusetts continue to contend with low reimbursements for services, growing administrative burdens such as pre-authorizations for imaging tests and prescription drugs, and increasing costs of operating a practice. These, as well as new impositions such as physician rating and tiering systems, are putting additional pressures on physicians of all specialties.

The number of physician employment ads in the New England Journal of Medicine jumped 30.7{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2006, double the rise of 15.4{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2005. Such increases indicate that physician recruitment activity is strong, and support the idea that recruitment and retention are difficult and that physician shortages are likely to remain a big problem in Massachusetts.

Meanwhile, physicians’ professional liability costs rose 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2006, while holding steady nationally. Medical liability, the dominant factor in the index in prior years, continues to have an enormous impact on physician practices. MMS research indicates that roughly half of the physicians practicing in the state are experiencing liability costs that exceed 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of their total business costs, and some physicians in high-risk specialties like obstetrics and neurosurgery pay premiums in excess of $100,000 annually.

In addition, the cost of maintaining a practice, including employer wages, office rental fees, and medical supplies, increased 2.8{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2006. For the period 1994-2006, the average cost of maintaining a practice in Massachusetts, including professional liability premiums, rose nearly 7.5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, 29{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} faster than the U.S. rate.

The MMS index measures the impact of nine indicators that influence the practice environment for physicians in Massachusetts: the number of applications to Massachusetts medical schools; the percentage of physicians over age 55; the number of employment ads in the New England Journal of Medicine; median physician income; ratio of housing prices to median physician income; professional liability costs; physician cost of maintaining a practice; mean hours per week spent in patient care; and annual number of visits per emergency department. The complete report may be read at www.massmed.org/mmsindex.