Poor Practice Environment in Massachusetts Causes Physician Shortages, Difficulty in Recruitment and Retention, and Reduced Access to Care, Says State Medical Society

Contact: Richard P. Gulla 
rgulla@mms.org 
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Massachusetts physicians see 13th straight year of decline in practice environment

Waltham, Mass. -- March 26, 2007 -- The Massachusetts Medical Society said today that a continuously deteriorating practice environment in the Commonwealth is causing physician shortages in specialty and primary care, creating difficulty in recruiting and retaining physicians, and reducing patient access to care. And those conditions, says the organization, should raise concerns as the state implements universal coverage.  

The Society issued those comments today as it made 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 percent 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 United States, providing a reference point to judge the changes in Massachusetts. For 2006, the U.S. index dropped 0.2 percent, its 11th consecutive drop.

"The persistent decline of the practice environment for physicians in Massachusetts should raise alarms with policymakers, healthcare officials, and government and legislative leaders alike," said Kenneth R. Peelle, M.D., President of the Massachusetts Medical Society, whose membership exceeds 18,600 physicians across the state.

Dr. Peelle said that one of the most disturbing findings of the analysis is that the deterioration of the state environment has occurred at a rate 25 percent 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," said Dr. Peelle, "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," said Dr. Peelle, "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?"

"This 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 health care businesses," said Dr. Peelle. "It doesn't make Massachusetts very competitive in trying to attract and keep a skilled physician workforce." 

Dr. 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 like physician rating and tiering systems that have little relevance to clinical care, are putting additional pressures on physicians of all specialties across the state.

Biggest Factors Contributing to the Decline in 2006

The three biggest factors contributing to the decline in the 2006 Massachusetts index: 

• Physician employment ads in the New England Journal of Medicine jumped 30.7 percent in 2006, double the rise of 15.4 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.
  
  
• Physicians professional liability costs rose 5 percent 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. Medical Society research indicates that roughly half of the physicians practicing in the state are experiencing liability costs that exceed 10 percent of their total business costs, and some physicians in high-risk specialties like obstetrics and neurosurgery pay premiums in excess of $100,000 annually.
  
  
• Physician's cost of maintaining a practice, including employer wages, office rental fees, and medical supplies, increased 2.8 percent in 2006. For the period 1994-2006, the average cost of maintaining a practice in Massachusetts, including professional liability premiums, rose nearly 7.5 percent annually -- 29 percent faster than the U.S. rate. 

Medical Society officials noted that all three factors increased at a rate substantially faster than the U.S. rate.

The Medical Society index measures the impact of nine indicators that influence the practice environment for physicians in Massachusetts: (1) the number of applications to Massachusetts medical schools; (2) the percentage of physicians over 55; (3)  the number of employment ads in the New England Journal of Medicine;  (4) median physician income; (5) ratio of housing prices to median physician income; (6) professional liability costs; (7) physician cost of maintaining a practice, (8) mean hours per week spent in patient care; (9) annual number of visits per emergency department. The complete index report may be read here: http://www.massmed.org/mmsindex

The Massachusetts Medical Society, with some 18,600 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society publishes The New England Journal of Medicine, one of the world’s leading medical journals; the Journal Watch family of professional newsletters covering 11 specialties; and AIDS Clinical Care. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts. Founded in 1781, MMS is the oldest continuously operating medical society in the country. For information, visit http://www.massmed.org.