WALTHAM, Mass. – Practicing medicine in Massachusetts keeps getting worse, with doctors particularly troubled by rising malpractice insurance rates, rising office costs, an aging work force, and patients’ use of emergency rooms, a new analysis by the Massachusetts Medical Society shows.
The society, which represents more than 22,000 doctors and medical students, publishes its MMS Physician Practice Environment Index annually, a statistical compilation of nine factors that influence the practice climate for physicians.
For 2009, the index declined 0.8 percent; it has declined in 16 of the 18 years it’s been done. Meanwhile, a comparable index for the United States as a whole rose by 1.3 percent in 2009 – though plummeting housing prices may have skewed the numbers.
“The causes of the sustained decline in the practice environment have been with us for some time, and this analysis is significant, because it carries implications for patients as well as physicians,” said Dr. Alice Coombs, president of the society, in a news release.
Coombs, an anesthesiologist and critical care specialist at South Shore Hospital, said a “strong practice environment” is essential to maintain a strong physician work force.
“This becomes even more critical with universal coverage, given the added pressures that it puts on physicians, especially those in primary care specialties,” she said. “The continued viability of physician practices should be a cause for concern about our state’s health care delivery.”
The society expressed particular concern about professional liability costs, which rose by 4 percent in 2009. For roughly half of Bay State doctors, they exceed 10 percent of their total business costs, the analysis shows, and some doctors in high-risk specialties, such as obstetrics and neurosurgery, pay premiums in excess of $100,000.
“The high cost of liability rates has been the driving force behind the decline of the practice environment for years,” said Coombs. “If there’s one step to take to begin to reverse the decline, it would be enacting liability reform.”
Liability reform would also reduce defensive medicine, Coombs said; a 2008 analysis by the society estimated that such practices – tests, procedures, referrals, hospitalizations, or prescriptions ordered out of the fear of being sued – cost $1.4 billion per year in the state.
Regarding ER use, the analysis shows that Massachusetts residents used ERs 3.5 percent more in 2009 than the previous year, and local ERs report 40 percent more visits than the U.S. average, 44,814 versus 31,872. Nationally, ER visits rose 2.8 percent.
“It should be recalled that one of the goals of the 2006 health reform law was to shift patient care away from emergency departments to primary care physicians,” the analysis says. “The data … show clearly that this has not been the result.”
General business costs for doctors – rent, support staff, supplies, etc. – rose by 3 percent in 2009, the index shows, while they declined by 1.3 percent in the national index. The average registered nurse now earns $40.78 per hour in Massachusetts, the index shows, up 74 percent since 1994, while nationally, the average wage is $32.76, up 43 percent since 1994.
Lastly, the share of physicians who are 55 or older rose by 3.2 percent in Massachusetts and 2.6 percent nationally, which the society said is “expected” but still “should raise concern as more physicians approach retirement age.”
Along with those factors, the index measures the number of applications to Massachusetts medical schools, the number of employment ads in the New England Journal of Medicine, median physician income, the ratio of housing prices to median physician income, and mean hours per week spent in patient care.
The decline in the housing market led to a 5.7 percent drop in the ratio of housing prices to doctors’ income in Massachusetts, and an 11.8 percent drop nationally. The employment ad count, meanwhile, dropped by 28.6 percent in the Bay State and 32.8 percent nationally.
Massachusetts physicians’ median income, on the other hand, has risen by 8.4 percent since 2006, to $216,700, the index shows; nationally, it has risen 9.5 percent, to $243,500.
The full report is available at www.massmed.org/mmsindex.
