The Massachusetts Medical Society (MMS) today released its Physician Practice Environment Index for 2002, and the results indicate a continued worsening of the work environment for doctors throughout the state.

The MMS Physician Practice Environment Index, a statistical evaluation of selected factors that shape the overall environment in which physicians provide patient care in the state, declined 3.9 percent for 2002. The 3.9 percentage point drop is the second largest decline ever in the number and marks the ninth consecutive year that the index has fallen since 1993.

"Physicians in the Bay State continue to face enormous challenges," said Thomas E. Sullivan, M.D., president of the Massachusetts Medical Society, which represents more than 18,000 Massachusetts physicians and medical students.

"Plunging reimbursements, the increasing costs of doing business and overwhelming administrative inefficiencies are affecting physicians of all specialties in all regions of the state. On top of all this, the huge jump in medical liability insurance premiums is like the proverbial "straw that breaks the camel's back." This nine-year decline is taking its toll on the physician workforce population, and the news is not good for doctors. And if it's not good for doctors, it's not good for patients as well."

Three factors dominated the 3.9 percent decline for 2002: professional liability insurance rates, up 12.5 percent; the number of applications to Massachusetts medical schools, down 9.9 percent; and the ratio of housing prices to physician incomes, up 7.9 percent.

Soaring premiums for professional liability insurance has now become the main driver of the changes in the index. And while not included in the 2002 index, malpractice insurance rates will jump another 20 percent on average for 2003.

The US Physician Practice Environment also continued its decline, but at a slower rate of 1.5 percent - a rate over 60 percent less than the statewide index. The US Index has declined for six years in a row.

Economist James M. Howell, Ph.D., president of The Howell Group, who developed the index with the Medical Society, said this continued, rapid descent in the practice environment for doctors is especially distressing to the health care system overall.

"The health care system is composed of many parts," said Howell, "but at the center of it all is the physician, and if the core of the system is eroding, then all of us need to sit up and take notice. What should be a great cause for concern are three factors: first, that we've had nine straight years of decline; second, that since 1999, the rate of decline has accelerated; and third, that the Massachusetts index is falling much more rapidly than the rest of the nation."

The cost of maintaining a practice was also a big factor in the sharper Massachusetts decline versus the US. Total practice costs in Massachusetts, which includes costs of medical malpractice insurance, jumped by 1.9 percent in 2002, compared to 1.1 percent nationwide.

For the 10-year period 1992-2002, the Massachusetts Index has fallen 22.6 percent, while the US index has declined 15.3 percent. However, since 1999, just four years ago, the rate of decline in both Massachusetts and the US indexes has accelerated because of the rising malpractice insurance rates.

From 1999-2002, for example, the Massachusetts Index dropped 4.5 percent - three times the rate for previous seven years. For the same period, the US Index fell 2.7 percent, versus 1.1 percent for the previous seven years.

Also telling are the increases in the cost of maintaining a physician's practice. Including liability insurance premiums, the total cost of maintaining a practice jumped 66 percent in Massachusetts from 1992-2002, versus 48.4 percent for the US. Within that same period, liability insurance costs have risen 74.3 percent in Massachusetts, versus 68.3 percent for the US.

"The significance of all this, of course," said Dr. Sullivan, is how it affects patient care. The results of the Index, coupled with the findings of our recently-released Physician Workforce Study (available at http://www.massmed.org/pages/workforce03.asp ) that showed shortages in critical specialties and problems with retention and recruitment of physicians, demonstrates that patient care is severely at risk.
   

"As more and more physicians leave the state and as it becomes harder and harder to recruit doctors to Massachusetts, due to adverse practice conditions, patients are finding it more difficult to get access to care. Waiting times and travel distances both become longer."

The Massachusetts Medical Society developed the index to measure the impact of nine indicators representing three major factors that influence the practice environment for physicians:

• Supply of Physicians, including the number of applications to Massachusetts Medical Schools, the percentage of physicians over 55, and the number of employment ads in the New England Journal of Medicine;
• Practice Financial Conditions, including New England median physician income, ratio of housing prices to median physician income, and professional liability costs;
• Physicians Work Environment, including physician cost of maintaining a practice, mean hours per week spent in patient care, annual number of visits per emergency department.

A full copy of the index report is available at http://www.massmed.org/pages/mmsindex.asp

The Massachusetts Medical Society, with 18,000 physicians and student members, is dedicated to educating and advocating for the physicians and patients of Massachusetts. Founded in 1781, the MMS is the oldest continuously operating medical society in the country. The Society owns and publishes The New England Journal of Medicine, the Journal Watch family of professional newsletters, AIDS Clinical Care, and produces HealthNews, a consumer health publication.