Stormy Climate For Mass. Docs, Report Says

Alice Coombs, M.D., president of the Massachusetts Medical Society, says the practice environment for physicians in the state is declining — to everyone's detriment:

Massachusetts can justifiably be proud of its leadership in health care. From world-renowned medical care to the establishment of universal coverage, the Commonwealth has set standards for others to follow.

Our successes and reputation are well deserved. We have some of the finest facilities and some of the finest physicians and medical personnel in the world. So it’s all the more surprising to learn that, year after year, the practice environment for physicians in the state continues to decline.

A strong physician practice environment is essential to maintain a strong physician workforce. And its importance should be self-evident: it has a direct influence on patient care. Yet the latest analysis of the practice environment by the Massachusetts Medical Society, released today, brings us more sobering news.

The Society’s Practice Environment Index, a statistical measure of factors that affect the practice climate for physicians, dropped again in 2009. Incredibly, the index has declined in 16 of the 18 years that the Medical Society has been analyzing such data.

The index is one important indicator of our health care delivery system because it reflects what our physicians contend with in delivering patient care. With universal care, this declining practice environment becomes even more significant, given the added pressures physicians face with more people seeking care.

A poor environment impacts the current workforce, but it also affects recruitment and retention, both of which have been difficult over the last decade. The Medical Society’s Physician Workforce Studies, taken annually over nearly a decade, have recorded shortages in many physician specialties, including primary care for four consecutive years. And the studies have shown that more than half of the residents leave the state after their training to pursue their careers in other locations.

While nine factors are examined in compiling the index, four are causing this latest decrease: professional liability rates on physicians; an increasing use of emergency department by patients; an aging physician workforce; and the rising cost of maintaining a physician’s practice.

The two most troublesome factors, however, are professional liability rates and the use of emergency departments by patients.

The high cost of liability rates has been the driving force behind the poor practice environment for years. The Medical Society’s workforce studies have recorded time and again the negative impact of liability on patient care. A separate study has shown that the fear of liability contributes to the widespread use of defensive medicine – tests, procedures, hospitalizations, or other actions ordered by physicians out of the fear of being sued. And that has huge implications for health care costs: such procedures conservatively cost the state $1.4 billion annually. Liability reform is long overdue.

The rise in emergency room use by patients is a phenomenon confirmed by other studies and highlights a new and disturbing dimension in this annual analysis, because it points to the delivery of primary care taking place in emergency departments. Massachusetts patients are continuing to rely more heavily on emergency departments for their medical care – at a rate 40 percent greater than the rest of the nation - and that is an escalating concern for primary care.

While Federal reform health care will address issues of primary care, it does not address or change professional liability reform.

A picture of the state’s practice environment from year to year is valuable by itself. But the Society’s analysis goes a step further, compiling an index for the U.S. that provides a reference point to judge changes in the state.

A comparison reveals stark differences between the state and the rest of the nation as the four major factors leading the state’s decline increased at a rate substantially faster than the national rate. The conclusion: when it comes to providing a welcoming environment for physicians, Massachusetts and the nation are headed in opposite directions. Since 2006, the Massachusetts Index has declined 1.5 percent, while the U.S. Index has advanced 1.2 percent.

Reversing the decline in the physician practice environment will lead to a stronger, more viable health care delivery system. The current climate should be cause for concern. And action.