Hard to be a physician... slightly harder in Massachusetts

From the Massachusetts Health Council:

DOCS SEE WORSENING ENVIRONMENT IN MASS.

Doctors say practicing in Massachusetts, where elected officials often tout gains under the 2006 universal health care access law, has become a tougher challenge. According to a Massachusetts Medical Society analysis released Tuesday, physicians face a growing burden from liability insurance rates, increasing use of emergency departments by patients, an aging physician workforce, and increasing costs associated with maintaining their practices. The society's latest Physician Practice Environment Index declined slightly, “representing a continued deterioration of the practice environment for physicians in Massachusetts.” The society identified liability insurance reform as the best step to take to improve the practicing environment, noting “defensive medicine” efforts aimed at preventing lawsuits come with a cost of $1.4 billion per year. Society officials say the index results conflicted with national surveys showing an improved climate for physicians. The report also concluded visits to the emergency department were up 3.5 percent in 2009 and that Massachusetts residents are using emergency departments at a rate 40 percent greater than in the nation. “A strong practice environment is essential to maintain a strong physician workforce, and both together mean better care for our patients,” society president Alice Coombs said in a statement. This becomes even more critical with universal coverage, given the added pressures that it puts on physicians, especially those in primary care specialties. The continued viability of physician practices should be a cause for concern about our state’s health care delivery.” The index has declined in 16 of the 18 years that it has been assembled.

There's nothing particularly new in this report (though the mention that Massachusetts residents are 40 percent more likely to use an emergency room than in other parts of the nation is alarming... and curious) which states that it's getting harder to practice medicine in Massachusetts.  We've been hearing that for a long time given the complexities and burdens of expanding payer requirements, much publicized malpractice woes, shortages of key staff, declining incomes, etc.  It is interesting to note that leading indicators for the U.S. and for Massachusetts seem to be moving in opposite directions.  Across the country, doctors are a bit happier.  In Massachusetts, a bit less so.

This coming decade will be marked by new advances in "physician extender" strategies.  Advance practice nurses will be given greater responsibility (for example, being able to order ancillary services, including home health care), primary care will continue to shift toward nurse practitioners and physician assistants, highly skilled technicians will assume tasks formerly completed by physicians, and the general public will become more accustomed to seeing physicians later on in the care process.  The debate will shift from whether this is a good or bad thing to how best to implement the changes.

Organizations such as the Massachusetts Medical Society will increasingly need to determine whether to support and lead this movement... or whether to buck it and defend the historical role medicine has played.