Costly Massachusetts ekes out small physician practice gain

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By Emily Micucci

The cost of doing business in Massachusetts is oft-lamented, and apparently, the field of medicine is not immune.

That’s according to the results of the annual Physician Practice Environment Index (PPEI) published last week by the Massachusetts Medical Society (MMS). While the Massachusetts PPEI has experienced an upward trend since a low point in 2010, in 2015, it continues to lag the U.S. index — and the delta appears to be widening.

The MMS has been measuring the quality of the physician practice environment for the state and the U.S. since 1992. According to the organization’s historical data, the PPEI stood at 71.6 in 2014, nearly 10 points below the U.S. index of 80. The state and U.S. indexes have each improved about three points since 2010, but Massachusetts appears to be struggling to catch up to the U.S., with the difference in indexes growing from about 7 percent in 2011 to about 9 percent last year. (The 2015 index is based on 2014 figures).

According to an e-mail statement from Dr. Dennis Dimitri, president of the MMS and a Worcester family physician, the physician practice environment in Massachusetts has struggled to keep pace with the U.S. because of the cost of doing business, as well as housing, and the fact that Massachusetts physician salaries have tended to be lower than the national average.

“Despite the small improvement, challenges remain for physicians,” said Dimitri, who is clinical associate professor and vice chair of the Department of Family Medicine & Community Health at UMass Memorial Medical Center and UMass Medical School.

While the PPEI is calculated based on eight factors, including the number of applications submitted to medical schools; the number of employment ads listed in the New England Journal of Medicine; median physician income and the cost of maintaining a practice, to name a few, Dimitri noted that the report “does not take into account the growing burdens of administrative, regulatory, and legislative requirements and mandates, all of which rob physicians of the valuable time necessary for caring for patients.”

But it’s not all bad news for Massachusetts doctors. According to Dimitri, “a bright spot is that many different measures demonstrate that the quality of care provided to patients in the Commonwealth is among the highest in the U.S , which speaks well of the physicians in Massachusetts.”

Med school applicants, income drive modest gains

Meanwhile, there were two factors that contributed to the 2015 PPEI index gain in Massachusetts, including an increase in applications to medical schools, which will help remedy the shortage of physicians that exists in the Bay State and across the country, as well as a slight increase in physician income in Massachusetts.

Dr. Stephen Tosi, president of UMass Memorial Medical Group, the doctors group owned by Worcester-based UMass Memorial Health Care, said while the index improvement is slight, he can sense that it getting easier to recruit physicians, despite the high cost of living and working in Massachusetts. And as the MMS data suggests, Tosi thinks that’s driven by a steady increase in medical school applicants since the early 2000s.

“I think that medicine is still a very attractive profession,” Tosi said.

Med school widens net

Locally, the University of Massachusetts Medical School has experienced a steady increase in applications over the last five years, according to Jennifer Berryman, vice chancellor for communications at the medical school. Meanwhile, there’s a major shortage in primary care physicians. The shortfall of all physicians could be as high as 90,000 by 2025, according to the Association of American Medical Colleges, and the primary care shortage, one of the specialties that struggles the most with supply, could be as high as 31,000.

Berryman said this was a key factor in UMass Medical School’s decision to add slots to its medical school class, which will, for the first time, make room for out-of-state students to attend. In two years, the medical school will boost overall slots from 125 to 150 students. She noted that the school specializes in educating medical students in primary care.

“And we’re seeing a lot of interest,” Berryman said.

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