The Massachusetts Medical Society (MMS) released its 2010 Physician Practice Environment Index, and the outlook was not good.

The index measures factors affecting the delivery of patient care from physician practices. This is the 16th year (out of 18) that the index has declined, despite the fact that in the rest of the United States the number has actually slightly improved. According to the MMS, the “decline in the Massachusetts Index provides strong empirical evidence that the physician practice environment continues to worsen.”

The MMS attributes this decline primarily to four key factors: professional liability rates, the percent of physicians over 55 years of age, the cost of maintaining a physician’s practice, and the increasing number of visits to emergency departments.

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The cost for a physician to maintain a practice in Massachusetts (including wages, office space, medical supplies, and professional liability costs) rose by over 3%, whereas nationally it declined by over 1%. The index also showed an increase in emergency room visits rather than visits to primary care physicians.

According to the report, the average emergency department in Massachusetts reported 40% more patient visits than the national average. Other factors measured by the index include: applications to medical schools, physician income levels, ratio of median housing prices to median physician income, number of hours spent of patient care

activities, change in malpractice rates, and number of advertisements for physician employment in the New England Journal of Medicine.