Why are doctors vanishing? USA
- From: Albert@xxxxxxxxxxxx
- Date: Sun, 14 Jun 2009 21:37:53 GMT
Why are doctors vanishing? USA
From ABC News -http://abcnews.go.com/sections/Business/Living/doctorshortage_031021-1.html
Dr. Bohn Allen practiced medicine for 42 years and had hoped to
continue for a few more. Instead, the 67-year-old physician told his
patients this past spring he would no longer be seeing them.
The reason? It wasn't his health, which he says is good. And it wasn't
that the Arlington, Texas-based surgeon doesn't enjoy surgery, which
he does.
It was because when Allen's malpractice insurance rose dramatically -
his premium was $36,000 in 2003; a 177 percent jump from $13,000 in
2000 - he found he could simply no longer afford to keep his practice
open.
'By the end of June it became apparent that I could not generate
enough cash flow to pay my overhead,' says Allen, now retired and
doing some consulting work, as well as serving as president-elect of
the Texas Medical Association. 'For the past six months I've been
paying my nurse out of my savings account.'
Allen is just one of many doctors across the country who have decided
to retire early, stop providing certain high-risk services like
obstetrics or neurosurgery or stop practicing medicine altogether
because of what they say is the rising cost of medical malpractice
insurance.
Some Patients Left Out
Chet Barnes, a 31-year-old firefighter who lives in Las Vegas,
experienced the problem first hand when his wife became pregnant last
year. As a result of rising insurance rates in the state, many
obstetrician-gynecologists were not taking pregnant patients.
After a home pregnancy test came out positive, Barnes' wife went to
her gynecologist, who told her she could not take her on as an
obstetrical patient because of the high cost involved. Other doctors
in Las Vegas gave them the same story.
Finally, the Barnes' found an ob-gyn who would see them - over two
hours away in Bullhead City, Ariz.
Fortunately for the couple, the intense media attention that followed
an appearance to tell their story at a medical conference in North
Carolina proved fortuitous - once the couple returned from their trip
a number of doctors offered to take them on as patients.
But Barnes says some of his friends were not so lucky. One couple he
knows had to deliver their child almost two hours away in St. George,
Utah.
'They had to drive all the way to St. George for their weekly
appointments,' he says.
States in 'Crisis'
While it's hard to come by firm numbers on how many doctors are
leaving the ranks, 19 states are considered by the American Medical
Association to be 'in crisis' because of patients' limited access to
health care, and another 25 states are showing problem signs.
The AMA says the rapidly rising costs of malpractice insurance is
causing many doctors in these 'crisis' states to either leave the
profession, move to another state with cheaper insurance rates or cut
back on riskier types of services they provide.
The Chicago-based physicians advocacy group is pushing for caps on
malpractice awards, among other moves, to help clamp down on the
rising costs of malpractice insurance.
But that solution is controversial. Many consumer advocacy and trial
lawyers' associations argue patients who suffer at the hands of
malpractice should be allowed unlimited damages, especially for the
patients' pain and suffering, known as non-economic damages.
'There is evidence that in states that have used caps, premiums didn't
go up as fast,' says Uwe Reinhardt, health care economist at Princeton
University. 'But you also pay a price in a sense that you have a cap
on pain and suffering.'
A Limit on Suffering?
Twenty-one states currently have varying caps, or limits, on
non-economic damages. Seven states have caps on total damages, that
is, non-economic plus economic damages, or the amount of money a
patient loses from lost wages or cost of medical treatment.
Proponents of such caps often cite California as a prime example of
how medical malpractice limits can help to keep doctors' insurance
premiums relatively low. That state enacted a cap of $250,000 on
non-economic damages in 1975.
Physicians' medical liability insurance in California rose 167 percent
between 1976 and 2000, compared to 505 percent in the rest of the
United States, according to the National Association of Insurance
Commissioners, the Kansas City-based organization of state insurance
officials.
'There is a correlation between states with caps and greater insurance
stability,' acknowledges Cheye Calvo, insurance policy specialist for
the National Conference of State Legislatures, a Washington,
D.C.-based association of state legislatures.
Other Reasons for Insurance Hike
But others maintain the cost of jury awards is not the only
contributor to rising malpractice premiums. The congressional
Government Accounting Office recently found while losses on
malpractice claims are the primary driver of medical malpractice rates
in the long run, other factors, such as rising reinsurance costs and
losses in insurance companies' investment portfolios, have also
contributed to the increase.
For example, the GAO found malpractice insurers experienced a decrease
in their investment income between 1998 and 2001 as interest rates
fell on bonds, which make up around 80 percent of insurers'
investments.
Further, a competitive marketplace for insurance in the 1990s forced
many companies to lower their prices to levels that did not cover
their costs, the GAO found, ultimately forcing many companies out of
the business altogether. With fewer insurers and less competition in
the marketplace, doctors often find themselves paying even higher
rates for malpractice insurance, say industry watchers.
The number of insurers offering malpractice coverage in the state of
Florida, for example, has shrunk to four companies from 66 in 2000,
says Florida Medical Association spokeswoman Lisette Gonzalez Mariner.
Indeed, the GAO found the largest underwriter of medical malpractice
insurance in Florida raised its premium rates for general surgeons in
Dade County by about 75 percent from 1999 to 2002, while the largest
insurer in Minnesota raised its premium rates only 2 percent during
the same period.
Minnesota does not have any caps on its medical malpractice awards,
while Florida recently enacted limits to a doctor's liability for
non-economic damages in most medical malpractice cases to $500,000.
'We found ourselves in a situation where we had insurance companies
pulling out of the state,' says Gonzalez Mariner. 'They have basically
the option of going without insurance, or, trying to find a company
where they could afford the rates or having to weigh whether or not
they were going to buy new equipment or lay off their staff.'
Is There Really a Crisis?
Others who are on the side of unlimited awards and deny doctors are in
a state of crisis were recently emboldened by another report. In the
report, the GAO concluded that in five states reporting problems in
patients' access to health care the problems were not substantiated or
did not affect health care on a widespread basis.
'Although some physicians reported reducing certain services they
consider to be high risk in terms of potential litigation, such as
spinal surgeries and mammograms, GAO did not find access to these
services widely affected,' the report concluded.
'According to the GAO, the non-partisan research arm of congress,
there is no crisis,' says Carlton Carl, director of media relations
for the American Trial Lawyers Association, which opposes medical
malpractice caps. 'There aren't doctors leaving the profession.'
For its part, the AMA says the GAO needs to look at a wider sample of
states before concluding patients' access to health care services is
not being compromised.
'You might have an area where there is only one obstetrician,' says
AMA president Donald Palmisano. 'If that obstetrician no longer
delivers babies, that area is in a crisis.'
Still, advocates for patients' rights argue capping insurance is not
the answer. Washington, D.C.-based consumer advocacy group Public
Citizen maintains the doctor shortage, especially in rural areas,
predates the rise in medical malpractice insurance premiums and argues
state medical boards should work harder to crack down on allegedly
negligent doctors.
Another solution the group advocates are different insurance rates for
different doctors, based on the number of claims made against them,
much like the auto insurance industry works.
'Ideally you would hope that the rates would go so high that they
would simply find another line of work,' says Jackson Williams,
legislative representative for Public Citizen.
Survivor's Story
Survivors of medical malpractice are also opposed to the caps, saying
that there is not one monetary solution to quantify the pain and
suffering that victims go through.
Deborah Surlas, who was left blind in her left eye and only now has
partial vision in her right due to one doctor's misdiagnosis in 1990,
was awarded $4.5 million in non-economic damages when her case went to
court.
Surlas, who paid her lawyers one-third of her award, says she thinks
malpractice caps would discourage lawyers from taking on cases like
hers, especially since it cost her legal team $100,000 to fight her
case.
'If you've got a cap of $250,000 and it's going to $100,000 just for
the court case, what lawyer is going to take that on?' she asks.
She adds that although her award was for pain and suffering, it has
helped her with her medical expenses since she's had to give up her
job working as a clinical nurse and later as a medical consultant
because of her difficulties seeing. She says she is fortunate enough
to have her husband to help support her, but says not being able to do
things like read, watch television or drive herself around has really
dealt a blow to her quality of life.
'Nobody hit the lottery,' she says of her malpractice award. 'We would
all give it back to have our lives back. There is no lottery here.
It's adequate in a financial way, but no, not in my life it's not.
.
- Follow-Ups:
- Re: Why are doctors vanishing? USA
- From: mg
- Re: Why are doctors vanishing? USA
- From: GlennR@xxxxxxxxxxxx
- Re: Why are doctors vanishing? USA
- From: Thumper
- Re: Why are doctors vanishing? USA
- Prev by Date: Half of primary-care doctors in survey would leave medicine
- Next by Date: Doctors Are Opting Out of Medicare -NYT
- Previous by thread: Half of primary-care doctors in survey would leave medicine
- Next by thread: Re: Why are doctors vanishing? USA
- Index(es):
Relevant Pages
|
Loading
