Med-mal rates may not mean fewer doctors
The common wisdom is that states with high rates of medical malpractice cases, or those considered plaintiff-friendly, will see declining numbers of physicians and specialists in particular. But a new report suggests that might not be the case.
In fact, a state in "malpractice crisis" may see a rise in specialists, because the doctors shy away from difficult cases, meaning more doctors are needed per capita. Researchers from the Oregon Health & Sciences University in Portland recently reported those surprising results at the annual meeting of the American Association of Neurolog-ical Surgeons in Chicago.
There currently are an estimated 3,229 active neurosurgeons in the United States certified by the American Board of Neurological Surgeons (ABNS). This corresponds to about one neurosurgeon for every 100,000 people in the United States, notes Zachary N. Litvack, MD, a neurosurgeon at the university. Neurosurgeons incur some of the highest annual malpractice premiums of any specialty, averaging more than $100,000 and as high as $300,000 per year in some states, he says. In 2005 alone, neurosurgeons paid a total of $28 million in malpractice claims, with the highest average payment per specialist surgeon ($465,000), and the single highest payment of any claim in any specialty ($5.6 million).
In 2002, the Council of State Neurosurgical Societies (CSNS) performed a survey of practicing neurosurgeons to assess the impact of malpractice on the work force. The results were published, along with a joint position statement from the two leading professional societies in neurosurgery the American Association of Neurological Surgeons and Congress of Neurological Surgeons as a report titled "Neurosurgery in Crisis." As a direct result of malpractice claims and increasing malpractice insurance premiums, the report said, nearly half of all respondents were likely to restrict their practice for example, limiting their practice to only spine, or not providing emergency or trauma coverage at a local emergency department.
Nearly one-third of respondents at that time stated that they were considering retirement, rather than continue to practice in the face of increasing insurance costs. One-fifth stated that they were considering moving their practice to a state with "better" malpractice conditions. Those changes in practice patterns would result in patients not being able to access lifesaving neurosurgical care, complex neurosurgical care or neurosurgical care close to home.
Based on the findings of the 2002 survey, Litvack and other researchers at Oregon Health & Sciences University decided to analyze ABNS data from 2005-2007, examining 4,584 active and retired neurosurgeons to look for a correlation between numbers of practicing and retiring neurosurgeons and the malpractice environment of each state.
"If malpractice has such a negative impact on practicing neurosurgeons, we hypothesized that states with high malpractice claims and high malpractice insurance premiums, the so-called 'crisis' states, would see a decrease in the number of practicing neurosurgeons over time, and an increase in the number of neurosurgeons moving or retiring from practice in that state," Litvack says. "Con-versely, states without major malpractice issues would see an increase in practicing neurosurgeons."
The results Litvack presented at the recent meeting showed just the opposite. Statistical analysis showed that states in "crisis" realized a 5% increase in the number of practicing neurosurgeons. In the 10 states with the largest increases in the number of neurosurgeons, eight states were "severe" states and five were "crisis" states.
Noncrisis states realized a 2% decrease in the number of practicing neurosurgeons. The size of malpractice claims had no impact on the number of practicing neurosurgeons in that respective state.
Litvack theorizes that the results were exactly the opposite of the hypothesis because neurosurgeons are restricting their practices to limit malpractice liability. This means that additional neurosurgeons are needed in the same geographic area to cover the spectrum of diseases and surgical needs of the population. In other words, two neurosurgeons now are needed to perform the job that used to be performed by one.
"While malpractice claims do not on the surface appear to affect demographics alone, they inevitably erode the system of providing neurosurgical care to patients," Litvack says. "As more neurosurgeons limit their scope of practice, patients will find it more difficult to obtain the expert care they need, and that is an issue that indeed needs to be addressed.
The common wisdom is that states with high rates of medical malpractice cases, or those considered plaintiff-friendly, will see declining numbers of physicians and specialists in particular. But a new report suggests that might not be the case.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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