OK back a few years ago the big to-do was “evil lawyers suing doctors out of business, malpractice insurance rates too high”. especially in places like Nevada, supposedly there was a shortage of OB GYN’s because the process of birth care was so fraught with liability that they were all sued out of existence.
Evil lawyers, poor doctors, greedy insurance companies. I know that in California they passed a bill limiting malpractice awards to 250k.
So what was the truth behind all of this? Were doctors really ‘fleeing’? If so, where were they going – as if no US state wasn’t filled with lawyers? Were the doctors actually guilty of malpractice–in which case they shouldn’t be practicing if they keep doing it–or were the charges trumped up?
And were the malpractice insurance companies guilty, or did they honestly raise rates based on the risk?
And have the new California-like malpractice limits helped doctors provide care, or protect malpractice-docs who now have limited liability?
I don’t think anyone was saying that doctors were literally “fleeing” but trial lawyers do their part to increase health care costs by making doctors pay more for malpractice insurance making you pay more for an office visit.
Of course they aren’t the only ones as the AMA does its part to limit the amount of doctors and specialists by setting caps on student enrollment, and insurance companies do their part by requiring massive amounts of paperwork and whole staffs dedicated to processing claims.
The government also does its part by keeping the drug laws which require patients to continue to visit doctor for known, needed medication. It would be like if you knew that your car needed an air filter, but the government passed a law saying that you couldn’t just go to Autozone and buy an air filter. You had to pay to take your car to an ASCE certified mechanic, pay out the ying yang for authorization to go to Autozone and buy an air filter.
Everyone is at fault, and everyone has their hands in the cookie jar. Who can change it and keep a large constituency?
“insurance companies do their part by requiring massive amounts of paperwork and whole staffs dedicated to processing claims.”
They certainly do not have large staffs handling claims. Over my 20 odd years in claims there’s been a trend of more work, less staff. That causes problems in the efficiency of the claims handling and the attention paid to them.
The cost of defending medical malpractice cases makes the cost of coverage so expensive. Capping awards helps but if you defend a case for a few years it gets very expensive. The lowest rate you can get for defense counsel is about $160 an hour. Insurers pay the defense and expert costs of their insureds. Malpractice cases require a fair amount of work. On every case that ultimately settles and you never hear about it’s probable the expenses exceed the amount of the settlement. Or even in a jury trial where the plaintiff loses it still costs the insurer a lot of money. The experts the insurers hire to testify, other doctors, charge insane rates $600 and hour and up. You’d think perhaps it would be in their interest to provide their services in this regard for a lower rate as it contributes to the cost of their insurance premiums.
In a society where litigation seems ever more prevalent and people often refuse to acknowledge their own culpability in these matters you get what you get.
I have a case on my desk right now where a 5 year old boy with a peanut allergy was given another kind of nut by his father and subsequently died of anaphylatic shock and his parents are suing his pediatricians and their allergist.
If your kid was allergic to peanuts, would you give him any nuts at all out of a bag of mixed nuts?
Well, I don’t know that the AMA directly controls enrollment. However, States and the Federal Government require that med schools be accredited, and the only nationally recognized accrediting body (as far as I can tell) is the Liaison Committee on Medical Education (LCME). So what do we find when we go to their website? “The LCME is sponsored by the Association of American Medical Colleges and the American Medical Association.” So the AMA does appear to have some influence over the number of med schools (and hence indirectly the number of doctors).
Then again, I don’t know how much influence sponsoring the accreditation body actually gets you, and if someone can shed some light on that situation, I’d much appreciate it.
Well IANAD but my brother is and he talks about this quite a bit. According to Dr. Zagna doctors aren’t making nearly as much as they used to. They’re doing fine, but they’re not raking in the boat loads they once did. It’s more like a very nice salaried job.
The reason has more to do with limits placed by HMOs and Medicare on what can be done and what can be charged rather than malpractice rates.
This is causing older doctors to consider retiring earlier (although I’m not sure about the logic behind that) and it’s changing the type of person going into medicine. He claims you’re not seeing nearly as much of the type-A personalities coming into the field. That one I believe. Unfortunately they’re moving into hi-tech where I am. Frankly I’d gladly pay doctors more if it meant getting rid of some of these A-holes.
That’s about what I’d expect a lobbying group to do. Pay for access, try to influence. How much they do influence, I don’t know. I do know it gets the AMA’s name out in front of the medical students, and tries to get them to join.
are finding malpractice insurance expensive. in the case of West Virginia, neurosurgeons have elected to leave the state, rather than pay >$170,000 yearly malpractice premiums.
If the cost of providing a service exceeds the income derived from that service, the service providers must either absorb a loss or cease business. That does appear to be happening in certain medical specialties.
I don’t think a week goes by without an article about doctors (obstetricians, especially) leaving or limiting their practice in our state due to malpractice insurance rates and/or risks. We’re not alone, and the problem is very real, with real impact on patient care.
It is often pointed out that the cost of malpractice insurance adds a very small amount to the total cost of health care, on the order of 5% or so.
This is true enough, but it doesn’t include the added cost of defensive medicine, that is, of medical tests and procedures performed not because the doctor thinks they are appropriate for the condition, but in order to forestall second-guessing after the fact. I suspect that the cost factor for this is considerable, but have not seen any studies. Does anyone know if this has ever been quantified?
In any case, I doubt that you can point to any one factor as THE reason for doctors leaving the practice of medicine. As noted above, insurance costs, paperwork, Medicare reimbursement rates, legal hassles, etc., etc., etc., all have a cumulative effect. Eventually, even Asclepius would through up his hands and say “Fuck it!”
I don’t know but read somewhere that a large percentage of doctors asked about this admitted to the practice. So, it likely does inflate the cost of health care significantly.
“In response to rising premiums and their fear of litigation, research
indicates that physicians practice defensive medicine in certain clinical
situations, thereby contributing to health care costs; however, the overall
prevalence and costs of such practices have not been reliably measured.
Recent surveys of physicians indicate that many practice defensive
medicine, but limitations to these surveys suggest caution in interpreting
and generalizing the results. For example, the surveys typically ask
physicians if or how they have practiced defensive medicine but not the
extent of such practices. In addition, very few physicians tend to respond
to these surveys, raising doubt about how accurately their responses
reflect the practices of all physicians. Some empirical research has
identified defensive medicine practices, but under very specific clinical
situations that cannot be generalized more broadly.”
GAO - August 2003 - MEDICALMALPRACTICE Implications of Rising Premiums on Access
to Health Care. This isn’t what I was looking at earlier but it’s from a huge report with 76 mentions of defensive medicine in it.
I happen to have a few different policies at hand right this moment. One is a physicians and Surgeons Liability Policy for a nephrologist providing $1,000,000 for each medical incident up to $3,000,000 overall in a one year period in 1986. The premium is $9043.
Another is for an orthopedist in 2002 with the same limits - $104, 672.
