QUALITY/MALPRACTICE: Questioning the accepted wisdom in Pennsylvania

In a slightly embarrassing article for the local state medical society, an article in the Allentown Morning Call suggests that stories of doctors leaving the state because of the malpractice crisis in Pennsylvania are massively exaggerated. Now this is in a state which has raised tobacco taxes to provide public money to pay physicians’ malpractice premiums, because of said crisis. However, the source for this information was organized medicine itself:

    The state medical society’s own statistics — never before disclosed publicly — show a gain of 800 doctors statewide from 2002 to 2003.”I would be willing to admit up to an 800 physician gain since 2002,” said Steve Foreman, who runs the society’s research department. ”But if we’re trading experienced specialists for general practitioners, we have a problem.” Yet here too state statistics show that the specialists hardest hit by rising medical malpractice rates are not leaving in large numbers.The number of neurosurgeons, general surgeons, ob-gyns and orthopedic surgeons in 2002 was 4,721, as measured by doctors who paid their insurance premiums. The number of those same specialists who applied in February for the state’s relief money: 4,665. That’s a loss of 56 specialists, but even 56 may overstate the situation.

Overall the article essentially says that the doctors have sold a bill of goods to the state and that their demands for immunity from lawsuits are invalid. The medical society has responded by saying that experienced older specialists are leaving and are being replaced by newly trained physicians (via Modern Physician):

    In addition, the society said Foreman “cautioned the reporter that Pennsylvania has seen a temporary increase of more than 1,000 doctors in training during the past two years that are included in the total number reported by the newspaper.” Meanwhile Pennsylvania’s licensing board for physicians indicated a drop of approximately 1,400 licenses during the same year the reporter used, the society said. Instead, the reporter chose to ignore the data, resulting in an apples-to-oranges comparison, and creating the erroneous impression that there was a significant increase in actively practicing physicians.

Positioning myself in the neutral ground between the crowd at MedRants and Ross the Bloviator (plus my own contributors Matt Quinn and The Industry Veteran), I end up feeling here like the med-blogger equivalent of the last moderate in the Israel/Palastine conflict. I do think that the malpractice situation needs reform, but I also think that the impact of soaring malpractice rates has been massively overstated by organized medicine, and that most of the cause is due to the price war among insurers in the 1990s. However, the lawyers don’t exactly cover themselves in glory either. What I keep reminding the universe, and what no one ever bothers paying attention to is the fact that anyway you cut it, malpractice itself accounts for well under 1% of health care costs. Defensive medicine, though, does have a big impact, of maybe up to 6-8% of all spending. But of course in general if they do more, doctors and the health care system make more. So parsing out the real incentives behind defensive medicine is very difficult. And this kind of article, which lays bare the aggressive politics on both sides of the conflict, reminds me more of an Israeli air strike in Gaza than a peace meeting at a Norwegian hotel.

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