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January 20, 2006

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The Bloviator

The issue I have seen far less frequently discussed -- and far more difficult to measure in any way that would not be immediately questionable based upon its sources (e.g. an AMA study of its members) or its methodology (e.g., qualitative study based on roundtable discussions or surveys in which responses could easily be coordinated) -- is how many physicians have altered their practices as a result of medical malpractice concerns. For example, how many family physicians have stopped delivering babies, or OB/GYNs now only do GYN work? How many surgeons stop taking on the most complicated cases? The Pew studies of Pennsylvania (Mello, Sage, et al) largely tiptoed around this issue, and I've not seen anything which has addressed it though anything but anecdote.

Anniken Davenport, Esquire

What everyone involved in this isssue (Baker included) misses is that there is simply no effective disciplinary system in place. As a former medical board prosecutor, I can tell you stories that would rival your worst nightmare. Yet doctors let doctors practice when clearly they shouldn't.

Martin

Kate,

There was a groundbreaking article in the health econ literature--I'm looking for it, haven't found it yet--on the distribution of physicians. It found that the distribution of physicians is essentially rational, once you take into account the populations being served and the declining number of GP/FPs.

Rick Latshaw

Kate,

A minor, but important point- salaries are higher areas that are underserved (rural areas) than in those overserved (urban areas)

Procedure volume and more high-intensive visits drive physician income and in less served areas, physicians can spend their time on these things, versus less profitable, well check-ups, followup visits, etc.

Many people coming out of medical school and residency recognize this, but choose lower salaries (still good obviously) for a better quality-of-life (in the view).

Rebecca, MD

Kate,
I want to second Rick's post above. As a general pediatrician, the income is 3-5X greater in a rural community than in most cities. (The issue isn't the underserved b/c the inner city usually pays like residency).

I don't know anyone who's completely left practice because of malpractice insurance, though I do know multiple family practice physicians who quit delivering babies. While the number of people who perform certain procedures may be becoming more limited, research shows that the more a person (and a hospital) performs a procedure the better their outcomes, so ultimately, maybe this will be better for patient care and decrease the need for Tort reform. The surgeons/OB's who are capable of doing the difficult/high risk procedures, including "routine" deliveries, will continue to do them, the rest will give up, and you and I will be safer for it.

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Some doctors actually quit because of malpractice?

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