Are doctors quitting because of malpractice?

This is another segment on Tom Baker's The Medical Malpractice Myth, you can view the rest of my series here.

Another oft-mentioned part of the medical malpractice puzzle is the flood of doctors leaving the system because they can no longer afford malpractice premiums.  Here (as opposed to defensive medicine and the number of lawsuits) the picture is somewhat unclear.   The number of doctors in practice has remained steady and even increased.  But some areas of the country don't have enough doctors, especially regions with large population growth and rural areas.  There isn't any direct evidence showing doctors are leaving practice because of malpractice rates.  Nor is there research showing they aren't. 

What's clear is the economics of physician supply and demand are at work in these trends, and in some places, malpractice premiums will have an effect on which doctors decide to stay in practice.

There was this saying in the 19th century that a doctor had a 50/50 chance of helping or hurting you.  We've come quite far from those days, thanks in part to the vice-like grip physicians have historically kept on supply and demand.  This stems from a number of reasons, including gaining professional credibility (and creating associations to grant it), preserving salaries, and excluding other types of medical practice (osteopathy, chiropractic, etc) from gaining respectability. 

But these controls on the number of rears in med school seats any given year have helped retain a regionally  fractured care system.  Most doctors prefer to live in populated areas. Salaries are also higher in populated areas.  And most doctors are able to find a position in said metropolitan areas, thus decreasing the likelihood that economic necessity will drive enough practitioners out to rural areas.

When it's already economically and emotionally unappealing to practice in rural areas, bloated malpractice premiums can act as a proverbial feather to tip someone off the edge of the cliff.  Some doctors will leave their practices because of it.  But is tort reform the answer?  No. Using tort reform to get  at the system's supply constraints is like only taking dessert out of your all-McDonald's diet to lose weight.  You might lose a couple pounds, but the real problem is still there.

That said, one study found that states with caps on damages had a 3% increase in the number of doctors per capita, and states with other tort reforms had a decrease in doctors per capita.  Not convincing research either way, except to say that a very slightly larger number of doctors will stay in practice with tort reform. 

Either way, malpractice itself isn't enough of a problem to send doctors running, nor is tort reform enough of fix to attract them in droves.  The malpractice/tort reform dichotomy is, however, a grand distraction in talking about the actual problems with medicine. 

Comments

[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.

[pharmacy]

PHARMACY http://www.pharmacy-land.com/

[herbs ed]

Some doctors actually quit because of malpractice?

[fsad]

buy fioricet http://intra.som.umass.edu/ugrad/_disc-oh/000000c6.htm
[url=http://intra.som.umass.edu/ugrad/_disc-oh/000000c6.htm]buy fioricet[\url]

[Jane]

http://galleriediesibizioniste.duoroot.info/ gallerie di esibizioniste
http://gaybelli.duoroot.info/ gay belli
http://supertette.duoroot.info/ super tette
http://programmipern70.duoroot.info/ programmi per n70
http://vecchichescopano.duoroot.info/ vecchi che scopano
http://videogratisrossana.duoroot.info/ videogratis rossana
http://nomiglitteratifemminili.duoroot.info/ nomi glitterati femminili
http://minchiagay.duoroot.info/ minchia gay
http://wwwpuntorossonet.duoroot.info/ www puntorosso net
http://donneincintechescopano.duoroot.info/ donne incinte che scopano