from pa state nurses assoc. enewsletter :
the malpractice crisis gripping pennsylvania has sown widespread discontent among doctors in high-risk specialties, affecting the quality of care their patients receive, according to a new study released today
by the project on medical liability in pennsylvania and funded by the pew charitable trusts. malpractice concerns could be harmful to the physician-patient relationship, as the interplay between financial and market pressures changes how physicians approach their work, the study says.
"physician satisfaction is often neglected or discounted as self-serving in policy debates," the authors say. "in this paper we outline a framework for understanding why physician satisfaction matters for patient care and what factors influence it. professional dissatisfaction deserves policy attention if it has damaging consequences for patients."
nearly 40 percent of pennsylvania high-risk specialists surveyed in 2003 were dissatisfied with the practice of medicine, twice as high as the national rate in 1999. studies have shown that satisfied physicians tend to be more attentive to their patients and have higher levels of satisfaction among their patients. but dissatisfied physicians have been linked to riskier prescribing practices or engaging in "defensive medicine" when treating patients.
"our findings suggest that the malpractice crisis in pennsylvania is decreasing specialist physicians' satisfaction with medical practice in ways that may affect the quality of care. the relationship may be cumulative, with an acute malpractice crisis acting as a 'last straw' among the physicians who are most affected by it," the report's authors conclude.
the report, "caring for patients in a malpractice crisis: physician satisfaction and quality of care," is part of a special section published in "health affairs" containing several other articles showing the complexity of the medical malpractice crisis.
according to the american medical association, about two-thirds of u.s. states are now in the midst of a malpractice crisis or showing signs of trouble. nowhere is the problem more acute than in pennsylvania, where several insurers have left the market and premiums for coverage through the remaining insurers have increased dramatically. to investigate the effects of the malpractice crisis on patient care, the authors conducted a series of interviews with representatives from pennsylvania physician groups, hospitals, and insurers, followed by a mail survey of 824 pennsylvania physicians in high-risk specialties (emergency medicine physicians, general surgeons, neurosurgeons, ob/gyns, orthopedic surgeons, and radiologists).