Published Dec 10, 2001
I'm not sure if this is happening in other states, but in WV we are losing alot of our doctors to other states because they are either losing their malpractice insurance or have to pay astronomical amounts. We had a special session of our state legislature last week and they only put a small band-aid on a rather gaping wound. WV awards one of the highest , if not THE highest, payouts for doctors being sued. It's similar to winning the lottery. Most cases don't even go to court because of the great expense. I live near the Ohio border and we have already lost all of our neurosurgeons. Their malpractice was between $110,000/yr and $220,000/yr EACH. Most of our orthopods have moved or took early retirement. Now many of our general and vascular surgeons are planning on leaving. In this age of a great nursing shortage I am looking for a 2nd job (I work in the OR). Is it like this elsewhere??? I am extremely unhappy about this situation. Besides calling and writing to the state representatives, I feel like my hands are tied. If you are in a state where you have not felt the effects of this yet, contact your congress people before your state gets in a situation like we have. Well, I feel a little better getting that off my chest. Thanks!!! Anyone else from WV feeling this too????
This is probably what I would call an early sign of wide spead doctor shortages to come. The health care enviroment is hostile in so many ways to anyone who wants to practice medicine as a nurse or a physician. First there will be spot shortages, then wide spread shortages. The smartest men and women have gone into the medical field in the past. They are smart enough to figure out that they should be doing something else. The malpractice enviroment is one of the reasons on a long list of things that makes me predict a doctor shortage is coming. Even now there are news reports in many parts of the country that MDs are starting to take early retirement due to falling reimbursements, heavy regulartion, a vindictive campaign by the goverment to control cost and the cost of malpractice insurance. Up until now people have been going into medicine anyway due to the fact that it still paid very well. That is all starting to change.
VickyRN, MSN, DNP, RN
The same litigious climate is one reason why many nurses opt out of OB--80% of the lawsuits and the client can sue you for 21 years from the time of the occurrence.
Many doc's in my neck of the woods don't want to do OB because of high liability and ski-rocketing Liability Insurance costs.
It really irks me when I see all the ambulance-chasing lawyers with their ubiquitous ads on TV, inciting peoples' greed. It really has gotten out of hand:( :(
NRSKarenRN, BSN, RN
SE PA has been especally hard hit by the same thing. Drs here are moving SOUTH...especially North Carolina. For Surgeons
P A Malpractice cost 100-150,000; NC cost : 30,000/year.
A large surgical group ~ 35 DRs staffing 11 hospitals will stop operating on 1/1/2001.
PA needstort reform.
Another part of the problem was that a 5 year backlog of Malpractice cases recently settled.
Docs say malpractice insurance, low reimbursements driving them out of Pennsylvania.
PATTI MENGERS, Of The Times Staff August 12, 2001
Dr. Kevin Claffey is off to Kentucky. Doctors Tarkten Pharr and Joseph Whitlark are setting-up shop in North Carolina. Dr. Mark Kelly is now hanging his shingle out in New Hampshire.
All are former Delaware County physicians. They are among the local doctors who have left the area just in the last month.
"It's breaking my heart to leave," confessed Claffey, 38, a Drexel Hill native who practiced general and vascular surgery at Delaware County Memorial Hospital in Drexel Hill for seven years.
"I'm 35 years old and it's hard to see much of a future in this area," declared Pharr, another vascular surgeon who was on staff at Delaware County Memorial Hospital for two years.
"If I thought I had anything resembling a viable choice, I'd stay," said Kelly, 41, an ear, nose and throat surgeon who practiced four blocks from his childhood home in Drexel Hill for 11 years.
Their exits are inspired by two common factors.
High malpractice insurance premiums combined with reduced reimbursement from insurance companies, they say, make Delaware County an undesirable place for doctors to practice.
They are part of a larger exodus that started at the beginning of the year, noted David McKeighan, executive director of the Delaware County Medical Society.
"In the opinion of our leadership here, it's a bona fide exodus," said McKeighan.
According to Pennsylvania Department of State records, there are 1,766 licensed medical doctors and 283 licensed osteopathic doctors in Delaware County.
Since 1997, Delaware County has lost 17 percent of its doctors, said Pennsylvania Medical Society President Dr. Carol E. Rose.
Since the beginning of the year, noted McKeighan, 31, doctors, mostly specialists, have left Delaware County. Four other local doctors have taken early retirement.
"I don't see an end to this in the long term. I don't think the future holds anything great for physicians in this area," said Kelly, recent past president of the Delaware County Medical Society.
In previous years, McKeighan, who has directed the medical society since 1985, saw an average of 10 members a year discontinue practice in Delaware County, primarily due to retirement.
"I'm losing six doctors a month between tort reform and the CAT fund," said McKeighan.
Since the beginning of the year, the Pennsylvania and Delaware County medical societies have been major players in lobbying the state Legislature for tort reform.
Their members feel changes must be made in the courtroom to curtail frivolous lawsuits and control exorbitant malpractice settlements that propel skyrocketing medical Liability Insurance premiums.
The high cost of malpractice insurance in Pennsylvania is not only driving doctors away, it is deterring them from setting up practice here, said Crozer-Keystone Health System Chief Executive Officer Gerald Miller, who testified before a state House insurance committee in February.
Miller oversees five Delaware County hospitals where, he said, patient access to medical care is lessened by the difficulty in attracting physicians to fill vacancies.
Patients now must wait six to seven weeks to get appointments with specialists like Ridley Park rheumatologist Dr. Martin Bergman, president of the Delaware County Medical Society, noted McKeighan.
The declining number of specialists has hampered her ability to get specialty diagnostic care for her patients and contributed to the overcrowding of local emergency rooms, said Dr. Maria DeMario, a family physician in Marple.
"There are not enough offices available to see patients so we have to send patients to the E.R. to get the full evaluations they need," said DeMario after lobbying state legislators in April.
The state-run Medical Professional Liability Catastrophe Loss Fund, also known as the CAT Fund, a supplement to malpractice insurance, is financed by a surcharge paid by health care providers and facilities. It is determined annually by the amount of medical malpractice settlements made in the state the previous year.
They hit an all-time high in 2000, said Bob Archibald, executive director of the Pennsylvania House of Representatives Republican Insurance Committee, which is headed by Delaware County state Rep. Nicholas Micozzie, R-163. Consequently CAT Fund premiums for doctors in the last year have increased, on the average, 26 percent. Some medical specialty classes increased as much as 50 percent.
Senate Bill 556, which would privatize the 26-year-old CAT Fund, and Senate Bill 406, which would reduce frivolous medical malpractice suits, were recently passed in the Pennsylvania Senate and will be addressed by the House when the General Assembly reconvenes in the fall. Both are supported by the Pennsylvania Medical Society and the Hospital and Health System Association of Pennsylvania as avenues for improving the local environment for doctors.
According to a survey by the American Medical Society, the average net income of doctors in the Middle Atlantic region after expenses and before taxes in 1998 was $225,000. Average professional expenses for Pennsylvania doctors for that same period was $245,000 per year.
Philadelphia area physicians received the lowest reimbursement in the country per patient per month from health maintenance organizations in January 2000, according to data in Interstudy Competitive Edge 10.2 collected from the 25 largest metropolitan service areas' state insurance departments.
According to the study commissioned by the Pennsylvania Medical Society, Philadelphia area physicians received $36 per HMO member per month as compared to Dallas doctors who received the highest reimbursement at $70.
The same study showed that businesses paid the seventh highest premiums and individuals paid the sixth highest to HMOs in the Philadelphia area where Independence Blue Cross and Aetna control 70 to 90 percent of the market.
Reimbursement averaged out to only $35 per operation in 2000 for Dr. Kevin Claffey and his partner, Dr. Lawrence J. Mayer, a general surgeon who is also his brother-in-law.
"Between 1999 and 2000 my partner and I did 70 more operations than we did the previous year and collected only $2,500 more," noted Claffey.
He said reimbursement for common procedures such as laparoscopic gall bladder removals have decreased 30 percent since he started performing them in 1994 at Delaware County Memorial Hospital.
His medical malpractice insurance increased by $15,000 in the last year and, if he had stayed in the area, was expected to increase by at least $20,000 next year.
So, in April, Claffey decided to accept a position at Twin Lakes Regional Medical Center in Litchfield, Ky., where his medical malpractice insurance is a third of what he paid here. He will see "a significant increase" in his income.
His partner will absorb his general surgery patients while other doctors will
have to absorb between 50 and 60 vascular patients, many of them on kidney dialysis. If he had stayed in practice in Drexel Hill, Claffey said it would have been difficult to pay for his children's college education or get out from under his own approximately $100,000 debt for his medical education. "People have the perception I'm wealthy. They don't know how much I spent to become a surgeon," said Claffey. His leaving is not only inspired by economic concerns, said Claffey, but by the constraints he felt from insurance companies in the care of his patients. "I cannot take care of my family the way I want to and I cannot take care of the patients the way I like because their care is dictated by the insurance companies," said Claffey in July before he left. He said he has seen nurse reviewers hired by insurance companies tell elderly patients who have undergone major surgery that they have to leave the hospital three days earlier than he feels is safe because their insurance won't cover them. "I've had physician reviewers for insurance companies who are non-surgeons tell me certain procedures are not indicated," said Claffey. The doctor and his wife, Anne Marie, who have a 23-month-old daughter, both are Drexel Hill natives and have family here, including Claffey's 8-year-old son from his first marriage. Claffey started working at Delaware County Memorial Hospital as an orderly at age 15 when he was a student next door at Monsignor Bonner High School. He was inspired to become a surgeon by his brother-in-law, whose practice he joined in 1994. His wife has been a registered nurse at Delaware County Memorial Hospital for about 13 years. Neither wanted to leave. "It's coming to the point where we can't survive here. Why should I stay here and struggle when I can be in a community that's thriving? What's my incentive to stay here and struggle every day to make ends meet?," asked Claffey 11 days before he saw his last Delaware County patient. Dr. Mark Kelly not only left behind family, he broke a long family tradition of doctors practicing in Delaware County. His father, two brothers and a great-aunt staged their medical careers here. He now practices ear, nose and throat surgery with two partners in Laconia, N.H. "My dad's 78 years old. I have a 4-month-old son. He won't be able to watch him grow-up," noted Kelly, who also has 6 and 8-year-old children. But the more than $40,000 he had to pay in malpractice liability insurance combined with poor reimbursement from insurance companies essentially made it impossible for him to practice medicine in Delaware County, said the doctor. His wife, Joyce, a nurse, helped defray his costs here by handling bills. "I might be a doctor but I'm not a dope," noted Kelly before closing his doors on July 31. "I can't run a business for the next 25 years under those conditions." Malpractice insurance costs about five times less and insurance reimbursement is 80 to 90 percent more in New Hampshire than in Delaware County, said Kelly. "I had actually looked at three or four other states. It doesn't matter where you look, it looks a lot better," noted the doctor. Two years ago when Dr. Tarkten Pharr completed a vascular fellowship in Connecticut and sought placement in the Philadelphia area to be near his wife's family, the recruitment agent actually laughed at him. "He said, 'We place more people out of Philadelphia than any other city in the country,'" recalled Pharr. "He was kind of prophetic. He said, 'You'll be calling me in two years' and he was right." Pharr is now establishing a vascular surgery practice with Dr. Joseph Whitlark at Lenoir County Memorial Hospital in Kinston, N.C. Pharr and Whitlark had partnered with veteran Dr. Homayoon Pasdar at Delaware County Memorial Hospital and felt they worked well together. "Dr. Pasdar will still be there. He'll be taking the practice," said Pharr who described Pasdar as "a true gentleman" who did not draw a salary so the younger doctors could be paid. Both Pharr and Whitlark have young families. Pharr and his wife, Maria, a family physician at Thomas Jefferson University Hospital, Philadelphia, have three sons ages 6, 4-1/2 and 5 months. Whitlark and his wife, Linda, a nurse, have 5-year-old twins and a 9-month-old daughter. Pharr and Whitlark paid $60,000 each in medical malpractice insurance while in Delaware County. In Kinston, N.C., they'll pay $15,000 each. While Medicare is the best payer in the Philadelphia area, said Pharr, it is the worst payer in Kinston. But insurance companies reimburse doctors 1.8 percent, or almost twice as much in Kinston as they do in Delaware County. "I can go down there and make immediately what my wife and I are making together now so she can stay home and take care of our 4-month-old," said Pharr in July. When his wife, who is also 35, returned to work after an 8-week maternity leave, she had to take a $10,000 pay cut to help defray the medical liability costs of her employer, Jefferson Health System, said Pharr. "When my wife was facing seeing more patients in less time for less money, that's when it clicked in my mind that there's not too much of a future here," said Pharr, who noted he is still also trying to pay his educational debt. To make Delaware County and the Philadelphia area more attractive to physicians, said Pharr, the tort system will have to be revamped and insurance reimbursement will have to increase. "Frankly, I don't believe it's going to happen, either one of those things," said Pharr. "We'll see what shakes out but I don't want to participate in it." Claffey knows at least seven young physicians who left Delaware County Memorial Hospital since the beginning of the year. "None of them have been replaced and probably will not be replaced," he conjectured. Eventually the declining number of doctors will have a major impact on access to medical care for the more than half a million residents of Delaware County, predicted Claffey. He noted, "Where will the community be five years from now, 10 years from now, when there is a generational gap in physicians?" Kelly said he is living testimony to the destructive impact of high medical malpractice premiums and low insurance reimbursement in Delaware County. "I'm leaving," said Kelly, "That tells it all - I'm leaving."
PA LAwyers response re Malpractice reform:
Letters: Medical malpractice 'crisis' is a myth
Delaware County Times July 08, 2001
To the Times: Your recent guest column by Dr. Mark F. Kelly, which complained of a tort liability crisis forcing most Delaware County doctors to go out of business, is just the kind of political pot-boiling that has become so popular today. It follows a formula: disseminate disinformation about a supposed crisis, and scare the people into supporting so-called "reform" legislation, which is not responsive to the crisis, but which will actually feather the nests of the complainer and his friends.
Thus, the doctors complain of a tort liability crisis when, in fact, the tort system has been shielding doctors for years, and verdicts are, in fact, getting no higher. From studies done by Harvard University Medical School, the New England Journal of Medicine (324 NEJM 370-376, 1991) and the American Hospital Association, we know that as many as 98,000 Americans die each year from medical negligence, and yet only 2 percent of these deaths result in law suits. That's some crisis!
The doctors do face a real crisis, which I will get to later, but it is not a tort liability crisis, it is a medical CAT Fund crisis, and it is a crisis which began abruptly this year and will end abruptly next year, without any tort "reform" legislation.
The crux of Dr. Kelly's crisis column is the survey conducted by the suburban county medical societies. Of the thousands of doctors in those counties, only 450 chose to respond to the survey questionnaire. This is not a scientific sampling, such as a poll would take. The survey data surely was drawn from doctors with an ax to grind - doctors who felt strongly enough about the subject to take the time to respond.
Furthermore, there is no guarantee that the responding doctors told the truth, or didn't try to shade the truth to suggest that there is a liability crisis. The best example of this is the reported "54 percent of the doctors in the three-county area [who] considered moving to another state or region," and the "59 percent [who] said they planned to retire early or enter another profession."
Can anyone seriously believe that most of the area doctors are considering abandoning the profession that has financed their life-styles so well? Dr. Kelly's surveyed physicians included Chester County doctors, where there hadn't been a single malpractice verdict against a doctor in 20 years, until November 1996. Are those doctors really thinking of closing their doors?
It is true that in the year 2001 there was an abnormally large increase in medical malpractice premiums. That is not the fault of the tort justice system, but, rather, the fault of the Pennsylvania CAT Fund, a system of paying for malpractice verdicts and settlements that the doctors themselves set up years ago.
The CAT Fund is not an insurance company, and does not establish reserves against which it can pay claims. Rather, the CAT Fund surcharges all Pennsylvania doctors an amount equal to what is has to pay out in verdicts and settlements from the previous year.
A one-time quirk in the Philadelphia legal system, however, caused the number of verdicts to be paid in the year 2000 to jump dramatically. The Philadelphia court wiped out its six-year backlog in two years, and in those two years there were therefore four times as many cases tried, and roughly four times as many verdicts to pay.
This means that CAT Fund payments - and the doctors' malpractice premiums - will drop down next year just as dramatically as they spiked up this year. The doctors' malpractice premium is a one- or two-year problem, which inevitably will go away. However, the "fixes" doctors propose for the tort system will never go away, once they are enacted.
Furthermore, the real cause of the alleged financial woes for doctors, as Dr. Kelly himself acknowledged, are the greedy HMOs that have been cheating physicians out of reasonable reimbursements for their services. Many physicians will admit privately that their real gripe is with the HMOs, but they can't fight the HMOs publicly. "You can't bite the hand that feeds you," as one doctor said to me.
The American Medical Association itself has identified HMOs as the real cause of any economic problems doctors may be experiencing. In the April 23/30, 2001, issue of its Internet newsletter (amednews.com, available at http://www.ama-assn.org/sci-pubs/amnews/pick_01/prsd0423.htm), the AMA's headline article was, "Low reimbursement rates and high competition cause more doctors to quit or move away from markets dominated by managed care." As Helen Hunt said in the movie, As Good as It Gets, "!#*%$##!! HMOs!"
I would like to put Dr. Kelly's survey from 450 disgruntled suburban doctors up against the data compiled by Citizens for Corporate Accountability and Individual Rights (CCAIR), a citizen's group in Washington which conducted the most comprehensive study on the rate of increase in malpractice insurance premiums ever done.
CCAIR looked at the premiums in all 50 states from 1985 through 1998. CCAIR concluded there was no discernable relationship between the tort law of a state and the rate of increase or decrease in their malpractice premiums. For example, the state closest to Pennsylvania, both demographically and in terms of amount of malpractice premiums written, is Ohio. Over the study period, Ohio enacted several "tort reform" measures for med mal cases that Pennsylvania did not. But Ohio ranked 43rd in rate of increase, while Pennsylvania ranked 39th (Like golf, on this list, the lower your number, the better you're doing.)
There is a way to fix the problems of malpractice and the cost of malpractice insurance, but it's a fix that Pennsylvania's doctors have rejected time and time again: Address patient safety and adopt a full-disclosure policy such as exists in Massachusetts.
In Massachusetts you can go onto the Internet and find out all about the doctor who is proposed to take care of you - everything from education, to experience with a particular operation, to the number of malpractice verdicts.
Massachusetts has used its system to weed out the bad apples, and now Massachusetts has a much lower incidence of malpractice, without forfeiting patients' rights under the guise of "tort reform." From 1985 to 1998, Massachusetts' med mal premiums increased at a much slower rate than Pennsylvania's. Pennsylvania's rate of increase was 39th in the country, while Massachusetts was 14th (Again, lower is better).
Not only does Pennsylvania lack these procedures needed to protect patients, the state did not discipline one single doctor for unsafe medicine practice last year. The cloak of secrecy that covers doctor's records needs to be lifted.
The medical malpractice "crisis" has a basis in myth, but no basis in fact. Pennsylvania citizens should let their legislators in Harrisburg know how they feel about preservation of patients' safety and legal rights. The mailing address for all Representatives is: P.O. Box 202020, Harrisburg, PA 17120-2020.
JOHN M. GALLAGER JR.
Gallagher, Schoenfeld, Surkin & Chupen
©The Daily Times 2001
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