Where Have All the Doctors Gone?

02/23/2016 // Hartford, CT, USA // cttriallawyers // Neil Ferstand // (press release)

Funny story. About a decade and a half ago, doctors and organized medical lobbies were picketing state capitols, threatening to leave states because of high malpractice insurance rates. Since they were doing this everywhere, I’m not sure where they were all going. France maybe?

In 2003, the American Medical Association was so sure of its claim that doctors were abandoning states, that they managed to get the U.S. General Accountability Office to study the data. I guess the AMA was convinced they’d find support for the argument that a widespread health care access “crisis” existed in this country. And that the legal system was to blame. And that the only way patients – particularly women and babies – would have access to doctors would be if they gave up their legal rights should they be harmed from negligent or reckless care.

The GAO did the study, alright. But what they found instead was that the AMA and doctors groups were basically lying. To put it nicely, they found the AMA’s arguments to be “inaccurate” and “not substantiated.” To the extent they could find any access problems at all, they were isolated and the result of numerous factors having nothing at all to do with the legal system or malpractice insurance.

See here for lots of other studies finding the same thing. Take the work of the Center for Health Workforce, part of the School of Public Health, State University of New York in Albany,which annually surveys physicians about why they leave New York State – a state with some of the highest insurance rates in the nation. They found “in 2014, only 45% of newly trained physicians reported plans to practice in the state.” But the single biggest reason these new doctors list for leaving New York is to be closer to their family (27%), followed by better jobs and salary elsewhere (14%). And as for the “Cost of Malpractice Insurance," what percentage leave because of that?  0. That would be “zero percent” who leave because of malpractice costs. Notably, New York’s legal system is not even listed as a reason. And this has been the situation for years.

But the truth has not stopped doctors from engaging in “access to care” fear-mongering. In Texas, the very same year the GAO published its report, the headline of a glossy brochure handed to patients all over the state was “Who Will Deliver Your Baby?”. Medical societies argued that the only way to bring doctors to underserved areas of Texas was for patients to enact a severe cap on damages, which voters – and the legislature – proceeded to do. But as has been repeatedly shown since the Texas Observer first pointed it out in 2007 in the article “Baby, I Lied”, not only did doctors not return to the state’s underserved areas after the cap was enacted, they never came back to the state at all.

Today, Maryland doctors are threatening that women won’t have access to their OB/GYN’s unless the state completely removes the right to jury trial for families of newborns who are catastrophically injured due to negligent care. (See our recent coverage.)

And I love this one. The head of the Connecticut State Medical Association recently went on a rant about doctors’ woes, targeting his greatest wrath for the liability system, which is used by patients who are harmed by negligent health care and sue because they need compensation – even though barely anyone actually does this. No matter. He says doctors are leaving Connecticut. Citing absolutely no evidence (because there is none), he claims, “liability costs are a major part of this retention problem.” Boy would I like to sic the Center for Health Workforce, School of Public Health, State University of New York in Albany, on this guy. Come to New York, my friend.

Then he says:

    Connecticut physicians have been up front and consistent in asking our elected officials to step back and consider the entire liability system (including tort law and alternative dispute mechanisms, such as health courts). Much has changed since the last review in 2005, so it is simply common sense to ask for another systemic look at our state’s liability system.

Oh I’ll say much has changed. First of all, we now know that preventable medical errors are the third leading cause of death in America and as noted, the vast majority of preventable errors that physicians commit never result in a claim at all. What’s more, since 2006, doctors nationwide have benefited from steadily dropping malpractice insurance rates.  As the editor of industry publication Medical Liability Monitor put it,

    For almost a decade, medical malpractice insurance rates have been declining while industry profits remain historically high. While many attribute the declining rates to increased competition for a shrinking market, the industry’s historic profitability has been buoyed by historically low claims frequency and indemnity severity as well as healthy reserve releases.

In other words, the number and size of claims are declining while insurance companies are rolling in dough. Now that’s something every legislature is the country should be looking into.


First published by PopTort.com 

Feb. 19, 2016

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