Study: Malpractice Crisis had Little Effect on Pa. Doctor Supply

Spiraling-malpractice insurance costs appeared to have little effect on the number of doctors in high-risk specialties practicing in Pennsylvania over a 10-year period, according to a new study.

Opponents of efforts to limit pain-and-suffering awards in medical malpractice lawsuits said the study refutes claims that insurance costs have forced doctors to leave Pennsylvania. A doctors’ lobbying group questioned the findings.

Researchers based their conclusion on an analysis of more than 47,000 doctors, including medical residents, who participated in the state’s medical-malpractice insurance fund known as Mcare from 1993 to 2002. The study was published online April 24 in the journal Health Affairs.

The study found that an average of 16 percent of doctors in high-risk specialties such as urology, neurosurgery and orthopedics stopped practicing in Pennsylvania each year from 1999 through 2002, which researchers defined as the “crisis period” after insurance rates spiked. The number of high-risk specialists leaving the state from 1993 through 1998 averaged 15 percent a year, by comparison.

“What this study shows is, at least on a statewide level, that (the malpractice crisis) doesn’t seem to have resulted in noticeable decreases in the number of physicians available in particular specialties,” said researcher Bill Sage, vice provost for health affairs at the University of Texas at Austin.

Researchers found that the total number of doctors practicing across all specialties in Pennsylvania increased by nearly 6 percent between 1993 and 2002 – from 181 to 191 per 100,000 residents – and the total number of high-risk specialists grew by 3.3 percent over the same period, from 138 to 142 per 100,000 residents.

The study identified a nearly 8 percent decline in obstetrician-gynecologists as the only notable decrease among high-risk specialists, but it also noted that the number of live births in Pennsylvania dropped during the study period, which researchers said may have contributed to that trend.

In recent years, the Pennsylvania Medical Society has unsuccessfully lobbied state lawmakers to pass monetary caps on pain-and-suffering awards in medical malpractice lawsuits. The organization has said high malpractice insurance rates have led doctors in high-risk specialties to leave the state.

Legislators and the courts have taken other steps to try to address rising insurance rates instead. Key changes include a state Supreme Court requirement in 2003 that an independent physician or expert certify the viability of a medical malpractice lawsuit and a 2002 law ending the practice of “venue shopping” in which attorneys move cases to the county where a favorable jury verdict is most likely.

Paul Lyon, a spokesman for the Committee for Justice for All, a Kingston-based group that opposes medical-malpractice award caps, said the study is the first objective analysis of whether medical-malpractice costs have affected the state’s supply of doctors.

“Finally, there’s a definitive study that shows the claim of a mass exodus from Pennsylvania was a hoax,” Lyon said.

The Committee for Justice for All was founded, and is primarily funded, by trial lawyers in northeastern Pennsylvania, Lyon said.

Medical society spokesman Charles Moran said he had not seen the study, but questioned the validity of any conclusions being drawn from the Mcare data.

His organization also examined the number of physicians participating in the state malpractice-insurance program – known as Mcare – in a report it released last year on statewide health care trends. But the organization did not try to interpret why the numbers were increasing or decreasing in a given year, Moran said.

“You cannot look at the Mcare data and conclude why a person comes or goes,” Moran said. “You’ve got to get down to the grassroots level for that information.”

Health Affairs: http://www.healthaffairs.org/