March 2003 • Volume 9 • Number 3 |
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BY SHIRL KASPER
 Hundreds of Missouri physicians -- more than 100 of them FPs -- gather in the state's Capitol in Jefferson City for White Coat Lobby Day Jan. 29, focusing on tort reform. |
Family physician Julie Wood, M.D., thought she had her future all planned. She finished her residency seven years ago and moved back to her hometown of Macon, Mo., intending to practice there until the day she retired.
Wood soon was delivering about 75 babies a year, with most of the deliveries covered through Medicaid. She admitted and delivered at the local hospital, but actually worked for an outreach clinic run by a larger hospital in nearby Columbia, Mo.
"I deliver babies. That's the favorite part of my practice,'' she said. "I wanted to deliver babies -- and watch them grow up."
But then the medical liability crisis hit, and Wood's malpractice premium soared from about $19,000 a year to $71,000.
Her situation worsened when the Columbia hospital decided to close its outreach clinics.
"We've basically had two big hits come at the same time," said Wood, president of the Missouri AFP. "They're saying our premiums may go up again, almost as much as they did recently. That's the thing: How long can we hold out here?''
In January, Wood announced that she was giving up her family practice -- and her hometown dream.
Wood is not alone. The need to shut down her practice was brought on by a liability crisis that is making national news. Following a New Year's Day walkout by surgeons in Wheeling, W.Va., more than 800 doctors in the Palm Beach, Fla., area walked off the job. In Mississippi, a dozen surgeons took leaves of absence from four Gulf Coast hospitals. And in New Jersey, a three-day physician slowdown early last month brought same-day surgeries and diagnostic procedures to a standstill.
 FP Julie Wood, M.D., of Macon, Mo., testifies to state legislators about skyrocketing medical malpractice premiums. |
In Texas, the governor declared a malpractice insurance emergency, and in Georgia, a new study indicated that one in five Georgia doctors was abandoning high-risk procedures. Statehouse rallies were making headlines, including one in Missouri, where an estimated 600 physicians, including Wood, turned out Jan. 29 for White Coat Lobby Day. Missouri doctors want to cap awards for noneconomic damages at $250,000, down from the current $547,000.
"It was very bittersweet to stand there in the rotunda (of the state Capitol),'' Wood said. "Everybody has a different worry to some extent, but it all boils down to the same problem: Access to care is going to be an incredible problem."
In Connecticut, AAFP Past President Neil Brooks, M.D., sent an Op-Ed piece to the Hartford Courant, saying that he was giving up his practice of 32 years because the liability crisis had "struck home.''
In rural Morrow County, Ohio, Brian Bachelder, M.D., president of the Ohio AFP, decided to stop delivering babies after his liability premium increased by $21,000 last year. Bachelder had been the only Morrow County physician providing obstetrical care.
In Florida, Miami FP Fleur Sack, M.D., "went bare'' last March --dropping her malpractice insurance after her premium reached $25,000 for $250,000 of coverage. In Florida, it's lawful to practice without malpractice coverage. "Basically, it doesn't matter,'' she said. "If you have $250,000 worth of coverage and you're sued for $10 million, you're still uninsured."
Sack, president-elect of the Florida AFP, believes that doctors who go bare see fewer frivolous lawsuits because the deep pockets of an insurance company are no longer there.
In rural Florida, FP Greg Sloan, M.D., of Chipley decided to go bare just last month after his malpractice premium went from $4,500 last year to $13,600 this year -- despite a blemish-free, 20-year career.
"It's just gotten to the point where we can't pay our staff and keep the doors open and pay those premiums, especially with the federal cuts with Medicare,'' said Sloan, who has been told his premium will mature out at $21,000 in a few years. "The thing now is, if I go bare and then have a claim against me, that would probably finish me off."
Physician activists may be making headway in some states.
At press time, New Jersey lawmakers had proposed a $300,000 cap on insurers' and physicians' liability for noneconomic awards, as well as a surcharge on health insurance companies to create a state fund to pay higher awards. Meanwhile, in Florida, Gov. Jeb Bush issued 60 recommendations to address the malpractice crisis, including a $250,000 limit on pain and suffering awards.
Yet there are still too many docs out there faced with questions about their future.
For Julie Wood, the answer came from Baptist Lutheran Medical Center in Kansas City: "Have you ever considered teaching?'' the program director asked her. Come June, Wood will be on the faculty of the center's family practice residency, a position that covers her insurance premium -- and allows her to continue delivering babies.
"Somebody used the word 'demoralizing,''' she said of her feelings about having to give up her hometown practice. "Not just the decision to leave, but the whole process of it ... . There are so many loops and hoops that I can't get through. It seems there are so many more hurdles every day that you can't get to your patients."
FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.
