WEB EXTRA!BY LESLIE CHAMPLIN
 A stream of white coats flows from Missouri to Kansas as FPs and other physicians symbolically flee Missouri's malpractice insurance crisis. The White Coat Flight was organized by the Missouri AFP. |
Malpractice premiums skyrocket. Underwriters drop coverage. Insurance companies abandon certain states. And, despite pleas from the medical community, some states' legislators turn a deaf ear to calls for resolution.
That inaction has spurred family physicians into action. They've gotten into their legislators' faces, as AAFP President Michael Fleming, M.D., of Shreveport, La., suggests (see "Q&A -- Michael Fleming, M.D.: 'I think it's time to get in some faces.'"). With help from their constituent chapters, FPs have begun turning to America's most powerful stimulus for change: the voters. In doing so, the FPs hope to intensify political pressure on legislators who have failed to respond to calls for legal reform.
Beginning to get noticed
Illinois legislators have consistently ignored skyrocketing malpractice insurance premiums. So Mark Macumber, M.D., a 35-year-old family physician, joined the ranks of the uninsured in order to provide services to the uninsured. His malpractice premium had escalated, so he cut costs by dropping malpractice insurance. In September, the Illinois AFP arranged a half-day media event, in which reporters toured Macumber's Patients First Clinic and grilled him about his decision to "go bare."
The tactic worked. In Chicago, three newspapers, five radio stations and the region's largest television station jumped at the chance to show Macumber caring for his patients and describing the negative effect of high malpractice insurance premiums on patients' access to care.
Before the Macumber story broke, the media had usually portrayed the malpractice insurance issue as rich physicians pitted against vulnerable patients, said Ginnie Flynn, Illinois AFP manager of public relations.
Response has been gratifying, said Macumber. Since the public learned of his position, an average of five new patients a week have called for appointments. A 20-minute stint on a call-in radio show ballooned to two hours because "the phones were full with callers," said Macumber. The news coverage spurred intense cyberdiscussion. Web logs -- individuals' online journals -- abound with references to Macumber. (See "Online journals discuss 'going bare.'")
Moreover, colleagues have offered to serve as attending physicians of record for Macumber's patients who may require hospitalization. An optometrist asked to join his practice to provide low-cost vision services to patients.
"I want to show people they could do something outside the system, and people would respond to it," said Macumber.
Taking it to the streets
Meanwhile, Missouri legislators failed this year to override the governor's veto of a tort reform bill.
"Our members just threw up their hands," said Diana Ewert, chapter executive of the Missouri AFP. "There's a sense (among the public and legislators) in the state that things aren't so bad that physicians are going to leave."
That's when the idea of a symbolic White Coat Flight developed. Well beyond the shadow of the Missouri statehouse, family physicians and their colleagues from other specialties from across the state converged on a Kansas City, Mo., neighborhood and took their message to the streets.
As neighbors watched and television cameras rolled, physicians donned white coats and marched from Missouri into Kansas. Drivers of passing vehicles honked their horns and their passengers flashed thumbs-up as a stream of white coats flowed across State Line Road.
"We have gotten a lot of positive support," Ewert said. "We framed the issue in a way that explains it's everyone who depends on a doctor in Missouri who is hurt (by the malpractice crisis). When you lose 700 doctors over five years, as Missouri has, you're creating an environment where health care is going to suffer."
Interested in learning more about the Illinois and Missouri activities and the potential to adapt them to your state? E-mail Flynn at gflynn@iafp.org; e-mail Ewert at dewert@mo-afp.org.
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.