 |
How come EVERYBODY Or mail checks to or you can use PayPal at Jimrob@psnw.com |
|
|
|
Posted on 01/11/2004 1:16:18 PM PST by FormerACLUmember
General practice physician Ronald Martin, MD, isn't expecting to make any money in his rural practice in Cambridge Springs, Pa., this year.
In fact, he's borrowing money from a family member to keep his practice afloat.
He has no choice if he wants to keep his medical license. In Pennsylvania -- one of the 19 states the American Medical Association says is in the midst of a medical liability insurance crisis -- physicians have to carry insurance in order to be licensed.
Insurance this year will cost Dr. Martin about $24,000. That's without assuming the higher risk -- and higher insurance premium -- associated with delivering babies. Dr. Martin gave up obstetrics years ago, and he stopped working in the emergency department this year in order to reduce his premium a bit.
Still, the $24,000 premium reflects a 400% increase in the cost of his medical liability insurance over the past three years. It's an increase that would be difficult for any small business to absorb.
On top of that, Dr. Martin has to pay more than $5,000 into the state's MCare fund, a catastrophic fund that Pennsylvania physicians contribute to in order to help pay jury awards throughout the state.
"I'm borrowing this time," said Dr. Martin, who turns 60 this year. "But I can't keep borrowing like this again and again."
Pennsylvania and West Virginia were the first states in the nation to start seeing medical liability insurers raise physician rates or leave the market. They were also the first states to see high-risk specialists retire early, move to other states or forgo procedures. The two states were also the first to watch residents and young physicians bypass them to set up practice in areas with a more friendly liability climate.
As 2004 begins, West Virginia's Legislature has implemented a $250,000 cap on noneconomic damages awarded in medical malpractice cases, something physicians say is key to reining in liability premiums. Texas also starts the year with a $250,000 cap that is just months old.
But Pennsylvania, which did get some tort reforms passed, is still working toward a constitutional amendment that would allow caps on noneconomic damages and limits on the fees that attorneys can collect.
While the push continues, it's not just the high-risk specialists that are being hard hit by premiums. The problem is continuing to spread to cradle-to-grave caregivers like Dr. Martin, the only physician in his rural town.
"It's very frustrating," said Pennsylvania Medical Society President Jitendra M. Desai, MD. "The worst thing that is happening is that doctors are leaving the state and young doctors aren't coming in."
Scratching the surface The Legislature is aware of the problems physicians face and in the days before Christmas gave physicians some short-term relief by cutting the amount they are required to pay into the state MCare fund.
Obstetricians, neurosurgeons, orthopedic surgeons and high-risk surgeons will not have to pay the 2003 and 2004 MCare assessment. Family physicians in rural areas who do obstetrics also are entitled to the full abatement.
Other physicians in Pennsylvania will have to pay 50% of their MCare bills for the two years.
The estimated $220 million in relief for physicians will come from a 25-cent tax on cigarettes. Physicians will have to stay in Pennsylvania through the calendar year in exchange for the abatement. If they leave before that time, they will have to pay 100% of the abatement they accepted.
"No state has done more to provide short-term relief to its physicians," Pennsylvania Governor Edward G. Rendell said in a statement. "I urge the Legislature to continue to focus on this issue and pass long-term reforms I have proposed, including patient safety, insurance and tort reforms."
Rendell signed the bill, part of the state's budget package, into law.
Sellersville, Pa., general surgeon John Pagan, MD, said the abatement is a welcome gesture. But he's not sure how much good it will do for him and the three other general surgeons in Pennridge Surgical Associates.
Before the abatement was passed, the group was faced with paying more than $1.3 million for insurance in the next 12 months. With the abatement, the group is still looking at more than $1 million in insurance bills next year -- $1,052,000 to be exact.
"The abatement is a small piece of the package," Dr. Pagan said. "Any relief is welcome, but it does not fix our problem."
And he said he believes attaching a requirement that physicians finish out the calendar year if they take the abatement could make it a less desirable option for physicians who are uncertain whether they can afford to stay that long.
At press time, the fate of Dr. Pagan and the other members of his group rested with whether they would be able to find affordable insurance for this year. At the rate they were quoted from one company, Dr. Pagan said that they would have a hard time making the payment even if they ran the practice like a clinic where physicians didn't take a salary.
The decision on whether to close the practice depended upon whether they could work out an arrangement with a hospital for more affordable insurance. Dr. Pagan and the other physicians have been telling patients they may have to close the practice, and the physicians have made an arrangement with a group in Delaware to provide care to postoperative patients if necessary.
"The decision will be made for us," said Dr. Pagan, who has been active in trying to get tort reform passed. "We don't want to leave. We don't want to stop practicing. We want to do what we were trained to do. But the decision will be made for me. I've fought a good fight and I'm at peace."
Long-term relief needed In order to attract younger physicians and keep older physicians from retiring early, physicians say Pennsylvania needs to pass a constitutional amendment that would allow noneconomic damage caps. And they say lawyer fees need to be curbed.
Not surprisingly, the Pennsylvania trial bar disagrees. Instead, it points to the cyclical nature of the insurance business, noting that insurance companies have gone through a spell during which they are receiving lower income on investments. Attorneys also say the state should focus on improving patient safety.
It's been an ongoing argument in Pennsylvania for several years now. And doctors say that as more of them leave the state, retire early or cut high-risk services, the state is growing ever closer to a meltdown.
At the end of 2002, physicians such as Pottstown colon and rectal surgeon Scot Paris, MD, found affordable insurance by obtaining a claims-made policy. But he knew the cost of that policy would go up when he received his bill at the end of 2003 and that it would be difficult to hang on another year if nothing changed politically.
"Last year, I knew it was going to get worse," Dr. Paris said. "This year, I feel the same way, but this year reality hits because the numbers just aren't doable."
|
How come EVERYBODY Or mail checks to or you can use PayPal at Jimrob@psnw.com |
|
|
|
'Claims-made' policies mean that the insurance company will not pay on any past or future lawsuits, only those filed while the policy is current. 'Occurrence' policies are standard for physicians, and pay any future claim made based on care provided while the policy was in effect. It's a bit like term vs. whole-life life insurance.
Claims-made policies are somewhat cheaper and can perhaps stave off the inevitable for some marginal practices. But they mean that the doctor is 100% personally liable for any lawsuits that arise next year, or the year after, or even 18 years later in the case of a minor.
Not many fleeing doctors are going to be lured back into medicine, if the price is the risk of losing one's life savings in a lawsuit filed long after retirement, due to a lack of occurrence insurance (aka tail coverage).
I am of the opinion that physicians should decide as a group to "go bare". Put the title to all assets in labyrinthine family limited partnerships and offshore trusts, drop all insurance coverage, and invest the money saved in a legal-defense fund that will fight EVERY SINGLE malpractice claim to the mat. Nothing will change until the trial lawyers are run out of business.
-ccm
Bottom line? Dr. Paris is ruined, destroyed, annihilated. A sad end to a good man and a needed professional.
This is a very, very sick society where the loathsome shysters can destroy a good guy like Dr. Paris.
Again, you are completely correct. However, the trail lawyer controlled legislatures, such as in the Commonmwealth of Pennsylvania, make it illegal to practice (at least in hospitals) without shyster extortion, oops i meant professional liability insurance.
In Florida, it is increasingly common to see doctors going bare. Hellava way to live your life though, after being in school to age 29.
The federal Nazis have always sued for anti-trust in such circumstances. Besides, organizing doctors is like herding cats.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.