Driving Physicians from Practice

I can’t imagine being forced to retire at age 50 — or younger in some cases — but that’s what’s happening to many doctors in this country because, as you’re probably experiencing first-hand, medical liability insurance has gone through the roof. Twelve states are considered in crisis, according to the American Medical Association (AMA), including Florida, Georgia, Mississippi, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Washington and West Virginia. And the anecdotes abound — accounts of OB doctors not delivering babies anymore because their malpractice insurance premiums are too costly; a trauma center in Las Vegas closing its doors for 10 days, and more. In fact, in Florida, premiums have increased as much as 80%. One newspaper reported that OB/GYNs in the state paid the highest premiums in the nation $108,000 to $209,000 a year. It’s easy to focus on these hard-to-believe examples of hardship, but it made me wonder how dermatologists are faring especially because most dermatologists don’t perform high-risk procedures that would entail acquiring huge amounts of liability insurance. A New Perspective Even some dermatologists, who are generally less hard hit by the increases than many surgeons, OB/GYNs and ER doctors, are choosing to call it a career. Fresh from the Florida Medical Association meeting, where he participated as delegate of the Florida Society of Dermatology, dermatologist Jeff Parks, M.D., had an interesting story to tell. The meeting, which was supposed to just be a general meeting, quickly turned to a focused discussion about the liability crisis, explained Dr. Parks, who is in private practice near Daytona. “It’s a really scary situation,” said Dr. Parks. Not only are established doctors closing their doors and dissolving their practices, but even new graduates are leaving the state to practice elsewhere. Dr. Parks himself has experienced a threefold increase in his liability insurance. He went from paying premiums of $7,000 to $21,000 a year. But because he’s only been in practice for 5 years — and has never even had a claim filed against him — he’s faring well compared to some of the other dermatologists in the state. “I’ve heard of some dermatologists over 50 who are just deciding to retire because their premiums are too high,” explained Dr. Parks. In addition, he said that the increase in insurance looks as if it will be permanent. In addition to the high premiums, many doctors have been faced with having to find a new insurer because theirs has left the state. In Florida, for example, at least five medical malpractice insurers had left the state — leaving only a remaining handful offering coverage. A Possible Solution Recently, legislation backed by the AMA was introduced before Congress. The legislation calls for a $250,000 cap on pain and suffering awards and punitive damages. All medical bills would be paid for under the bill. In addition, legal fees would be limited to 15% of awards in excess of $600,000. (Typically, these fees range from 33% to 40%.) The legislation, paired with an increasing awareness by the general public about the negative effects of increasing premiums on healthcare delivery, could paint a brighter future. Until something gives to ease this crisis, Dr. Parks maintained that “The important thing is that all physicians come together as one voice and fight for legislation. It’s a tough battle because the lawyers have a powerful lobby, but it’s one we must try to win.” This trend and others are covered in this month’s cover story, which begins on page 36. Contributing Editor Louis Pilla does an excellent job of summing up the trends and issues facing the field of dermatology. Whether frightening or challenging, these trends reveal an interesting look into your future.