Understanding the Liability Crisis for Rural and FP Docs

Rich Roberts authored a paper entitled Understanding Physician Liability Insurance for Family Practice Management last October. Im sure most if not all of you have seen it, but just in case you haven't here's a link to the URL: http://www.aafp.org/fpm/20021000/47unde.html

E-mail: [email protected]

Federalize Liability For Underserved

Liability Needs a Federal Touch  - from 2002

As a rural physician of 18 years, 850+ deliveries, and who is considering leaving OB not because of loss of interest but rather because of an increase in liability costs from $14,000. / year to $35, 000. / year this year, I would be in full support of such a proposal.

Brian Bachelder, MD    President Elect Ohio AFP   [email protected]

In Kirksville we have 7 family docs doing OB and 3 OB/GYN's. The recent 100 - 300% increases in malpractice insurance is making even the FP's who have been committed to providing this service think about eliminating OB from their practice. There is no way that the OB group could take up the slack. This will be a crisis to our community, which I am sure will be occurring elsewhere. Is there anything going on nationally of significance to avert this trend?         Stephen L. McKernan, ND, DO, FAAFP

On another list serve we were discussing some federal remedies for rural health, we wanted 3 fairly brief suggestions for White House Advisors who requested this from Dennis LaRavia at a recent Rural Health Policy Meeting. Some of you may soon be at the FP Health Policy Meeting in DC so there is reason for broad discussion.

One area brought up by Dennis was the area of federal incentive dollars to programs and medical schools who actually graduate rural physicians.

I have an additional suggestion that may be a bit more complicated than asked, but simple from our point of view:

Why not federalize liability coverage for those serving the underserved?

A. Liability costs do not reflect reality in premiums vs costs. The risk is low, even for the highest rish area of obstetrics as evidenced by Nesbit study of 100 rural docs over 10 years with only one major claim, JFP February OB study in high risk native pop by the Leemans etc. Also we know that liability risk is low in situations where patients are in continuity with physicians, especially rural and underserved where patients have few if any other options

B. Liability is lots of lawyers and legal costs, liability efforts bypass the poor anyway because they are poor, legal aid is underfunded, and their lives are too complex and day to day for such long term efforts

C. Having a state or federal attorney general reduces the nuisance suits greatly as evidenced by Tom Dean in SD

D. Underserved, even when medical care is in error, still have to be served by federal and state programs so they should have a voice in reducing costs and errors

E. We should assure that we set up accountability in a non-punitive environment, but with peers who understand conditions and have compassion for the underserved and service as a priority

F. Doctors, devoted to service, would appreciate the break instead of more hassles, paperwork, or costs

Why not cut out the middleman who gets a great share of the costs and also ties up our court systems?

Impact:

Might actually increase interest in the underserved and a major decrease in overhead, especially for those who have to take special pains to care for only 30 or so OB patients a year.

Might increase ob and prenatal access over time or at least decrease the numbers leaving each year.

Might actually be a benefit that rural doctors in shortage areas would use, as opposed to the 10% bonus which they do not access much at all.

Would be an impediment to leaving service to the underserved

[email protected]

Just got this from the AMA's weekly e-mail newsletter. I thought it was interesting that the decision to practice obstetrics was tied primarily to rising malpractice premiums. Is this as major an issue for family physicians practicing obstetrics? My impression was that students and residents going into family practice and choosing not to practice obstetrics do so because of lack of interest, lifestyle issues, or perceived (or real) lack of support from their medical community or hospital. Family docs could certainly fill the void to provide access to prenatal/perinatal care. -Ron Labuguen

2) AMA speaks out on professional liability insurance issue The April issue of SELF Magazine features an article entitled "Who will deliver your baby?" discussing the impact of the current ob/gyn shortage nationwide. Rising malpractice insurance rates are prompting record numbers of obstetricians to scale back their practice to gynecology only. In 2001, eight states saw two or more liability insurers raise rates by at least 30% last year, according to an AMNews analysis. Commenting on this downward-spiraling liability crisis, AMA Secretary-treasurer Donald J. Palmisano, MD, JD, said, "The situation is seriously threatening women's access to care. Not only are seasoned physicians quitting OB practice, but obstetrics is having a very difficult time recruiting new doctors."

Learn more http://www.ama-assn.org/sci-pubs/amnews/pick_02/prl10107.htm

Ron Labuguen [email protected]