Surgeon’s Malpractice has doubled from 2009 to 2011, and OB/GYNs has quadrupled from 2005 to 2011!

Doctor's malpractice insurance cost rise has little impact in Pittsburgh region so far Sunday, November 11, 2001 By Christopher Snowbeck, Post-Gazette Staff Writer Pennsylvania doctors predicted in January that escalating malpractice insurance premiums would force many physicians to flee the state, but that hasn't occurred in the Pittsburgh area. To be sure, defections are increasingly common in the Philadelphia area. Last month, a group of 18 orthopedic surgeons said they would stop performing surgery, though they continue to practice in Delaware County, rather than pay malpractice premiums of $130,000 per doctor, up from $65,000 two years ago. But such announcements are practically nonexistent in the west, where work force numbers suggest the region isn't suffering from a lack of doctors. For example, while the birth rate has declined in Western Pennsylvania in the past 15 years, the number of doctors specializing in obstetrics and gynecology has boomed, according to the state's Medical Professional Liability Catastrophic Loss Fund, or CAT Fund. Whereas 388 ob-gyns were practicing in Western Pennsylvania in 1987, the number had grown to 513 by last year, an increase of roughly 30 percent. "The statistics that are in hand at this time do not reflect a mass migration," said John Reed, director of the CAT Fund, which defines Western Pennsylvania as a 27-county area. "That does not, however, answer the question about whether physicians will leave in the future. At this point, we're fortunate that most physicians are still here." Like other doctors, Dr. Jeff Baum, president-elect of the Pennsylvania Orthopedic Society and a surgeon at UPMC St. Margaret, says excessive jury awards are to blame for the fast-rising malpractice insurance premiums, and the solution is tort reform. Among other things, that means passing laws to cap the amount of money juries can award for the pain and suffering of injured patients in medical malpractice cases. But John Gismondi, a trial lawyer in Pittsburgh, countered that problems in the malpractice insurance market stemmed not from large jury awards but from the insurance companies' stock market investments and previously underpriced policies. Doctors should focus on preventing errors, Gismondi said, rather than asking the Legislature to curtail the rights of plaintiffs. Despite the higher premiums at his office, Dr. Frank DiCenzo, an obstetrician in Sewickley, is sticking around, but he predicts other doctors will leave or, in the case of his specialty, will stop delivering babies. Six years ago, DiCenzo's practice paid $78,000 for malpractice insurance covering five ob-gyn specialists and a gynecologist who didn't deliver babies. Some doctors have come and gone since then, but by last year, the tab for the same mix of doctors was almost $286,000. Barb Condit, the practice's business manager, expects next year's premiums to exceed $300,000. The increase in malpractice premiums has been coupled with stagnant reimbursement rates, which leaves reimbursement for specialists in Western Pennsylvania well below the national average, according to DiCenzo. "At the current reimbursement level, we are receiving about $40 to $60 per hour for each hour of direct patient care," DiCenzo said. "This is the equivalent of what a lawn mower repairman, plumber, car mechanic or painter gets reimbursed for his or her services." Further complicating the fiscal picture is the rising cost of technology that doctors must buy to improve their practices, said Dr. Helen F. Krause, an ear, nose and throat surgeon at UPMC Passavant. But physicians' arguments about reimbursements, compensation and the impact on the physician work force don't always fit with national studies on the subject. Physician reimbursement here, for example, might not be what it once was, but it's not necessarily out of line with national averages, according to a recent study by the Pennsylvania Medical Society. The study found that Pittsburgh physicians rank 17th among the 25 largest metropolitan areas in HMO reimbursements, a rank commensurate with the cost of living and size of the area. The study did find problems with physician reimbursements in Pennsylvania, but, as with malpractice premiums, the worst of it is in Philadelphia, where physician pay ranked dead last. "HMO payments to doctors in Philadelphia are some of the worst payments in the United States," said Dennis Olmstead, chief economist with the Pennsylvania Medical Society. "But I couldn't sit here today and tell you that physician payments in Pittsburgh are 20 percent lower than they are in Ohio or New York." At least two national reports published this year suggest that some doctors have been enjoying pay increases. Medical Group Management Association reported this year that median compensation for specialists increased 6 percent to $256,494 between 1999 and 2000. Orthopedic surgeons saw their median compensation increase by more than 5 percent to $335,646. Pay for ear, nose and throat surgeons declined less than 1 percent to $235,415, but ob-gyns' median income increased about 2 percent to $236,353. A survey released last month from Merritt, Hawkins & Associates in Dallas found that practices looking to hire specialists were paying more, too. And there's a question as to whether the flight of doctors would dangerously deplete the overall supply of physicians here. It's hard to get a precise picture of the local physician work force, but 1993 and 1995 numbers from the Dartmouth Atlas of Healthcare show that Pittsburgh had about as many doctors as the national average in the three specialties being hardest hit by the premium crunch: orthopedics, neurosurgery and obstetrics. More recent CAT Fund figures show a decrease in the number of neurosurgeons in Western Pennsylvania since the mid-1990s. Whereas there were 80 neurosurgeons in 1995, the number fell to 72 by 2000. But the number of ob-gyns increased from 455 to 513 over that same period, and the number of orthopedic surgeons grew even more dramatically, from 278 to 354. Orthopedic surgeon Baum said part of the reason for the increase in physicians in his profession was that doctors are more specialized in the procedures they perform. What's more, the research community has grown, he said, meaning that not all of the new doctors are providing care to patients. Baum acknowledged that the increasing ratio of physicians to patients could be a factor in why doctors can't afford higher premiums, as more providers compete for the same number of patients. But the MGMA salary figures are higher than what many orthopedic surgeons here make, he said, and rising malpractice premiums are being eclipsed as a problem by insurance companies that have stopped offering policies here. "I just heard today that [for] 60 percent of the orthopedic surgeons in the Greensburg area, their insurance carrier would not renew their insurance," Baum said. "Have droves of orthopedists left the western part of the state yet? No, they haven't. But I don't know what's going to happen come the new year."