Disappearing doctors Featured

12:25pm EDT May 26, 2004
When Dr. Domingo Gonzalez, a board certified neurosurgeon, reopened his practice in 2001, he never thought he would be out of business by 2004.

Gonzalez, who practiced in Canton from 1972 to 1980 before returning to his native Argentina, was able to get malpractice insurance in the first two years back in practice that protected him against any claim for the rest of the patient's life. By 2003, coverage had been reduced to specific claims, and the cost was $13,000 per year.

But he was shocked when insurance for the next year skyrocketed to $52,000.

"I couldn't afford that," says Gonzalez, who now works part-time in Lorain assisting other neurosurgeons with patient screenings. "I was forced to close. It's not because I had 1,000 claims, I just had one claim, and I'm not even sure it will ever go through. The situation is really bad."

Gonzalez says insurance companies are paying doctors less, overhead costs to run a practice are increasing and malpractice insurance costs -- especially for high-risk specialists like neurosurgeons and obstetricians/gynecologists -- are spiraling out of control.

According to the Ohio State Medical Association, Gonzalez's case isn't unique.

"The major dilemma right now is that liability insurance for physicians is becoming unavailable in some cases and out of reach affordability-wise in others," says Tim Maglione, senior director of government relations for the OSMA. "There are OB/GYNs paying anywhere from $80,000 to $140,000 per year just for insurance. What is happening is some doctors have to make a tough choice as to whether to stay in practice with those types of increases.

"Another example is neurosurgeons are paying premiums for one individual from $150,000 to $200,000 a year just for liability insurance. It's driving very good doctors out of practice."

The states that don't have this problem are the ones that have enacted tort reform that puts limits on how juries decide malpractice cases. They also have a mechanism in place that screens out frivolous cases early in the process.

Ohio has recently enacted a tort reform bill, and Maglione is hopeful that some sort of screening process will follow.

"How this affects employers is in the availability of health care services for employees," says Maglione. "Physicians don't have the ability to negotiate higher reimbursements from the managed care companies. For most employers, if the prices or costs of providing a product go up, they can increase their prices, but in medicine, that isn't a reality."

With fewer doctors, wait times increase. Doctors also have to practice "defensive medicine" to protect themselves from lawsuits.

"Doctors are doing a number of tests and procedures, not because they are clinically required or justified, but just to protect them from lawsuits," says Maglione. "It does drive up the cost of health care and is reflected in the premiums that employers pay.

"We're hoping employers will raise awareness with their employees about the litigation crisis the state is experiencing. It's not just in medicine, but in the manufacturing and service sectors. We're trying to educate people that unnecessary and frivolous lawsuits hurt Ohio's competitiveness, whether the suit is against a physician or a small business. We've got to do something about these lawyers that continue to advertise with the free consultation, no-money-down, risk-free offers that almost create a lottery-like atmosphere in the calls for lawsuits."

Gonzalez hopes the situation will change, but is pessimistic it will happen soon enough to help him.

"Many doctors are closing offices and leaving the state," says Gonzalez.

Maglione agrees.

"When a child comes into an emergency room with head trauma, they Doctors) are the ones that are going to be there to help," says Maglione. "If malpractice costs drives them out, who is going to be there?" How to reach: OSMA, (800) 766-6762