| Dr. Loren Finley, MD, the only independent OB/GYN physician left in Gig Harbor, describes some of his experiences of being in a high-risk practice this way: For the average baby delivery today, he collects about the same amount of money as he did in 1990, and even less for a hysterectomy. In the meantime, his rent has doubled, and malpractice insurance rates have gone up five times. Even so, his policy has reduced coverage from $2 million to $1 million, and to keep it at his old $2 million coverage he would have to nearly double his current malpractice insurance premium (to about $120,000 per year).
For all doctors, rates have not kept up with inflation. Washington has lower Medicaid reimbursement rates by the federal government compared to many other states, and health insurance companies base their reimbursements on those rates. At the same time, doctors find themselves spending more time on paperwork and less with patients.
“Our costs have gone up tremendously for all physicians,” said Finley, a Gig Harbor resident who practices in Gig Harbor and Tacoma. “Because of all the insurance changes, the real dollars we receive have gone considerably down — the profit margin has narrowed.”
Finley’s story is not unique. When he opened his Gig Harbor office about four years ago, the area had four OB/GYNs, two of whom were full time, he said. Aside from his independent practice, MultiCare has a few obstetricians in Gig Harbor part time.
“Tacoma has seen a reduction from 25 to nine (OB/GYNs) in three years,” he wrote in an editorial for the local weekly paper in July 2004. “In the last four years, 39 percent of family practitioners, and 19 percent of OBs have dropped obstetrics.”
Finley is perhaps among the more outspoken OB/GYNs in the area. Several Kitsap practitioners declined to give interviews on malpractice insurance. But their concerns are familiar to the public and to the state lawmakers, who have been lobbied for many years by the medical community to effectively deal with the topic of tort reform.
“We really do have a problem. The physicians know we have a problem, and the lawyers did a good job of muddying the waters, effectively blocking the doctors’ efforts to educate the population,” he said, referring both to the tort reform impasse in the 2005 legislative session, and to the opposing tort reform-related petitions that were placed on the November 2005 ballot, both of which failed.
“Trial lawyers… didn’t want to win (Initiative) 336, they just wanted to make sure (Initiative) 330 failed,” he said. “They succeeded… and the losers will be the population of the state as a whole.”
The problem, Finley and his colleagues point out, is that many current practitioners are in their 50s. Some are retiring early, others are exiting the industry — but even those remaining in practice will be difficult to replace because it’s hard to recruit new practitioners to come to the state.
“The net result, and not just from malpractice insurance but also the total business climate, means we cannot recruit people,” he said.
Finley speaks from experience. His son is studying to be an orthopedic surgeon, and so far undergraduate schooling has cost him $40,000. He will need to borrow $200,000 for medical school, which means his loan repayment will be around $2,000 to $3,000 per month for 10 years.
“He is going in with eyes wide open, knowing all the options. Most physicians don’t encourage their families to go into medicine,” he said. “Right now, in high-risk specialties… there are a whole lot of people in their low-50s, and very few young people coming in. In five to 10 years, we’ll have a waive of retirements, and no one to replace them.”
Finley acknowledges that malpractice insurance rates are only part of the problem, and that they are not out of line in Washington compared to other states. But he said it’s a myth that insurance companies are benefiting. Physicians Insurance, the only company in the state that covers high-risk specialties, is a for-profit company owned and operated by physicians. Last year, insurance costs have come down slightly, he said, because the company’s costs to defend cases are reflected in the insurance premiums.
Various parties have offered opposing solutions to what doctors and insurance companies see as a crisis. For Finley, the solution lies with society. Our society encourages lawsuits, he believes, and the society will have to determine, on a nationwide basis, what cap should be placed on pain and suffering claims (payouts beyond medical expenses and economical damages). In addition, he believes the field should be leveled with the Medicare reimbursements.
Without of a solution, “what will happen is an access to care crisis where people are physically harmed because there’s nobody around (to help them),” he said. |
