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<a href="http://abcnews.go.com/sections/wnt/DailyNews/malpractice_insurance020305.html" target="_blank">ABC News Article - "Crushing Cost of Insurance"</a>
Interesting Article from ABC News on Malpractice Insurance
- Thread starter Pinky
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Is this a problem in a lot of states. I know West Virginia is losing a lot of docs to bordering states because of malpractice. Our state government has just tried to help by creating it's on Malpractice Insurance for those docs that get dropped but I believe the rate is 10% of the highest rate in the state (Not a great deal) I haven't seen much on this board about it and was wondering if others are worried. I plan to go into FM and would love to deliver some babies but probably can't afford to do that.
What do you guys think?????
What do you guys think?????
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I believe there was an article in the philadelphia inquirer about docs leaving philadelphia in droves to practice in other states (ie Southern NJ) because the malpractice premiums in philadelphia have jump 2-5X! I cannot fault them from jumping ship. Malpractice awards and number of suits are really out of hand.
There will need to be some sort of tort reform, but I doubt it will happen because ex-lawyers make the laws and trial lawyers probably have a stronger lobby than physicans (IMHO).
It's hard to figure out ways that are not unconstitutional, such as getting rid of a jury trial and make it binding arbitration, or better yet instead of judge have a panel of physicians decide the case as is done in one of the scandinavian countries. The malpractice rate in those countries is much lower than the US. The other system involves putting a "cap" on damages. This would work well for insurance companies because then your risk is defined somewhat if one can predict # of events per year. Thus insurance premiums would stabilize if the number of claims stayed relatively constant because the "upside" possibility in monetary damages would be capped.
There will need to be some sort of tort reform, but I doubt it will happen because ex-lawyers make the laws and trial lawyers probably have a stronger lobby than physicans (IMHO).
It's hard to figure out ways that are not unconstitutional, such as getting rid of a jury trial and make it binding arbitration, or better yet instead of judge have a panel of physicians decide the case as is done in one of the scandinavian countries. The malpractice rate in those countries is much lower than the US. The other system involves putting a "cap" on damages. This would work well for insurance companies because then your risk is defined somewhat if one can predict # of events per year. Thus insurance premiums would stabilize if the number of claims stayed relatively constant because the "upside" possibility in monetary damages would be capped.
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I hate to keep being the bearer of the supply/demand economic curve, but areas with high malpractice and low remediation have high physician drop out rates and low acceptance by new physicians. In variably, if premiums are indeed determined by award cost, and there are fewer providers, fewer procedures, and therefore fewer lawsuits than logic would dictate that there would be lower premium rates to mediate retention. See physicians have never understood the power they posess. To us it's always been, "this is a business...and I can't believe rates are this high...and how can I afford to live". Look if something is a business, learn the business. The reality is no one should know it better than you do (trust me you don't need an MBA to know how to run a business...it just requires acutely understanding what your market does...period). Practices are going to a group model, because then you can spread out risk. If you are either: a) in a very competitive market, or b) run a speciality practice in a high risk field, be prepared to absorb elevated premiums. The doctors in vegas run a very high risk practice in a very litiginous state, and philly is a very crowded market. That's why practicing medicine in the midwest or the south is every physicians best bet (actually practicing in vegas is fine, just don't practice for the big hospital there because they shove the malpractice on the specialty groups instead of spreading out through out all hospital staff, and getting premium reduction on volume...it's completely stupid and who ever is their business manager should be shot). Anyway, malpractice is an issue and always has been. Probably always will be. It's just more obvious now because remediation is less, but malpractice claims and pay out is more. My advice to all is be very careful of the premium rates on malpractice wherever you go...they really try to screw individual and high specialty groups. Join a multi-specialty group. Payment of malpractice is dispersed..and they are then able to derive more revenue from higher billing procedures while defraying malpractice costs across the practice. Research before you jump in to any practice opportunity...that should really help you. And those states where doctors are leaving in droves...well that's where the highest pay and the lowest rates will exist in ten to twenty years.
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sorry to add a point,
The one thing you can't account for unfortunately is any state that does not set premium ceilings (meaning based on the payout of all claims within the year, no insurance provider can rise above a certain ceiling of premium cost). In those states, insurance companies can arbritarily raise rates as high as they want. And yes...that does suck. On top of that, states where there are limited insurance providers...you are screwed to, because there is no competitive force in that market. When both happen...you're in deep trouble.
Case in point...west virginia. Alambama actually has ceiling premiums...so does georgia, and florida. I could go on...but that is extremely boring.
The one thing you can't account for unfortunately is any state that does not set premium ceilings (meaning based on the payout of all claims within the year, no insurance provider can rise above a certain ceiling of premium cost). In those states, insurance companies can arbritarily raise rates as high as they want. And yes...that does suck. On top of that, states where there are limited insurance providers...you are screwed to, because there is no competitive force in that market. When both happen...you're in deep trouble.
Case in point...west virginia. Alambama actually has ceiling premiums...so does georgia, and florida. I could go on...but that is extremely boring.
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I'm not so sure that supply/demand economics has much to do with it. At least to my simple mind it seems more like a solvable problem. The insurance companies are not to blame, they have to raise insurance rates to maintain a profit through the many multiMILLION $ awards given in the past few years in Vegas. They don't settle, then if they lose they pay 4 times as much because some idiot jury awards $8.4 million. You can't blame the doctors because they are obviously trying not to make mistakes but they do happen. Hard to blame the lawyers going for these cases. They don't feel any responsibility to the community or any moral obligation past the $$ and we shouldn't expect more from them. We know better than that. So who is to blame? According to the Las Vegas papers California passed laws capping jury malpractice awards and rates have remained reasonable. The lawmakers, despite some being attorneys themselves, do have a responsibility to the community. If they allow this to continue between 20 and 50% of all physicians will leave Vegas by June. I would--can you imagine spending $200,000 a year for insurance. Many doctors have stopped taking home a salary to keep their business afloat. Almost all the OB/GYNs and surgeons (all types)will be forced out. What a disaster to a city that gets 60,000 new residents moving in every year.
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Yeah,
Actually you are right...I'm trying to remember the twelve states where Micra (or mitra) rules don't exist...and low and behold West Virginia, Nevada, and Pennsylvania are all on that list. I stand corrected...there are no premium ceilings at all..which happens to be the biggest reason. Shame really for all the insured patients of vegas....lucky that the fee for service market is still so lucrative in that city. Or else there might be no physicians at all. It'll change...it had to in california or else the exodus out here would have started much earlier.
Actually you are right...I'm trying to remember the twelve states where Micra (or mitra) rules don't exist...and low and behold West Virginia, Nevada, and Pennsylvania are all on that list. I stand corrected...there are no premium ceilings at all..which happens to be the biggest reason. Shame really for all the insured patients of vegas....lucky that the fee for service market is still so lucrative in that city. Or else there might be no physicians at all. It'll change...it had to in california or else the exodus out here would have started much earlier.
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•••quote:•••Originally posted by wbd161:
•What's the story with California anyway? Property values have indeed skyrocketed over the past few years but there must be other reasons physicians are moving out. What are they?•••••The reimbursement rates in California are rather dismal due to the strong HMO stronghold on the state. Great place to train, bad place to practice.
•What's the story with California anyway? Property values have indeed skyrocketed over the past few years but there must be other reasons physicians are moving out. What are they?•••••The reimbursement rates in California are rather dismal due to the strong HMO stronghold on the state. Great place to train, bad place to practice.
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$200k per year for insurance? How is that possible? I seriously doubt those docs many any more than perhaps 300k per year which is high, even for a surgeon.
Are you seriously telling me they give up 2/3 of their income for insurance? Thats insane.
I expect insurance to be expensive, maybe $20k per year for surgeons. But anything above that is ludicrous. Doctors salaries are falling, I predict that in 20 years the avg doctor salary will be closer to 100k. Insurance rates cant remain as high as they are as salaries fall, otherwise not only would it be not wise to practice medicine, but nobody will be able to afford paying out $50k for insurance.
I think its absolutely unfair and outrageous that I should have to give up 50% (or greater) of my income for insurance. There is no other profession that even comes close to that kind of burden.
Are you seriously telling me they give up 2/3 of their income for insurance? Thats insane.
I expect insurance to be expensive, maybe $20k per year for surgeons. But anything above that is ludicrous. Doctors salaries are falling, I predict that in 20 years the avg doctor salary will be closer to 100k. Insurance rates cant remain as high as they are as salaries fall, otherwise not only would it be not wise to practice medicine, but nobody will be able to afford paying out $50k for insurance.
I think its absolutely unfair and outrageous that I should have to give up 50% (or greater) of my income for insurance. There is no other profession that even comes close to that kind of burden.
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Physician Unionization...
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Ok,
Guys relax. Let me address the points sequentially:
1) These states don't have caps, because this is the first time they are facing any of these issues. California made caps as soon as the issue arose. If you don't it doesn't become feasible for anyone to practice (though the increase in the cost of living, and the emergence of managed care were two things they didn't consider).
2) Insurace companies don't want doctors to leave. They make their money in widespread premium. They recognize that by jacking up the premium they reduce the number of physicians who can pay (by attrition). They will lobby just as badly as anyone else to put caps.
3) The majority of states not the minority provide malpractice caps. There are certain states that haven't because the monetary payouts had never been that high, until now.
4) DOCTORS...MAKING A HUNDRED THOUSAND. Dude, if you honestly believe that...you need to get out now. Don't even look back...just get out. Do anything else...if you are making a 100,000 and malpractice is 50,000...then you are equivalently a school teacher. Teaching people is as rewarding as saving their lives, with far less stress. I would be a school teacher, and at least give yourself an extra ten years of income. Look at it this way...if you make 50,000 net...and you have 90,000 in loans...NO ONE WILL GO INTO THAT FIELD....PERIOD. There will be such a shortage, they'll be giving scalpels to orphans to start cutting.
5) Despite managed care, the average salary for a medical resident in the US is 36,000. In 1980 that number was 18,000. The adjustments are for cost of living. My belief is that not only will physicians maintain their current standard of living (which by pure economic forces will happen), it might actually increase. Unionization is one option, the other is direct contracting with employers. There are many group practices that provide that service (they basically obviate the middle man, and go right to the employers and give the employees direct, uninterrupted care). The reality is the future will just be more empowered individual choices. More of the cost of health care will fall on individuals, and when that happens they will definately be more careful about cost and savings, etc. Insurance companies are already starting to offer market force plans. Trust me, getting directly reimbursed for services is far better, than hoping you get something back when you file an insurance claim.
6) Doctors will always make good money, but we won't be aggregiously wealthy (unless we diversify into real estate or medical devices or bio tech, etc.). That was the past, so if you are expecting the future to be the same you are sorely mistaken. Internists won't make millions of dollars a year. But, you will have a good life, make a very good salary, have a relatively stable job, and in some cases, have a very entrepreneurial practice. And you have a disposable income to invest with...EVEN IN SOCIALIZED COUNTRIES, DOCTORS DON'T MAKE A 100,000 A YEAR (or the equivalent there of in their currency, and if they do...they don't have school loans or malpractice because the government covers and caps respectively).
Listen, I love this board. I think it's a great place to post concerns and questions...AND IN THE END YOU SHOULD BE A DOCTOR BECAUSE YOU LOVE IT. I know that sounds like rhetoric, but it's true. Unfortunately...IT IS HARD...REALLY HARD...to find justification to do anything IF THE SALARY LEVEL SHRINKS THAT MUCH AND YOUR DEBT LEVEL IS THAT HIGH. If that happens, it will become a fast cycle of departure for most physicians. They will not apply, and also leave in droves.
In closing, do I wish in the end that I hadn't become a physician? If I didn't like it...I suppose I would. I percieve that I would just state hatred for it all and never come back...but that isn't reality. I like medicine, I like what I do. I don't think in twenty years I'll be making 100,000 dollars (considering that the average american income will be fifty thousand...I highly doubt I will). I believe the system of medicine will be very different. I believe money will still pour into healthcare, because it is a universal problem. I don't think we will become as wealthy as our predecessors...but I also don't believe we'll be hurting. In the end, I think it's the best job you can have...outside of being an entrepreneur. If you believe medicine is dead or a dying field, get out... by the sheer fact that you have gotten this far, you are smart enough to do and be something else. It is naive to believe even if you love something, that you wouldn't want to be remediated somehow for it. Make the right decisions, and find another career. I just believe that in the end, I will do something I genuinely enjoy doing, get paid well to do it, and have the opportunity to do a lot of interesting things on the side.
Guys relax. Let me address the points sequentially:
1) These states don't have caps, because this is the first time they are facing any of these issues. California made caps as soon as the issue arose. If you don't it doesn't become feasible for anyone to practice (though the increase in the cost of living, and the emergence of managed care were two things they didn't consider).
2) Insurace companies don't want doctors to leave. They make their money in widespread premium. They recognize that by jacking up the premium they reduce the number of physicians who can pay (by attrition). They will lobby just as badly as anyone else to put caps.
3) The majority of states not the minority provide malpractice caps. There are certain states that haven't because the monetary payouts had never been that high, until now.
4) DOCTORS...MAKING A HUNDRED THOUSAND. Dude, if you honestly believe that...you need to get out now. Don't even look back...just get out. Do anything else...if you are making a 100,000 and malpractice is 50,000...then you are equivalently a school teacher. Teaching people is as rewarding as saving their lives, with far less stress. I would be a school teacher, and at least give yourself an extra ten years of income. Look at it this way...if you make 50,000 net...and you have 90,000 in loans...NO ONE WILL GO INTO THAT FIELD....PERIOD. There will be such a shortage, they'll be giving scalpels to orphans to start cutting.
5) Despite managed care, the average salary for a medical resident in the US is 36,000. In 1980 that number was 18,000. The adjustments are for cost of living. My belief is that not only will physicians maintain their current standard of living (which by pure economic forces will happen), it might actually increase. Unionization is one option, the other is direct contracting with employers. There are many group practices that provide that service (they basically obviate the middle man, and go right to the employers and give the employees direct, uninterrupted care). The reality is the future will just be more empowered individual choices. More of the cost of health care will fall on individuals, and when that happens they will definately be more careful about cost and savings, etc. Insurance companies are already starting to offer market force plans. Trust me, getting directly reimbursed for services is far better, than hoping you get something back when you file an insurance claim.
6) Doctors will always make good money, but we won't be aggregiously wealthy (unless we diversify into real estate or medical devices or bio tech, etc.). That was the past, so if you are expecting the future to be the same you are sorely mistaken. Internists won't make millions of dollars a year. But, you will have a good life, make a very good salary, have a relatively stable job, and in some cases, have a very entrepreneurial practice. And you have a disposable income to invest with...EVEN IN SOCIALIZED COUNTRIES, DOCTORS DON'T MAKE A 100,000 A YEAR (or the equivalent there of in their currency, and if they do...they don't have school loans or malpractice because the government covers and caps respectively).
Listen, I love this board. I think it's a great place to post concerns and questions...AND IN THE END YOU SHOULD BE A DOCTOR BECAUSE YOU LOVE IT. I know that sounds like rhetoric, but it's true. Unfortunately...IT IS HARD...REALLY HARD...to find justification to do anything IF THE SALARY LEVEL SHRINKS THAT MUCH AND YOUR DEBT LEVEL IS THAT HIGH. If that happens, it will become a fast cycle of departure for most physicians. They will not apply, and also leave in droves.
In closing, do I wish in the end that I hadn't become a physician? If I didn't like it...I suppose I would. I percieve that I would just state hatred for it all and never come back...but that isn't reality. I like medicine, I like what I do. I don't think in twenty years I'll be making 100,000 dollars (considering that the average american income will be fifty thousand...I highly doubt I will). I believe the system of medicine will be very different. I believe money will still pour into healthcare, because it is a universal problem. I don't think we will become as wealthy as our predecessors...but I also don't believe we'll be hurting. In the end, I think it's the best job you can have...outside of being an entrepreneur. If you believe medicine is dead or a dying field, get out... by the sheer fact that you have gotten this far, you are smart enough to do and be something else. It is naive to believe even if you love something, that you wouldn't want to be remediated somehow for it. Make the right decisions, and find another career. I just believe that in the end, I will do something I genuinely enjoy doing, get paid well to do it, and have the opportunity to do a lot of interesting things on the side.
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Actually, I've always wondered why more people don't support the idea of a physician's union?
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•••quote:•••Originally posted by lilycat:
•Actually, I've always wondered why more people don't support the idea of a physician's union?•••••Private practice physicians or physicians who work at different hospitals cannot unionize to negotiate contracts with insurance companies unless congress passes a law that exempts physicians from federal anti-trust laws. There is one state where physicians are unionizing, I don't remember what state, but the government is letting the unionization go on in this one particular state to see what it does to health care in the area.
•Actually, I've always wondered why more people don't support the idea of a physician's union?•••••Private practice physicians or physicians who work at different hospitals cannot unionize to negotiate contracts with insurance companies unless congress passes a law that exempts physicians from federal anti-trust laws. There is one state where physicians are unionizing, I don't remember what state, but the government is letting the unionization go on in this one particular state to see what it does to health care in the area.
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•••quote:•••The doctors in vegas run a very high risk practice in a very litiginous state, and philly is a very crowded market. ••••Just wanted to clarify. Cases in Nevada go to a medical malpractice review board (run by a group of physicians) before they are allowed to go trial. This prevents frivolous lawsuits/claims. A physician that I worked for had to go in front of this panel and the case was subsequently thrown out. I wouldn't say that the state of Nevada is "litiginous" in the sense of malpractice cases, maybe auto accidents.
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•••quote:•••Originally posted by Bucco:
•Is this a problem in a lot of states. I know West Virginia is losing a lot of docs to bordering states because of malpractice. Our state government has just tried to help by creating it's on Malpractice Insurance for those docs that get dropped but I believe the rate is 10% of the highest rate in the state (Not a great deal) I haven't seen much on this board about it and was wondering if others are worried. I plan to go into FM and would love to deliver some babies but probably can't afford to do that.
What do you guys think?????•••••I always thought that West Virginia had a shortage of physicians because physicians don't want to live in West Virginia. One reason that their malpractice insurance is so high is probably from Ob/Gyn insurance skyrocketting in that area, a lot of things can go wrong during birth if the baby's parents were related to each other before they got married <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
Just kidding
•Is this a problem in a lot of states. I know West Virginia is losing a lot of docs to bordering states because of malpractice. Our state government has just tried to help by creating it's on Malpractice Insurance for those docs that get dropped but I believe the rate is 10% of the highest rate in the state (Not a great deal) I haven't seen much on this board about it and was wondering if others are worried. I plan to go into FM and would love to deliver some babies but probably can't afford to do that.
What do you guys think?????•••••I always thought that West Virginia had a shortage of physicians because physicians don't want to live in West Virginia. One reason that their malpractice insurance is so high is probably from Ob/Gyn insurance skyrocketting in that area, a lot of things can go wrong during birth if the baby's parents were related to each other before they got married <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
Just kidding
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Well..
So let me assume then that these cases have gone to trial even after they have come up, and that is where the jury awarded massive punitive damanges. Hmm...well....they'd better cap it...or else every drunk, gambler 20 miles around the strip who gets a laceration...will have to drink a pint of cuervo and buy a needle, spool and thread. Any internal injuries...well...stick a straw in there and see if you hit the right viscous space...
So let me assume then that these cases have gone to trial even after they have come up, and that is where the jury awarded massive punitive damanges. Hmm...well....they'd better cap it...or else every drunk, gambler 20 miles around the strip who gets a laceration...will have to drink a pint of cuervo and buy a needle, spool and thread. Any internal injuries...well...stick a straw in there and see if you hit the right viscous space...
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I have a question. If a physician is part of an HMO, is their malpractice covered by the HMO? Are there any group practices that provide malpractice insurance, or is it directly from the physician's salary?
I was asking because if so I could see more doctors being forced into larger companies just to pool the malpractice risk (e.g. larger companies may be able to negotiate better rates maybe?).
Thoughts?
I was asking because if so I could see more doctors being forced into larger companies just to pool the malpractice risk (e.g. larger companies may be able to negotiate better rates maybe?).
Thoughts?
