malpractice and surgery troubles

[drbruce]

As I'm from the UK, it came as quite a surprise to me to find out how much US surgeons are paying for malpractice medical insurance.

We do have sue happy lawyers in England but most of them are kept in a huge box that has been securely locked and they only ever let out in order to sue greedy multi millionaires and celebrities. Why can't you have this system in the US?

In the US, I read that neuro, CT, general surgeons are being forced to move elsewhere to get away from expensive states or even into early retirement and it seems incredible to me that this kind of barbaric practice of suing people who are trying to save your life is being freely allowed to continue in a country that is a worldleader in medicine. One such neurosurgeon reported that after paying malpractice premiums his take home income was only $64,000 per year, hardly enough to pay off his expensive university tuition fees or buy his daughter that pony she always wanted. Even British junior doctors are being paid more than that! High school grads will have no incentive to enter medicine.

What the hell is going on in the US and when will your government intervene to reduce these stupid malpractice insurance premiums?

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[johankriek]

never as long as the lawyers have a strong lobby..

I agree major major problem in the USA

 

[Miami_med]

As I'm from the UK, it came as quite a surprise to me to find out how much US surgeons are paying for malpractice medical insurance.

We do have sue happy lawyers in England but most of them are kept in a huge box that has been securely locked and they only ever let out in order to sue greedy multi millionaires and celebrities. Why can't you have this system in the US?

In the US, I read that neuro, CT, general surgeons are being forced to move elsewhere to get away from expensive states or even into early retirement and it seems incredible to me that this kind of barbaric practice of suing people who are trying to save your life is being freely allowed to continue in a country that is a worldleader in medicine. One such neurosurgeon reported that after paying malpractice premiums his take home income was only $64,000 per year, hardly enough to pay off his expensive university tuition fees or buy his daughter that pony she always wanted. Even British junior doctors are being paid more than that! High school grads will have no incentive to enter medicine.

What the hell is going on in the US and when will your government intervene to reduce these stupid malpractice insurance premiums?

Simple, we'll just sue people who get sick. Then they will be scared into being well and they won't need surgeons. If anyone complains we'll sue.

 

[ghost_its]

To the OP, you've hit on a particularly painful part of practicing/training in medicine in the US. Unfortunately as the other replies have already mentioned, right now nothing will happen. Here's my take on it, I apologize if this seems oversimplified to everyone, please feel free to flame me and/or add your thoughts to this

The simple key to understanding pretty much everything in the US is MONEY. There is a perception in the general population that doctors HAVE it, despite the contrary being the case in many instances nowadays. In reality we are being squeezed by increasing malpractice insurance (more money OUT of our pockets) and constantly decreasing pay for our services from health insurance companies and Medicare (private and governmental sectors - LESS money coming INTO our pockets). Now, the lawyers and their lobby in the US are very strong (The vice-presidential candidate for the US position in 2004 was a malpractice lawyer) and I agree that there is a need for their services as well, BUT NOT to the extent that we see right now, with the number of completely frivolous law suits being brought to the courts against physcians, who many times were not even involved in the care of the plaintiff. (BTW, I train in one of the worst malpractice markets in the US, this being Philadelphia, PA, where the juries are notorious for siding with the plaintiffs in majority of malpractice suits regardless of merit) This compounded with the previous false notion that doctors have a ton of money, there's naturally a tendency to try extract exorbitant sums of money from us by the lawyers (who of course usually get a percentage of the "winnings"). California is one of the few exceptions to this because they have set up malpractice payout caps on lawsuits, limiting the amount of damage that can be monetarily done to a physician. Also, the unknown effects that the public does not see, are that even if you are found innocent, many times the case will be on your permanent record, which many times still leads to increased insurance rates from the malpractice companies. (PLEASE, correct me if I'm wrong on that last sentence, but that's the way I understand it right now.) Under these kinds of pressures, it is no wonder that we are losing physicians in such tough markets as where I'm training. Many move to other states with better control (i.e. California for instance) and many retire as the OP has already mentioned. I personally know of patients, who are forced to drive 2-3 hours to see an OB/Gyn because many of them retired in their area due to these problems and the rest are so booked up with existing patients that they cannot take new ones.

So the bottom line is that it all comes down to the almighty DOLLAR. And until someone prominent dies or a daughter/son of a powerful politician/lawyer bites the dust because they were in an accident and couldn't find a trauma surgeon within any of the hospitals in the area, there will be absolutely no will to change anything. People on average are not stupid in the US, but are mostly IGNORANT, and until something hurts their pocketbook directly or hurts their family directly, no one really gives a crap. And even then, unless it's someone powerful or a politician that can raise hell then nothing still happens...

Looking back at it, sounds pretty cynical what I wrote... We'll see what happens. I guess I'd have to agree with Morgan Freeman when he say at the end of SEVEN "The world's a beautiful place and worth fighting for. I agree with the second part." We're all fighting in our little corners to make this a little bit better place in our own way.

Getting off my soapbox now, too tired to type and rant anymore

 

[Miami_med]

To the OP, you've hit on a particularly painful part of practicing/training in medicine in the US. Unfortunately as the other replies have already mentioned, right now nothing will happen. Here's my take on it, I apologize if this seems oversimplified to everyone, please feel free to flame me and/or add your thoughts to this

The simple key to understanding pretty much everything in the US is MONEY. There is a perception in the general population that doctors HAVE it, despite the contrary being the case in many instances nowadays. In reality we are being squeezed by increasing malpractice insurance (more money OUT of our pockets) and constantly decreasing pay for our services from health insurance companies and Medicare (private and governmental sectors - LESS money coming INTO our pockets). Now, the lawyers and their lobby in the US are very strong (The vice-presidential candidate for the US position in 2004 was a malpractice lawyer) and I agree that there is a need for their services as well, BUT NOT to the extent that we see right now, with the number of completely frivolous law suits being brought to the courts against physcians, who many times were not even involved in the care of the plaintiff. (BTW, I train in one of the worst malpractice markets in the US, this being Philadelphia, PA, where the juries are notorious for siding with the plaintiffs in majority of malpractice suits regardless of merit) This compounded with the previous false notion that doctors have a ton of money, there's naturally a tendency to try extract exorbitant sums of money from us by the lawyers (who of course usually get a percentage of the "winnings"). California is one of the few exceptions to this because they have set up malpractice payout caps on lawsuits, limiting the amount of damage that can be monetarily done to a physician. Also, the unknown effects that the public does not see, are that even if you are found innocent, many times the case will be on your permanent record, which many times still leads to increased insurance rates from the malpractice companies. (PLEASE, correct me if I'm wrong on that last sentence, but that's the way I understand it right now.) Under these kinds of pressures, it is no wonder that we are losing physicians in such tough markets as where I'm training. Many move to other states with better control (i.e. California for instance) and many retire as the OP has already mentioned. I personally know of patients, who are forced to drive 2-3 hours to see an OB/Gyn because many of them retired in their area due to these problems and the rest are so booked up with existing patients that they cannot take new ones.

So the bottom line is that it all comes down to the almighty DOLLAR. And until someone prominent dies or a daughter/son of a powerful politician/lawyer bites the dust because they were in an accident and couldn't find a trauma surgeon within any of the hospitals in the area, there will be absolutely no will to change anything. People on average are not stupid in the US, but are mostly IGNORANT, and until something hurts their pocketbook directly or hurts their family directly, no one really gives a crap. And even then, unless it's someone powerful or a politician that can raise hell then nothing still happens...

Looking back at it, sounds pretty cynical what I wrote... We'll see what happens. I guess I'd have to agree with Morgan Freeman when he say at the end of SEVEN "The world's a beautiful place and worth fighting for. I agree with the second part." We're all fighting in our little corners to make this a little bit better place in our own way.

Getting off my soapbox now, too tired to type and rant anymore

Part of the problem is frivolousness, and part of the problem is the standards themselves. In much of the US, med mal lawsuits are based on the the community "standard of care." This means that any doctor performing any service is required to perform it up to the level of care available in the community. For example, a FP who reads an ECG must do so at the level of a cardiologist if a cardiologist is available in the community. Thus, said FP must either open himself up to litigation every time he reads an ECG because he might miss something obscure, or he limits his practice to exclude ECGs because of the liability. If the FP misses something obscure, or fails to run another test that could have caught something based on a common finding, he is liable. There is no responsibility on the part of the patient in the current system.

This is even more true in simple situations. Patient comes in and has blood test. Patient's test is abnormal. Doctor's staff forget to call patient. Patient never bothers to check up with the staff. It is still the doctor's fault. Again, the doctor is liable. The lawsuit isn't "frivolous," but the patient should have some responsibility here as well. The standard is too severe. Anyone who has ever worked any other job knows that sometimes calls just don't get made. Both sides need to make an effort.

This is also the case with OB. Most FPs won't touch OB in the cities because of the standards of care issue, so all delieveries go to OB/Gyns. When kids die, every mistake is $1 million plus. This "mistake" may be not doing a C-section fast enough, when mom begged you to do all you could to do a vaginal birth. In any case, there are not enough people delivering babies because of the malpractice, those that do are swamped and overworked, making them more likely to make mistakes. They will then be more likely to be sued, leave the profession, and make things worse.

Ok, I'm done now.

 

[supercut]

Yep, that's the US system. I doubt it will change any time soon. Since nearly all of our lawmakers are lawyers, well....guess who they look out after.

We all have our issues. I'm sure your system has some flaws too!