Malpractice insurance mandatory?

[GoofyDoc]

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Is it a requirement to have malpractice insurance? I'd like to know if there are any physicians who practice without it. IMO, insurance is evil and I'd love to see all forms of insurance abolished. Wouldn't one end up paying more for insurance over the course of his/her practice than one would if actually sued successfully? This is just reasoning on my part. It's been a while since I've seen actual numbers, so excuse my ignorance.

 

[Poety]

Yes, you have to have it to have privileges at any hospital 🙂

 

[BKN]

Is it a requirement to have malpractice insurance? I'd like to know if there are any physicians who practice without it. IMO, insurance is evil and I'd love to see all forms of insurance abolished. Wouldn't one end up paying more for insurance over the course of his/her practice than one would if actually sued successfully? This is just reasoning on my part. It's been a while since I've seen actual numbers, so excuse my ignorance.

Actually, its not and there are a few Docs who practice bare. I don't know if any hospitals still allow Docs on staff without, but it was done in the past. It does leave the hospital holding the bag, but if a governmental hospital in some jurisdictions they are immune or have limited liability and may not care. Or you could have an office only practice.

There's an ethical issue with leaving yourself unable to make recompense for damage you may have caused, but honestly the courts are so bad at fairly identifying the medically injured that it wouldn't bother me too much.

Another wrinkle that a financial planner told me about is to put all of your assets in your spouse's name. The down side is the probability of divorce is much higher than the probability of being sued above malpractice limits. And if you have done this, the settlement conference is going to be the shortest on record.

 

[GoofyDoc]

Thanks for the input. I don't think I'd ever put all my assets in my husband's name! 😀

 

[f_w]

There are a couple of neurosurgeons in high-litigation states who figured they might as well take the risk. They are very open about it and start their consent with 'hello I am the uninsured Dr zzzz....'
But they were in practice for many years before they decided to drop their insurance coverage, if you try to start your career without insurance you will have a hard time finding a hospital to credential you (also, some states require any holder of a medical license who is engaged in active practice to carry insurance).

 

[NinerNiner999]

Wouldn't one end up paying more for insurance over the course of his/her practice than one would if actually sued successfully?

I suppose this depends on what you consider to be "successful." Different specialties must pay different rates that correspond to their risk (risk defined by the insurer as frequency of being sued, average amount of settlement/judgement, region/location of physician, etc). So, for the internist who pays $5000 per year in malpractice there is an assumed low risk involved for both the specialty and award of judgement. On the other hand, the OB or the Neurosurgeon who pay $120,000 per year for malpractice are likely to incur more frequent (in the case of the OB) or more economically damaging (in the case of the NSU) litigation. Don't get me wrong, I am not pro-insurance (I too think all insurance companies have a special place reserved for them in the depths of the darkness), but the cost of insurance is not determined by the companies - it is a reflection of the litigiousness of our society.

To answer your question, there is no comparison to the amount spent on insurance versus the amount spent on losing a lawsuit. Even for those paying 100K+ premiums in high risk fields, one $15 million judgement (VERY common in OB, Neurosurgery), plus the legal fees to defend such a case, plus the cost of lost wages while in litigation, is easily (and justifiably so) worth the price of the premium. But, here is where it really doesn't matter - insurers will cover you for your first lawsuit and/or settlement. Depending on the award (their loss), you may or not be covered by them again for future coverage (or they will raise your rates). This is interesting to consider in that if you need to work, you need insurance, and once you have to use your insurance, you may not be able to renew your policy (or be insured by other providers). In short, there is no insurance for your job.

Over the course of their careers, OB's and NSU's may pay upwards of $3 million for malpractice protection, but is a mere fraction of what it would actually cost them if sued "successfully."

 

[CameronFrye]

but the cost of insurance is not determined by the companies - it is a reflection of the litigiousness of our society.

That's partially true, but another huge factor on malpractice premiums is the stock market. The person in charge of malpractice at my hospital talked to my class about malpractice and tort reform. Basically, she said that malpractice premiums have always been cyclical, depending on investment performance and tort reform is not a silver bullet. For example, the state of Virginia has a cap on malpractice awards (I believe it's currently around 1.7 million). While that's good for some fields, it causes physicians in other fields to overpay, b/c they'll go ahead and pay for 1.7 million dollars worth of coverage, which is overkill for some fields.

 

[f_w]

That's partially true, but another huge factor on malpractice premiums is the stock market.

Thank you for regurgitating that mantra of the malpractice shysters. They are pretty good at repeating it over and over again, and by now even physicians believe it to be true.

There is a little kernel of truth to this: Yes, some of the commercial insurers had issues with the performance of their investments, which reflected in their pricing. But what the instigators of this lie ignore is the fact that premiums of the mutual non-profit insurers underwent similar increases, even though they don't have any investments in the stock market at all. The factor driving malpractice cost up are the increasing numbers of lawsuits and the increasing awards in these lawsuits. The 'stock market' is a smoke screen thrown up by the people who have an interest in the death of tort reform. It wants to make me puke when I see some a#_(^)e bar-association president trying to tell legislators that it is the salaries of the ominous 'insurance company executives' who drive up malpractice premiums, not the lawsuits.

Caps are indeed not the silver bullet. As the successful example of the california tort reform demonstrated, limitations on the percentage of the verdict the shysters can squeeze out of their clients are far more effective. (In NYS, an attorney administering an estate for example is limited to 6% of the value for his fee. As a result, the industry has become a lot more civilized and the cases were attorneys managed to milk estates out of half of their money have gone away)

 

[GoofyDoc]

To answer your question, there is no comparison to the amount spent on insurance versus the amount spent on losing a lawsuit. Even for those paying 100K+ premiums in high risk fields, one $15 million judgement (VERY common in OB, Neurosurgery), plus the legal fees to defend such a case, plus the cost of lost wages while in litigation, is easily (and justifiably so) worth the price of the premium.

I had no idea malpractice judgements could be so high. $15 million??!! Perhaps we should sue the lawyers for making our jobs difficult. 😡

 

[f_w]

One reason they are so high is the fact that physicians are insured. The tort industry is allways looking for a 'deep pocket'. (This is why people won't sue 'joes tire and lube' if they flip their POS Explorer after a underinflated overheated tire blows, no they sue Ford, Firestone and the state highway department.)

 

[CameronFrye]

Thank you for regurgitating that mantra of the malpractice shysters. They are pretty good at repeating it over and over again, and by now even physicians believe it to be true.

I'll admit that I certainly don't know a whole lot about this issue. After reading your post, I looked around for more info on this subject. I was disappointed to find that there really isn't much good info out there. Most of the articles I found were written by someone with a vested interest in the outcome of this debate (lawyer or insurance groups mostly). Do you know of any good (impartial) studies that have been done on this issue? I assume that the "truth" is much more complicated than any of the sides make it out to be.

 

[undecided05]

It's almost comical, if not sad at how little most of you know about med mal, but at least it doesn't stop you from spouting off the evils of malpractice lawyers. It's somewhat similar to how patients think that they know more than physicians b/c they heard about something on a commericial or have access to the internet. That's for another story though...
As to the OP's original question, it is possible in most parts of the country to practice without med-mal insurance, but in those areas it is required to have a set amount of cash in a separate bank account in case you were to be sued. I know of at least two states where that number is $250,000 in cash.

 

[NinerNiner999]

It's almost comical, if not sad at how little most of you know about med mal, but at least it doesn't stop you from spouting off the evils of malpractice lawyers. It's somewhat similar to how patients think that they know more than physicians b/c they heard about something on a commericial or have access to the internet. That's for another story though...
As to the OP's original question, it is possible in most parts of the country to practice without med-mal insurance, but in those areas it is required to have a set amount of cash in a separate bank account in case you were to be sued. I know of at least two states where that number is $250,000 in cash.

There is nothing comical about this - Until punitive damages are reduced, malpractice awards will continue to rise. As long as the "jury of our peers" continues to be seated by lay people without medical knowledge and lawyers can spin their case into sound bites heard easiest to those who make decisions from the television there will be no "tort reform." The lawyers in Florida have already managed to convince the public to invoke major detrimental changes towards physicians (just an example).

 

[undecided05]

"Until punitive damages are reduced, malpractice awards will continue to rise"

Please refer me to any legitamate article which states that malpractice awards are on the rise.

"lawyers in Florida have already managed to convince the public to invoke major detrimental changes towards physicians (just an example)."

Such as?

 

[BKN]

"Until punitive damages are reduced, malpractice awards will continue to rise"

Please refer me to any legitamate article which states that malpractice awards are on the rise.

"lawyers in Florida have already managed to convince the public to invoke major detrimental changes towards physicians (just an example)."

Such as?

Here's a link to ACEPs state by state report card on emergency care. Among other things, it includes a rating and a short explanation of the malpractice environment and the state of tort reform in each state. Texas and California are apparently the big winners. In TX our rates are falling after only 1 year of the new laws. Apparently, Florida has made some changes to their laws that might be helpful, but without a hard cap on noneconomic damages, it's unclear whether they will work.

http://www.msnbc.msn.com/id/10792076/

 

[3dtp]

"Until punitive damages are reduced, malpractice awards will continue to rise"

Please refer me to any legitamate article which states that malpractice awards are on the rise.

"lawyers in Florida have already managed to convince the public to invoke major detrimental changes towards physicians (just an example)."

Such as?

Agree.

In Shakespeare's Henry VI, "The first thing we do is kill all the lawyers."
The reason Shakespeare's character said this was that the lawyers were the people who stood in the way of monarchial totalitarianism. The lawyers enforced, even on the King and nobility, the law of the land, and the legal code of England. Take away the lawyers(courts), the king can do as he pleases and the people are powerless.

I hear these figures bandied about by the tort reformers.
According to the local courts where I live, per capita lawsuits are lower than they were at any time in our history, going back to the revolution.

We hear in the newspapers (those bastions of integrity and accuracy) of large med-mal and product liability awards, but what they don't report is how much the actual check is written for, after appeals and reversals and settlements, if any are considered. They never report that the $6Bazillion award was reduced to $600,000 on appeal and settled for even less than that.

Please someone give us a credible reference that tort liability reform saves anybody any money except the insurance companies.

I would like to see hard facts on the following:
A. Incidence:
1. Lawsuits per physician-procedure-year
2. Lawsuits per 100,000 population (per capita)
3. Percent of lawsuits reaching a jury verdict (ie how many are dismissed by the judge?)

B. Severity:
1. Percent of meritorious lawsuits awarded any judgement that is not reveresed on appeal or set aside by the judge.
2. Amount of awards/settlements actually paid by the defendant/insurer (ie how big was the final check?)


C. Trends
1. What is the trend in all of the above over the past 200 years?
2. What is the trend over the past 100 years that med-mal has been a target?


The issue of tort liability reform has come up in every industry we have ever engaged, product built or service provided. I think that we have safer products (cars, buses, lawn mowers, washing machines, industrial equipment, etc.) and processes because of the risk of liability and without that risk we look to our personal economic interests ahead of our obligations.

Is it expensive? Sure, but immune surveillance is an expensive biologic process, too, and we wouldn't want to do with out it. Yes, there are abuses. We should do what we can to minimize those, but I am willing to accept the occasional abuse to insure that people do have access to protections.

Whenever you limit liability and risk, an incentive is created to forego the optimum for society and individuals. A greater risk is that legal immunity will create incentives for people to not do the right thing, or at least free them from the consequences of doing the wrong thing. In some cases doing exactly the wrong thing that benefits them personally, knowing if they get caught, there is no price to be paid.

So, if we are going to take away these protections for common folks, we need to be very sure there is good evidence to support the need. The courts are the people's first and last line of defense.

 

[EctopicFetus]

It's almost comical, if not sad at how little most of you know about med mal, but at least it doesn't stop you from spouting off the evils of malpractice lawyers. It's somewhat similar to how patients think that they know more than physicians b/c they heard about something on a commericial or have access to the internet. That's for another story though...
As to the OP's original question, it is possible in most parts of the country to practice without med-mal insurance, but in those areas it is required to have a set amount of cash in a separate bank account in case you were to be sued. I know of at least two states where that number is $250,000 in cash.

Well arent you Mr know it all?

While it is true that part of the reason the overall med mal insurance rates have gone up partially due to the stock market anyone with 1/2 a brain can understand how states with tort reform pay less in med mal that states that dont. For example one of the mods on the EM site is in Cali and I believe he mentioned med mal for him was about 15K after he is in for 5 yrs (for those who dont know your rates are lower in the beginning) in Chicago (no tort reform in IL) EM docs are paying about 50K.. Is there a different stock market in Chicago than Cali?

Anyways I dont know this stuff about priveldges but undecided the question wasnt so much about simply practicing without insurance but as you can tell people are mentioning getting priviledges in a hospital. If you dont have privledges as a neurosurg you might not be working too much!

 

[EctopicFetus]

A. Incidence:
1. Lawsuits per physician-procedure-year
2. Lawsuits per 100,000 population (per capita)
3. Percent of lawsuits reaching a jury verdict (ie how many are dismissed by the judge?)

From one of my courses I believe the numbers are something like 70% of all med mal cases get dismissed / tossed and get NO money. The other 30% get money and I think the average Jury award is in the $700K range, of course they dont know about settlements since many of them are sealed. (these stats are after all appeals have been exhausted IIRC. (Sorry I couldnt find the link, the original papers come from memag.com(or org) It is Medical Economics

I was told from an EM doc in Fla (no tort reform) that nationwide EM docs get sued 1 in 7 years, in Fla he told me it is 1 in 4 (anectdotalfor sure).

C. Trends
1. What is the trend in all of the above over the past 200 years?
2. What is the trend over the past 100 years that med-mal has been a target?

I believe there is a smaller percentage of lawsuits that gets paid but the numbers are bigger (for numerous reasons).

Sorry I had no hard data but thats just some stuff I read/what taught previously..

 

[EctopicFetus]

Lastly a famous trial attorney (plaintiffs attorney) has his record available.

http://news.findlaw.com/newsmakers/john.edwards.html

Another specialty Edwards developed was in medical malpractice cases involving problems during births of babies. According to the New York Times, after Edwards won a $6.5M verdict for a baby born with cerbral-palsy, he filed at least 20 similar lawsuits against doctors and hospitals in deliveries gone wrong, winning verdicts and settlements of more than $60M.

He also had a case that went to the jury and he got a $23.5 million in a jury verdict.

Lastly, juries do not really comprehend medicine (not saying docs should be sued) but as people in the medical field know, a ton of C sections are performed these days compared to 1970's. Currently 23-30% formerly about 7%, many of these were done because of a percieved correlation to CP, however even though C Section numbers are up and John Edwards got rich suing people on these cases the number of CP cases per 100K live births is unchanged. A little food for thought..

 

[EctopicFetus]

Lastly, a little more food for thought.. We are practicing such defensive medicine these days for fear of being sued that we are driving up the cost of overall healthcare. Everyone under the sun getting CTs (costing in the $600 to 1K) range, tons of useless other studies being run, many are forced to practice CYA medicine because they dont want to get sued.

 

[Doctor Bagel]

In Shakespeare's Henry VI, "The first thing we do is kill all the lawyers."
The reason Shakespeare's character said this was that the lawyers were the people who stood in the way of monarchial totalitarianism. The lawyers enforced, even on the King and nobility, the law of the land, and the legal code of England. Take away the lawyers(courts), the king can do as he pleases and the people are powerless.

I hear these figures bandied about by the tort reformers.
According to the local courts where I live, per capita lawsuits are lower than they were at any time in our history, going back to the revolution.

We hear in the newspapers (those bastions of integrity and accuracy) of large med-mal and product liability awards, but what they don't report is how much the actual check is written for, after appeals and reversals and settlements, if any are considered. They never report that the $6Bazillion award was reduced to $600,000 on appeal and settled for even less than that.

Please someone give us a credible reference that tort liability reform saves anybody any money except the insurance companies.

I would like to see hard facts on the following:
A. Incidence:
1. Lawsuits per physician-procedure-year
2. Lawsuits per 100,000 population (per capita)
3. Percent of lawsuits reaching a jury verdict (ie how many are dismissed by the judge?)

B. Severity:
1. Percent of meritorious lawsuits awarded any judgement that is not reveresed on appeal or set aside by the judge.
2. Amount of awards/settlements actually paid by the defendant/insurer (ie how big was the final check?)


C. Trends
1. What is the trend in all of the above over the past 200 years?
2. What is the trend over the past 100 years that med-mal has been a target?


The issue of tort liability reform has come up in every industry we have ever engaged, product built or service provided. I think that we have safer products (cars, buses, lawn mowers, washing machines, industrial equipment, etc.) and processes because of the risk of liability and without that risk we look to our personal economic interests ahead of our obligations.

Is it expensive? Sure, but immune surveillance is an expensive biologic process, too, and we wouldn't want to do with out it. Yes, there are abuses. We should do what we can to minimize those, but I am willing to accept the occasional abuse to insure that people do have access to protections.

Whenever you limit liability and risk, an incentive is created to forego the optimum for society and individuals. A greater risk is that legal immunity will create incentives for people to not do the right thing, or at least free them from the consequences of doing the wrong thing. In some cases doing exactly the wrong thing that benefits them personally, knowing if they get caught, there is no price to be paid.

So, if we are going to take away these protections for common folks, we need to be very sure there is good evidence to support the need. The courts are the people's first and last line of defense.

Exactly -- thanks for taking the time to fill out such a detailed response. Before we jump to tort reform, I want to see more solid data that medical malpractice is behind things like the physician shortage and increasing health care costs. Some doctors are bad actors, and some plaintiffs have verifiable, horrible injuries as a result -- we need to recognize that before pushing for things like caps on recovery.

 

[TheThroat]

Lastly, a little more food for thought.. We are practicing such defensive medicine these days for fear of being sued that we are driving up the cost of overall healthcare. Everyone under the sun getting CTs (costing in the $600 to 1K) range, tons of useless other studies being run, many are forced to practice CYA medicine because they dont want to get sued.

I work with 13 staff physicians and they all practice defensive medicine. Some have actually said, "There is no way this CT/lab/culture will be positive, but I will always check it just in case there is an unrelated complication." Why does the US have the highest healthcare costs in the world but don't have the best health?

I argue that it is because of the fear that docs have of being sued. We all live in fear of lawsuits, and this fear results in unnecesary tests and over-treatment that does not improve health, but does cost money.

 

[TheThroat]

Please someone give us a credible reference that tort liability reform saves anybody any money except the insurance companies.

So my partner paid around $35K in yearly malpractice premiums per year for most of the 90's and then, all of a sudden, just a few years ago, his premiums dropped to around $12K. WHY?

Because he lives in Texas.

Texas recently passed a tort reform law which capped punitive damages at $250K.

Of course this is anecdotal and doesn't meet you request for a "credible reference," but my partner has no reason to lie, either.

Personally, I like not having to pay $20K plus to the malpractice insurance company.

 

[TheThroat]

So here is an article on the malpractice crisis in Florida, and its effects on physicians reducing services in rural areas (where there is a high demand for physicians):

Brooks RG, Menachemi N, Hughes C, Clawson A. Impact of the medical professional liability insurance crisis on access to care in Florida. Arch Intern Med. 2004 Nov 8;164(20):2217-22.

BACKGROUND: Almost half of the US states face serious problems with professional liability insurance (PLI). Despite this, little is known about how this crisis is affecting access to care, particularly in rural areas. METHODS: We surveyed physicians practicing in rural Florida in 2003. The primary assessment was on changes in health care delivery by service type and specialty. Secondary outcomes included changes in PLI premiums and the effect of changes in premiums on service delivery and practice satisfaction. RESULTS: Four hundred eleven (52.6%) of 781 physicians decreased or eliminated health care services during the past year. Overall, 73 (61.3%) of 119 decreased or eliminated vaginal deliveries; 60 (52.6%) of 114, cesarean sections; 186 (51.7%) of 360, hospital-based surgical procedures; 209 (46.4%) of 450, emergency department coverage; 103 (41.7%) of 247, endoscopic procedures; 187 (40.9%) of 457, office-based surgical procedures; and 105 (34.5%) of 304, mental health services. Elimination of services was highest for general surgeons (78.4%), surgical specialists (73.6%), and obstetricians/gynecologists (70.2%). Premiums for PLI rose a mean of 93.5%. Difficulty finding or paying for PLI was listed as an important factor by those reducing or eliminating services and by those planning to leave the community within the next 2 years. CONCLUSIONS: The current crisis in medical PLI in Florida has a major impact on the availability and delivery of health care services to rural areas. Given the number of states that are experiencing similar insurance market upheavals, adverse effects on access to care are likely occurring nationwide.



Conversely, here is an article showing the effects of tort reform on physician supply (unclear if this improves patient care, though):

Kessler DP, Sage WM, Becker DJ. Impact of malpractice reforms on the supply of physician services. JAMA. 2005 Jun 1;293(21):2618-25.

CONTEXT: Proponents of restrictions on malpractice lawsuits claim that tort reform will improve access to medical care. OBJECTIVE: To estimate the effects of changes in state malpractice law on the supply of physicians. DESIGN: Differences-in-differences regression analysis that matched data on the number of physicians in each state between 1985 and 2001 from the American Medical Association's Physician Masterfile with data on state tort laws and state demographic, political, population, and health care market characteristics. MAIN OUTCOME MEASURE: Effect on physician supply of "direct" malpractice reforms that reduce the size of awards (eg, caps on damages). RESULTS: The adoption of "direct" malpractice reforms led to greater growth in the overall supply of physicians. Three years after adoption, direct reforms increased physician supply by 3.3%, controlling for fixed differences across states, population, states' health care market and political characteristics, and other differences in malpractice law. Direct reforms had a larger effect on the supply of nongroup vs group physicians, on the supply of most (but not all) specialties with high malpractice insurance premiums, on states with high levels of managed care, and on supply through retirements and entries than through the propensity of physicians to move between states. Direct reforms had similar effects on less experienced and more experienced physicians. CONCLUSION: Tort reform increased physician supply. Further research is needed to determine whether reform-induced increases in physician supply benefited patients.

 

[TheThroat]

The issue of tort liability reform has come up in every industry we have ever engaged, product built or service provided. I think that we have safer products (cars, buses, lawn mowers, washing machines, industrial equipment, etc.) and processes because of the risk of liability and without that risk we look to our personal economic interests ahead of our obligations.

That's the point. Companies that produce "products and processes" are not doctors. I don't think that all doctors are lambs that sacrifice for their patients, but MOST do have the patient's best interests at heart.

From the beginning of medical training I was inundated with the professional model that I should attempt to adhere to. From the Hippocratic Oath, to medical ethics courses, to seminars, I have been made acutely aware that "personal economic interests" are not to be considered when making medical decisions.

So are there "bad actors" out there? Sure. But the sad fact is that a good lawyer can make a jury believe anything, with or without hard medical evidence to support the case. John Edwards success with suing OB's for delivering kids with CP is a good example.

So what is the effect of medical liability lawsuits? Here is an article (note the last line of the abstract):

Sloan FA, Whetten-Goldstein K, Githens PB, Entman SS. Effects of the threat of medical malpractice litigation and other factors on birth outcomes.
Med Care. 1995 Jul;33(7):700-14.

Most major health reform proposals include reform of medical malpractice. A major objective of the current medical malpractice system is to improve quality of care. The authors examine the effect of variations in the threat of medical malpractice, measured by claims frequency and payments per exposure year, on various indicators of birth outcomes, fetal deaths, low Apgar score, death within 5 days of birth, infant death, and death or permanent impairment at 5 years of age. Data came from 2 sources: a Survey of Obstetrical Care of 963 women in Florida in 1992 who delivered 5 years previously; and a fetal death and a linked birth-death file obtained from Florida Vital Statistics for 1987. Among the outcomes considered, only fetal deaths decreased in response to an increased threat of being sued, and this relationship was only obtained from one of the data sets. Overall, no systematic improvement in birth outcomes in response to an increased threat of medical malpractice litigation was obtained.

 

[docB]

Is it a requirement to have malpractice insurance? I'd like to know if there are any physicians who practice without it. IMO, insurance is evil and I'd love to see all forms of insurance abolished. Wouldn't one end up paying more for insurance over the course of his/her practice than one would if actually sued successfully? This is just reasoning on my part. It's been a while since I've seen actual numbers, so excuse my ignorance.

I want to go back to the OP's question of what costs more, insurance or paying up on suits. I can tell you that for EM it's better to have insurance. You can estimate the numbers yourself and see that if you plan on working for 30 years, and you carry the typical 3 million aggregate policy if you lose all 3 million that = $100K/yr. Since the typical EM med mal policy is about half of that the insurance makes sense.

 

[f_w]

Does it pay to have liability insurance on your car ?

 

[3dtp]

That's the point. Companies that produce "products and processes" are not doctors. I don't think that all doctors are lambs that sacrifice for their patients, but MOST do have the patient's best interests at heart.

I agree with you that most doctors do have the patient's best interests at heart. But I disagree with your implication that doctors do not produce processes. Health care delivery is indeed a process, beginning with a patient that first walks in your door. The process is determining what is needed to arrive at a diagnosis, executing those steps, then determining what action to take to treat the diagnosis. There's a lot of ambiguity, and inter/intraphysician variability, but it is a process, nonetheless.

From the beginning of medical training I was inundated with the professional model that I should attempt to adhere to. From the Hippocratic Oath, to medical ethics courses, to seminars, I have been made acutely aware that "personal economic interests" are not to be considered when making medical decisions.

Also true, but, the only way to be sure this is not a factor is to be 100% altruistic, which means we need to adopt a Canadian style payment system, ie the government pays what it thinks it needs to, we become employees of the government (which we are nearly there anyway because of medicare), with working conditions, locations, and wages determined by the government. If the government has my best interests at heart, (doubtful) then this is a great idea. Or we adopt, with controls, capitalistic idealism moderated by altruism, which I think a lot of doctors do. For sure I wouldn't put up with what we have all gone through for the present incremental cost over what I was making and could be making in my former field, giving up a good 10 years of prime life to get here. Without incentives, we strive for mediocrity. With the correct incentives, we strive for excellence.

So are there "bad actors" out there? Sure. But the sad fact is that a good lawyer can make a jury believe anything, with or without hard medical evidence to support the case. John Edwards success with suing OB's for delivering kids with CP is a good example.

I really agree with you there. It could have been worse, he could have been president. But this is where we need judges who are intelligent enough to not allow these lawyers to hoodwink juries. I don't know the solution. Wish I did, and I think about this and hope that every kid I delivered in my OBG time turns out to be a genious until they're 19, anyway. Sad fact is that fetal monitoring has not changed the rate/frequency of anything except c-sections. There was a report that chorio has more to do with CP than "birth trauma/hypoxia theory" that Edwards did such a great job exploiting.


So,
We have studies that say in Texas with a $250k non-economic damages cap, med-mal rates dropped significantly. But the several studies also raise new questions.

What was the effect on the insurance companys' exposure and underwriting losses? Should they have dropped more? Have they been stable since that time? What percentage of the total payouts were for actual (ie economic) damages that were not capped. I suspect in the case of a CP patient, however specious the connection is, the economic portion of the claims are far higher than the non-economic, but that is a guess only, no hard figures.

I agree with you that a medical malpractice should not be a jackpot as some think it is. It is a tragedy when and where it happens, and in fact is part of the same Oath, First do no harm.

This is an interesting discussion. Thanks for bringing it up, folks. Lots of food for thought.

 

[3dtp]

Does it pay to have liability insurance on your car ?

Yes, in my home state. 1. If you don't have insurance, the no-fault laws do not apply and you can be sued up the wazoo if you're in an accident. 2. They take your drivers license away and fine you big bucks.

So, not a free market here. Ya gatta gat it or ya walk.

In my residency state, you don't need it if you put up a bond around $100k or so with the state. And you can't get a car loan without it. so, you don't have to buy it if you have lots of money to tie up.

 

[TheThroat]

I agree with you that most doctors do have the patient's best interests at heart. But I disagree with your implication that doctors do not produce processes. Health care delivery is indeed a process, beginning with a patient that first walks in your door. The process is determining what is needed to arrive at a diagnosis, executing those steps, then determining what action to take to treat the diagnosis. There's a lot of ambiguity, and inter/intraphysician variability, but it is a process, nonetheless.

I agree on this.

Also true, but, the only way to be sure this is not a factor is to be 100% altruistic, which means we need to adopt a Canadian style payment system, ie the government pays what it thinks it needs to, we become employees of the government (which we are nearly there anyway because of medicare), with working conditions, locations, and wages determined by the government.

Actually, the Canadian system is not too bad for docs (pays pretty well), but it sucks for patients who want elective surgery (hernias, sinus surgery, etc). They often have to wait a pretty long time to get their surgery.

I really agree with you there. It could have been worse, he could have been president. But this is where we need judges who are intelligent enough to not allow these lawyers to hoodwink juries. I don't know the solution.

I am a big believer in arbitration or juries of medical experts. When it comes to medicine, there is no such thing as "a jury of your peers" in our current system.

This is an interesting discussion. Thanks for bringing it up, folks. Lots of food for thought.

Ditto on that.


On the original point, I don't know of any hospital that allows a doc to work there without malpractice insurance. Think about it: someone wants to sue you, and they find out that you aren't covered. Well, where will the money come from then? Oh, the hospital has tons of money. We'll sue them then. No hospital wants to be in that position. So, working without insurance sounds like a fine idea, but since I can't admit patients into a hospital after I operate on them, it just doesn't work for me.

 

[f_w]

Does it pay to have liability insurance on your car ?

Yes, in my home state. 1. If you don't have insurance, the no-fault laws do not apply and you can be sued up the wazoo if you're in an accident. 2. They take your drivers license away and fine you big bucks.

That was a rhetorical question.

We buy insurance to cover risks that are larger than our resources. If the potential payout is higher than what I can just pay out of pocket, I need insurance. That is why my residency POS had 'liability only'. A potential loss of $4000 I could deal with out of pocket, hence buying comprehensive would have been a waste of money.

Same in malpractice. Most claims are less than the value of you insurance. So, if you have 300k idling in the bank and you are willing to use it in case someone sues you (and you are willing to take the risk of bankruptcy for a higher award), you could conceivably do without malpractice coverage. Some physicians do, it is just very hard to get priviledges at a hospital or payment from third party payors. Nobody wants to be left holding the bag for an uninsured physician.

 

[3dtp]

That was a rhetorical question.

Long day...actually there are a lot who don't have insurance, many who don't have driver's licenses. They can't get insurance without a DL and they can't get a DL without paperwork (birth certificates, passports, visas, things like that) and if they try the INS finds out and off they go back to Chihuahua, so they do without either. Makes for some interesting side of the road negotiating.

G'night. 😴