Maximum Salary

[notinkansas]

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Now we know that the current administration not only thinks it's acceptable to impose a statutory cap on salaries, but we now know what that figure is.

Don't be so naive as to think that the $500,000 maximum will remain limited to those that took TARP money. Once the administration's plot to take over health care is complete, we won't be too far from a cap on physician pay. I'm not saying I think it will happen tomorrow, or even 10 years from now. Within 20 years, yes. It's key to note that this cap includes salaries and cash bonuses. It doesn't include stock bonuses or any form of compensation that is tied to long term performance of the company. But this is a form of compensation not available to physicians, especially once we become de facto government employees.

So all questions about how much student loan debt is acceptable, how big a mortgage is reasonable, etc must now be viewed through the filter of "How will I handle these obligations when my pay is capped at $500,000" Remember you will lose roughly half of that gross amount to taxes.

Just food for thought!

 

[Ttan]

Are you sure that's food?

 

[medicinesux]

meanwhile, you can damn bet that there will be NO caps placed on the ever increasing tuitions colleges and universities get away with charging.

 

[bigdan]

...where's the national tort cap?

dc

 

[CoffeeCzar]

If corporatism is going to rank supreme over capitalism, I say we turn the AMA into a powerful union like the UAW that actually has power over policy makers. Then, we can lobby the government for constant medicare "cost of living adjustments". Once we bankrupt medicare and the insurance companies, lets claim they are too big to fail and bail them out because, if we don't, it will kill too many hard working American's jobs.

 

[michaelrack]

...where's the national tort cap?

dc

tort reform is working in some states. MS has a $500,000 non-economic damage cap. In Mississippi, malpractice insurance for a nonsurgeon with a clean record costs less than health insurance (and much less than a family policy). My malpractice insurance keeps on going down- for the last 4 years. For me, malpractice insurance is less than 1% of revenue and less than 2% of income (salary).

http://www.washingtonexaminer.com/o...ident----its-called-Mississippi-59990137.html

http://www.mcandl.com/mississippi.html

 

[Winged Scapula]

tort reform is working in some states. MS has a $500,000 non-economic damage cap. In Mississippi, malpractice insurance for a nonsurgeon with a clean record costs less than health insurance (and much less than a family policy). My malpractice insurance keeps on going down- for the last 4 years. For me, malpractice insurance is less than 1% of revenue and less than 2% of income (salary).

🙁 I pay about 25% of my gross income in malpractice (although if I stayed in PA, I'd be paying 50%)

 

[ChiDO]

🙁 I pay about 25% of my gross income in malpractice (although if I stayed in PA, I'd be paying 50%)

If you work in a private practice, is it unheard of for the cost of malpractice insurance to be subsidized by the business or a hospital (if you work for them)?

I'm looking into a surgical field and this is one aspect that really freaks me out.

 

[JHopRevisit]

May I summarize this thread?

1) Obama's financial regulations are only the first step of a nefarious socialist scheme to place wage limits on American workers, starting with us poor, underpaid doctors.

2) $500,000 caps on physician wages are EVIL!

3) $500,000 caps on malpractice damages are ABSOLUTELY NECESSARY!

4) In Mississippi, a law that limited how much money you can take away from doctors caused doctors to have more money, thus proving that tort reform is absolutely necessary for any legitimate healthcare reform.

I'm sorry, I know I'm being a jackass and making fun of you guys, and that I'm a traitor to my profession, but I think you're being ridiculous.

 

[Law2Doc]

tort reform is working in some states. ...

"Working" is in the eye of the beholder. What is best for the negligent physician is not always best for society. The person negligently insured has costs, which if not covered by the legal system, will be covered by society (the taxpayers). And while your medmal liability and insurance cost has gone down, I suspect you and the insurance companies haven't passed those savings on to the consumer/patient. Thus the patients/their insurers are still paying a ton for "defensive medicine" costs that are no longer necessitated. Healthcare didn't get appreciably cheaper for patients in those states. I think when you look at whether something like tort reform is "working", you have to look at it from the perspective of the non-physician. Because physician is a very small percentage of the interests involved, and probably not the group politicians were most seeking to appease when they passed those laws. From a voting public aspect, I'm not sure tort reform was a success at all in the states that have passed it.

I would also note that all of those groups who said they would go out of business without tort reform (OBGYNs) really haven't gone out of business in many cases in states that didn't pass tort reform. For all their complaining (which started decades ago), their bark was worse than their bite. You guys have to realize that medical malpractice (all tort law, actually) isn't written to punish doctors. It's written to help the person who was negligently injured. In most cases it does this very well. If someone has a debilitating injury that will require a lifetime of care, through a botched procedure or medical oversight, then the law says they should get just compensation. And when that involves someone with a lifelong injury, his legitimate costs and damages can easily end up in the millions. That's what's fair. Tort reform turns this on its head -- it's not about what's fair to the injured party, it protects the negligent party, but putting a cap on damages, which may have nothing to do with the actual damages. So if you take off your doctor's hat, you probably will see that it's not a good law for the typical voter (who is much much much more likely to be a patient than a doctor in his life). And so it probably doesn't "work" for the people who put the rules in place, UNLESS it works out that the typical voter pays a lot less for medical care/insurance. And in the states that have enacted tort reform, we have seen doctors and insurance companies making more money, and not passed on all of the benefits to the consumer. Maybe they pass on a token amount, but it's a money maker for the parties that were never intended to be benefitted under tort law. It's against age old notions of jurisprudence. There are many better ways to accomplish the elimination of frivolous cases and crazy jury awards besides short-sighted caps. (Specialized courts with medical expertise and the power to administer appropriate awards have been used with much success in some arenas). But caps are simply bad news for the consumer/voter, and should never be lauded simply because you are on the other side of the table and can benefit.

 

[JHopRevisit]

You guys have to realize that medical malpractice (all tort law, actually) isn't written to punish doctors. It's written to help the person who was negligently injured. In most cases it does this very well.

I agree with much of what you said, but I really disagree with this point.

Tort reform does a heckuva job punishing doctors, a middling job of helping people who were negligently injured (there's pretty solid literature that lower SES patients are completely ignored by the tort system) and a terrible, just terrible job of convincing anyone to do anything about what caused those errors in the first place. Tort law is built on solid legal foundations, but that doesn't change the fact that it does nothing to encourage systemic changes that reduce errors and save lives. I also know that's not what tort is supposed to do, but it's pretty much the only error-punishing system we have, and we need something to address our medical error epidemic besides strongly worded JAMA editorials. I'd like to see tort reform that focuses less on how much money doctors get to keep and more on how it can be channeled to save lives.

 

[Moonglow]

Originally Posted by Law2Doc
You guys have to realize that medical malpractice (all tort law, actually) isn't written to punish doctors. It's written to help the person who was negligently injured. In most cases it does this very well.

Let's hear you throw that out when you are on our side of the court room.

http://www.ama-assn.org/amednews/2008/09/15/edsa0915.htm

 

[notinkansas]

May I summarize this thread?

1) Obama's financial regulations are only the first step of a nefarious socialist scheme to place wage limits on American workers, starting with us poor, underpaid doctors.

Correction: Obama's policies in general is the next step of a nefarious socialist scheme to move the US as rapidly towards socialism as possible. Setting up the infrastructure for the government to take over health care is just one of many aspects of this plan

2) $500,000 caps on physician wages are EVIL!

Salary caps of any level on any profession are EVIL. Limiting anyone's success is ridiculous. The only thing it does is make poor people feel better temporarily by "sticking it to the rich". How is a salary cap in any field going to improve anything? It WON'T

I'm sorry, I know I'm being a jackass and making fun of you guys, and that I'm a traitor to my profession, but I think you're being ridiculous.

You are a jackass. But, for the moment we still live in a free country and you have the right to speak your mind. I hope you appreciate it while you still have it!

 

[Winged Scapula]

If you work in a private practice, is it unheard of for the cost of malpractice insurance to be subsidized by the business or a hospital (if you work for them)?

I'm looking into a surgical field and this is one aspect that really freaks me out.

If you are in private practice, you aren't working for/an employee of a hospital.

What incentive is there for a hospital to pay part of your malpractice? They can't require you to operate there which would be a Stark Law violation. There are certainly employee models where your malpractice is paid as part of the package, but this isn't PP, and one generally earns less.

I'm not an expert on all practice models but there would also be no incentive for a practice, "the business", to subsidize your malpractice. In the end it comes down to what goes out, must come in. If they are paying some or all of your malpractice, then you are being paid less. This is why surgical practices are loathe to hire anyone part-time; your malpractice and overhead aren't 1/2 of the full time workers, but your AR is.

The amount of malpractice paid varies wildly by specialty, by state and by procedures you do (for example, if I wanted to add some aesthetic plastics to my delineation of privileges, I'd have to have a rider on malpractice, costing me more).

 

[michaelrack]

....

 

[michaelrack]

"Working" is in the eye of the beholder. What is best for the negligent physician is not always best for society. The person negligently insured has costs, which if not covered by the legal system, will be covered by society (the taxpayers). And while your medmal liability and insurance cost has gone down, I suspect you and the insurance companies haven't passed those savings on to the consumer/patient. Thus the patients/their insurers are still paying a ton for "defensive medicine" costs that are no longer necessitated. Healthcare didn't get appreciably cheaper for patients in those states. I think when you look at whether something like tort reform is "working", you have to look at it from the perspective of the non-physician. Because physician is a very small percentage of the interests involved, and probably not the group politicians were most seeking to appease when they passed those laws. From a voting public aspect, I'm not sure tort reform was a success at all in the states that have passed it.

I would also note that all of those groups who said they would go out of business without tort reform (OBGYNs) really haven't gone out of business in many cases in states that didn't pass tort reform. For all their complaining (which started decades ago), their bark was worse than their bite. You guys have to realize that medical malpractice (all tort law, actually) isn't written to punish doctors. It's written to help the person who was negligently injured. In most cases it does this very well. If someone has a debilitating injury that will require a lifetime of care, through a botched procedure or medical oversight, then the law says they should get just compensation. And when that involves someone with a lifelong injury, his legitimate costs and damages can easily end up in the millions. That's what's fair. Tort reform turns this on its head -- it's not about what's fair to the injured party, it protects the negligent party, but putting a cap on damages, which may have nothing to do with the actual damages. So if you take off your doctor's hat, you probably will see that it's not a good law for the typical voter (who is much much much more likely to be a patient than a doctor in his life). And so it probably doesn't "work" for the people who put the rules in place, UNLESS it works out that the typical voter pays a lot less for medical care/insurance. And in the states that have enacted tort reform, we have seen doctors and insurance companies making more money, and not passed on all of the benefits to the consumer. Maybe they pass on a token amount, but it's a money maker for the parties that were never intended to be benefitted under tort law. It's against age old notions of jurisprudence. There are many better ways to accomplish the elimination of frivolous cases and crazy jury awards besides short-sighted caps. (Specialized courts with medical expertise and the power to administer appropriate awards have been used with much success in some arenas). But caps are simply bad news for the consumer/voter, and should never be lauded simply because you are on the other side of the table and can benefit.

You make some good points, though I would like to point out that MS caps only non-economic damages.

One possible benefit of malpractice reform that you don't mention is that it may increase the # of physicians in a state. I am originally from California. For the time being I am staying in MS, where I did my sleep fellowship, because of the favorable economic environment for physicians. Malpractice reform is one part of the favorable economic environment (other parts include the generally low tax rate and competing private insurers, unlike in Alabama where BC/BS dominates and holds down rates). If economic prospects were similar in CA, I would leave MS in a second.

 

[Law2Doc]

...Tort law is built on solid legal foundations, but that doesn't change the fact that it does nothing to encourage systemic changes that reduce errors and save lives. ...

This is simply a false statement. Virtually every safety feature, warning label or safety protocol exists due to tort law. In medicine, that xray you take every time you put in a central line is done because of the legal risks in not doing it. The "time out" they do in the OR is done because the hospital cannot afford the liability of doing surgery on the wrong limb/organ. Every warning label you see on a medication or product is driven by tort law. And many people, including doctors, conduct themselves in ways that are very lawyer conscious, ranging from double checking meds they are about to administer, to a post-op xray, to checking labs they might have ignored 30 years ago. So yes, these tort laws do drive how people do things, and while it's sometimes wasteful, it's often not.

Doctors dislike tort law because it cuts into the bottom line, often unfairly. But that doesn't mean that the purpose of tort law isn't a good one, and it doesn't mean that it isn't serving the people it was enacted to serve. So again, I suggest if you want to dispute tort law, you have to look at it from the perspective of the non-physician, because that's who the law is for. And for them, capping it may not be the right approach. There are other, smarter ways to reform. Capping is easy and helps doctors and insurance companies. But frequently what's good for the insurance company is not good for the general public.

 

[Law2Doc]

Let's hear you throw that out when you are on our side of the court room.

I have always been on the physician side of the courtroom. I just am able to see things from the perspective of non-physicians as well.

 

[Law2Doc]

...If economic prospects were similar in CA, I would leave MS in a second.

You might, but on average these laws haven't resulted in significant redistribution of doctors. People select their areas of practice for various personal reasons more often than financial ones. The person who grep up in Delaware and has roots there isn't going to move to Texas for a few extra dollars. People coming right out of med school may have this mobility, but a few years later people are settled and not about to move to pay a bit less in medmal insurance. It just doesn't happen in any statistically appreciable fashion.

 

[ChiDO]

Virtually every safety feature, warning label or safety protocol exists due to tort law. .

And this is what frustrates me the most. I understand that people should be compensated when a physician operates on the wrong limb or comes into work drunk and puts patients in danger. However, I feel that common sense doesn't exist in our society anymore and many people want the "get rich quick schemes."

For example, regarding those "warning labels," I read a warning label on birthday candles, that they "SHOULD NOT BE USED AS EAR PLUGS." I mean seriously. Some ****** decided to stick candles in their ears, probably busted their ear drum, and then sued the candle maker because there was no warning label that they shouldn't be used as ear plugs...give me a break.

How about the warning labels on McDonalds coffee, that the drink may be hot...of course it's fricken hot, you just ordered a coffee.

People need to be held accountable for their actions and I would hope that some common sense would be in order, however, that doesn't seem to be the case.

 

[dilated]

This is simply a false statement. Virtually every safety feature, warning label or safety protocol exists due to tort law. In medicine, that xray you take every time you put in a central line is done because of the legal risks in not doing it. The "time out" they do in the OR is done because the hospital cannot afford the liability of doing surgery on the wrong limb/organ. Every warning label you see on a medication or product is driven by tort law. .

So in, say, Britain with a no-fault legal system none of those things happen, right?

Oh, right. Those things all still happen despite not having some shyster lawyer advertising on TV about suing you. What doesn't happen is all those stupid unnecessary head CTs in the ED for someone who bumped their head. I can see virtually no advantages to our tort system for doctors or patients compared how the rest of the world does it. There is a huge, huge advantage for one group though... fortunately they write the laws.

 

[exPCM]

🙁 I pay about 25% of my gross income in malpractice (although if I stayed in PA, I'd be paying 50%)

You are effectively working 3 full months out of each year just to pay your malpractice insurance. This is absolutely sickening and an indication of just how out of control malpractice insurance is today.

 

[EctopicFetus]

my wife is a lawyer.. and truly I think they just dont get it.

a few points..

1) lawyers are out there to win they dont care about anything else.

2) if tort law is so wonderful why are we still committing malpractice?

3) you really think we get x rays after a central line or do a "time out" so we dont get sued? Thats idiotic.. we do it to make sure we dont harm our patients.. in the end we do this job to help people we dont spend all day everyday worrying about lawsuits..

yes i finished a residency and am in private practice in EM. I work at 3 hospitals.. one is a huge level 1 trauma center, 1 is a fair sized community hospital.

I also agree that this system is simply designed to have us practice defensive medicine where we ct more than we need to, we admit chest painers because "what if?"

it sucks..but i love my job!

 

[EctopicFetus]

You are effectively working 3 full months out of each year just to pay your malpractice insurance. This is absolutely sickening and an indication of just how out of control malpractice insurance is today.

That doesnt even include your income tax or social security..

 

[Excelsius]

🙁 I pay about 25% of my gross income in malpractice (although if I stayed in PA, I'd be paying 50%)

!!!

 

[xanthines]

So is the maximum payout what's bothering physicians? I've heard very few cases that go to court are ever decided in favor of the plaintiff (ie, patient). It seems like most complaints are just settled out of court, while less expensive than a lengthy trial is still pretty costly.

Would it be better to have a higher barrier of entry, so to speak, to bring forth a lawsuit? Perhaps a specialized judge (one of those MD/JD's?) to review the case for merit? That way, a truly non-liable physician could avoid both the costly settlement and the costly court case?

-X

 

[Excelsius]

And this is what frustrates me the most. I understand that people should be compensated when a physician operates on the wrong limb or comes into work drunk and puts patients in danger. However, I feel that common sense doesn't exist in our society anymore and many people want the "get rich quick schemes."

For example, regarding those "warning labels," I read a warning label on birthday candles, that they "SHOULD NOT BE USED AS EAR PLUGS." I mean seriously. Some ****** decided to stick candles in their ears, probably busted their ear drum, and then sued the candle maker because there was no warning label that they shouldn't be used as ear plugs...give me a break.

How about the warning labels on McDonalds coffee, that the drink may be hot...of course it's fricken hot, you just ordered a coffee.

People need to be held accountable for their actions and I would hope that some common sense would be in order, however, that doesn't seem to be the case.

In the US we take everything too far. Consumer protection is vital in our corporate world, but these protections are becoming more of a formality than real protections. For example, if a tire company is sued because some guy overinflated his tire and then drove down the road at 40% more speed than the tire was rated, the company will likely lose when it is sued. However, this same company is able to employ powerful lobbyists to lax the laws on pollution control and is able to "cut costs" elsewhere by improper disposal of its waste - into our rivers and lakes. So now what we have is an ostensible consumer protection: one guy was paid where he shouldn't have been and millions of other consumers end up being affected. Moreover, for every person who successfully sues the tire company over bogus claims and wins, the company will try to become more parsimonious by cutting costs elsewhere that will affect many more consumers.

In terms of doctors, there are some who don't even deserve to practice. These guys are careless and not knowledgeable. What they do is spoil the reputation of all doctors. As a result, malpractice litigation becomes ubiquitous - the public thinks all doctors deserve it and the government believes that it's the right way to keep doctors in check. Insurance costs go up, doctors become frustrated, care less about patients, more mistakes take place, and the vicious cycle keeps going. I think that if the doctor is happy with his job, he'll tend to care more about his patients and make less mistakes. So one place that needs reform is the residency. It seems to traumatize a lot of doctors so that by the time they are out, they are pissed and want to make up for all those years of disrespect they had to endure. Patient care is not the first thing on their mind. Combined with unfair malpractice costs, the situation becomes far worse. That's the problem here: everyone is concentrating on that one guy who sues the company for his own misuse of the tire, yet no one is paying attention to the bigger picture.

Residency should be a much more controlled environment. Many premeds go into medicine for good reasons. Sure, many of these reasons are too idealistic, but you don't want to break every single positive bone in their body even before they finish residency. That, combined with malignancy in medicine, will forever warrant the downward fall of all doctors because the profession is eating itself from inside out while the government is trying to contain the zone of influence by squeezing in the outer edges. I only see doctors blame the system, patients, and everyone else (including in this forum). I have never seen anyone trying to also look into the problems that doctors themselves are responsible for... Sooner or later we'll see a implosion since the path is not changing, except for the worse.

 

[LucidSplash]

So is the maximum payout what's bothering physicians? I've heard very few cases that go to court are ever decided in favor of the plaintiff (ie, patient). It seems like most complaints are just settled out of court, while less expensive than a lengthy trial is still pretty costly.

Its not just the maximum payout. Many of the cases that are settled out of court are settled because of the fear of a verdict in favor of the plantiff even when there was no malpractice. Additionally - malpractice insurance premiums rise anytime a suit is filed, regardless of the outcome. The cost is significant even when the case is found to be frivolous. Its largely impossible to recoup monetary losses spent defending oneself against a lawsuit.

 

[lipomas]

We are turning into a populist society - everyone thinks almost every other person's salary is excessive (even though they themselves are undercompensated), and all they want to do is scream about it. I have even heard people railing on about teachers making $35k a year as excessive because they get two months off in the summer. Airline pilot salaries have dropped, what, 50% (not including inflation!), and people still think they are overpaid. Medicine is changing. I doubt there will ever be a "cap" on income unless the way healthcare is paid for is DRASTICALLY changed. But income is certainly not going to be what it once was.

However, the argument in the original post about not getting income from stock, performance, etc, is not accurate since many private practices are organized as corporations which include stock. This may be decreasing as more physicians become hospital employees, however.

 

[deleted89854]

The costs of defensive medicine are very significant, and dwarf those due to settlements, verdicts, and increased malpractice costs (although these are the ones often passed on directly to the physician). Pan-CT scanning (head, face, CTA of chest, abdomen, pelvis +/- recon) of traumas costs approximately $25,000/pt. Pan-lab testing in the ED (CMP, CBC, LFTs, Amylase, Lipase) costs >$1000/patient. There is no argument that CXRs are needed after line placement, and time-out prevents wrong site/wrong patient surgery. However, there is a difference between things we do which improve outcomes and things we do to prevent lawsuits (although the two occasionally overlap).

 

[Winged Scapula]

!!!

Yeah. WTF.

Clearly, you aren't familiar with the cost of malpractice for a surgeon in the fine state of Pennsylvania. It exceeds 6 figures and the subspecialty I do generally requires an additional rider (due to the high litiginousness). There is a reason why so few medical school and residency graduates in the state actually stay there and practice.

 

[dragonfly99]

I think that caps on noneconomic damages are totally reasonable. The patient can still recover damages for lost income, medical care, actual damages to the patient...just not greater than 500k in "pain and suffering" or punitive damages.

For the idealistic med students above who posted asking whether most things aren't just settled out of court - how would you like to get sued for no good reason and have your insurance company settle out of court and give the patient 20k or something just to get them to go away, because it's cheaper to pay a few thousand than to defend you. Then YOU, the doctor, get your name put in a national databank called the National Provider Databank that essentially labels you as somebody who committed malpractice. And you have to explain that every time you try to get a new job, get privileges (i.e. permission) to work at a new hospital, and maybe even to patients who look this kind of stuff up. I think I read somewhere that 60% of ob/gyns get sued during their careers (probably higher?). Are there really that many incompetent docs? If the answer is no, then that to me says that our malpractice system is broken, and we need some sort of tort reform. But this isn't just limited to medicine. People do this all over society. They want someone to pay because they had an accident, there was some act of God or natural disaster, or they are just unhappy with their lives and they want some free money. And anyone who thinks that winged scapula and the others (surgeons/proceduralists) aren't passing on the high cost of their malpractice insurance to consumers of health care needs his/her head examined IMHO.

 

[xanthines]

Idealistic? I haven't been called that in awhile!

I guess I phrased my post badly. Yes, I'm all too aware actually, that anytime you go to court it costs money, malpractice or not. People keep talking about tort reform, but there doesn't seem to be a big impact, if any, in states that have caps on non-economic damages.

Therefore, I suppose my original question is this: How much of a pay cut (%, $$$'s, whatever, I'm just looking for a gestalt answer here) would you take in exchange for a better, more fair, more streamlined malpractice trial system whereby ONLY the truly negligent are punished, although not excessively? Likewise, the "frivolous" cases would have little no impact on the physician in matters of time and/or money.

No, I don't have any idea on how this would specifically work, I'm just trying to understand what the real problem is from a systems analysis point of view. There's a lot of emotion flowing out there, and rightly so, but sometimes a dispassiontate view can be useful. Right? 😕

-X

 

[smq123]

Clearly, you aren't familiar with the cost of malpractice for a surgeon in the fine state of Pennsylvania. It exceeds 6 figures and the subspecialty I do generally requires an additional rider (due to the high litiginousness). There is a reason why so few medical school and residency graduates in the state actually stay there and practice.

I remember reading a post where a med student from another state (Texas, I believe) wanted to do an away rotation in Pennsylvania. That person was unable to because her school's malpractice insurance policy, adjusted for her state's low rates, didn't come anywhere close to the amount that the hospital in Pennsylvania required.

That's why I think that the PA state goverment's plan to forgive your med school loans after TEN years of practicing in Pennsylvania is not going to be a very popular option for most people.....

I think I read somewhere that 60% of ob/gyns get sued during their careers (probably higher?).

I would say it's probably higher, and going to continue to climb. When I was a med student, I was told that if you go into OB/gyn, you should expect to be sued, because it's likely to happen eventually.

I guess I phrased my post badly. Yes, I'm all too aware actually, that anytime you go to court it costs money, malpractice or not.

It's not just money. It's emotional cost, too.

There are awful stories out there of physicians who were sued, and even though they won, the experience was so traumatizing that they either got out of clinical medicine or (in some extreme cases) attempted suicide.

The lay public blathers on and on and on about the "emotional cost of malpractice on the patient," but they fail to see the emotional cost of being named in a bull**** lawsuit.

Therefore, I suppose my original question is this: How much of a pay cut (%, $$$'s, whatever, I'm just looking for a gestalt answer here) would you take in exchange for a better, more fair, more streamlined malpractice trial system whereby ONLY the truly negligent are punished, although not excessively? Likewise, the "frivolous" cases would have little no impact on the physician in matters of time and/or money.

Why should you have to be willing to accept a paycut to implement a system that filters out UNfair lawsuits? 😕

I'm not willing to accept a paycut. I think that a system whereby frivolous cases are filtered out should be considered a MANDATORY part of this whole process.

Part of the problem is is that it doesn't really cost someone a lot of money to sue someone. Yeah, you hire a lawyer, but that's it. It should cost the plaintiff a fairly high amount to even place the claim in the first place. If there's merit in their claim, they can be reimbursed later. Some kind of obstacle to suing a doctor means that you better reallllly think something happened that justifies your claim....not something stupid.

The costs of defensive medicine are very significant, and dwarf those due to settlements, verdicts, and increased malpractice costs (although these are the ones often passed on directly to the physician).

Getting the lay public to understand this is ridiculously hard, though. One of my friends, who is very bright, has said that malpractice costs are only a "small fraction" of healthcare costs in this country. Trying to explain the CYA CT/MRI/pan-scan to him was an exercise in futility. "But...if you don't THINK that there's anything wrong....why get the CAT scan?" <sigh>

 

[SouthernSurgeon]

3) you really think we get x rays after a central line or do a "time out" so we dont get sued? Thats idiotic.. we do it to make sure we dont harm our patients.. in the end we do this job to help people we dont spend all day everyday worrying about lawsuits..

Um...no. The time-out originated directly out of lawsuits for wrong site/side surgery. It may seem like "the right thing to do" now, but L2D is exactly right on its origins. It was fought by many surgeons when hospitals started requiring it - they were forced to do it by hospital policy; they did not start doing it to avoid harming patients.

 

[JackADeli]

Its not just the maximum payout. Many of the cases that are settled out of court ...even when there was no malpractice...

So, let me tell you a little tale about malpractice and the attornies' perspective of justice.... In my medical school, there is/was a tradition of having a combined law-student & med-student session to discuss malpractice and "fairness". They present a generic case in which BOTH sides in the lecture hall 100% agree absolutely NO malpractice has occurred. They agree the "standard of care" of met. It is a case in which a bad outcome has occurred.

They turn to the med-students and physicians and ask should there be a malpractice compensation? The answer is "no".

They turn to the attornies and law-students.... the answer is, "it's not that simple.... we should consider what the cost of litigation would be, the amount of insurance coverage of the physicians and hospitals, the unfortunate plight of the patient, and then recognizing the lack of malpractice,... we should mathematically arrive at a "fair" out of court settlement that will save money from avoiding litigation".
They then ask the attornies and law-students, "should you be paid for this?".... They answer, "Absolutely, our efforts and work are saving money for the docotors and providing compassion for the patient and/or family that through no fault of their own have suffered misfortune..."
They then ask, "if the case goes to trial and a verdict is found that no malpractice has occurred, should the patient have to cover the costs?"..... The attornies and law-students, "no, that would be unfair".

Yep, it's clear to me that medical tort law is all about "justice".....

 

[ChiDO]

So, let me tell you a little tale about malpractice and the attornies' perspective of justice.... In my medical school, there is/was a tradition of having a combined law-student & med-student session to discuss malpractice and "fairness". They present a generic case in which BOTH sides in the lecture hall 100% agree absolutely NO malpractice has occurred. They agree the "standard of care" of met. It is a case in which a bad outcome has occurred.

They turn to the med-students and physicians and ask should there be a malpractice compensation? The answer is "no".

They turn to the attornies and law-students.... the answer is, "it's not that simple.... we should consider what the cost of litigation would be, the amount of insurance coverage of the physicians and hospitals, the unfortunate plight of the patient, and then recognizing the lack of malpractice,... we should mathematically arrive at a "fair" out of court settlement that will save money from avoiding litigation".
They then ask the attornies and law-students, "should you be paid for this?".... They answer, "Absolutely, our efforts and work are saving money for the docotors and providing compassion for the patient and/or family that through no fault of their own have suffered misfortune..."
They then ask, "if the case goes to trial and a verdict is found that no malpractice has occurred, should the patient have to cover the costs?"..... The attornies and law-students, "no, that would be unfair".

Yep, it's clear to me that medical tort law is all about "justice".....

This is a great story....and sad....

 

[scpod]

....For the idealistic med students above who posted asking whether most things aren't just settled out of court - how would you like to get sued for no good reason and have your insurance company settle out of court and give the patient 20k or something just to get them to go away, because it's cheaper to pay a few thousand than to defend you. Then YOU, the doctor, get your name put in a national databank called the National Provider Databank that essentially labels you as somebody who committed malpractice....

In an actual case where I rotated for third year.... a surgeon was sued by a patient and the hospitalist consulted for medical management was sued as well. The hospitalist's insurance providor settled for 50 grand before the depositions were even taken. Two weeks later the case was dropped for lack of evidence. The hospitalist was never given the chance to defend himself, but it is now part of public record that he settled in this case. His malpractice is going up and it's just another strike on his record. Where's the justice in that?

 

[Winged Scapula]

In an actual case where I rotated for third year.... a surgeon was sued by a patient and the hospitalist consulted for medical management was sued as well. The hospitalist's insurance providor settled for 50 grand before the depositions were even taken. Two weeks later the case was dropped for lack of evidence. The hospitalist was never given the chance to defend himself, but it is now part of public record that he settled in this case. His malpractice is going up and it's just another strike on his record. Where's the justice in that?

This is not a new concept.

Employees of hospitals or other organizations where malpractice is provided as part of a package, may be required to allow the employer to decide whether or not to settle. So this is not unusual - employer decides to just make everything go away with a relatively smallish amount check to the plaintiff, the accused gets no say in whether or not to settle, and regardless of the reason for settling (ie, to get it over with vs you know you'll lose in court), its reported to the NPDB (and state boards) without those involved being able to addendum WHY it was settled or defend themselves.

There have been cases of hospitals requiring employees who demonstrate themselves to be "suit-worthy" to pay back the settlements, or a portion thereof.

Usually the way it works is that an attorney will draft a settlement request, sort of feeling the waters out, especially if they aren't sure they have an "open-shut" case. These letters can be done with no discovery process, no depositions other than what the plaintiff claims. They ask for a large sum of money (more than they know they are going to get) and see what rolls in. For a couple of hours of work and a percentage of the "take", it can be very profitable. Some will actually do the legwork before sending the letters out, but I am told many do not, simply feeling like they will get a settlement a good percentage of the time just for scaring people with all their fancy talk.

If a settlement is refused, then the attorney goes back to the plaintiff and sees if they want to pursue (remember, that will incur more charges, going to court etc.) and they will start doing some actual research, expert testimony, etc. if the plaintiff does want to sue. Most malpractice companies will not provide you an attorney until you have been sued. Thus, in the case above, if the hospitalist was only served with a settlement request, he may have never been offered counsel (because they are not required to), may not have sought it out himself (these guys are expensive), and the hospital decided to settle without much input from him/her. 😡

One advantage in private practice: I decide whether or not to settle. My malpractice company cannot settle without written consent from me.

Moral of the story: if an employee check your liability contract and see if they are allowed to settle without your consent. Do not sign if they do.

 

[JackADeli]

...if an employee check your liability contract and see if they are allowed to settle without your consent. Do not sign if they do.

Yep, demand a "consent to settle" clause.

 

[Law2Doc]

And this is what frustrates me the most. I understand that people should be compensated when a physician operates on the wrong limb or comes into work drunk and puts patients in danger. However, I feel that common sense doesn't exist in our society anymore and many people want the "get rich quick schemes."

For example, regarding those "warning labels," I read a warning label on birthday candles, that they "SHOULD NOT BE USED AS EAR PLUGS." I mean seriously. Some ****** decided to stick candles in their ears, probably busted their ear drum, and then sued the candle maker because there was no warning label that they shouldn't be used as ear plugs...give me a break.

How about the warning labels on McDonalds coffee, that the drink may be hot...of course it's fricken hot, you just ordered a coffee.

People need to be held accountable for their actions and I would hope that some common sense would be in order, however, that doesn't seem to be the case.

The hat photo is a joke and not based on legal issues. All the others exist because sadly somebody somewhere used the product incorrectly, got hurt (or killed a pet), and it was deemed that it would have been cheaper for the company to put a warning label on the product. Dumb people have dried their pets in ovens and microwaves. Children have died in dishwashers and washing machines. While one would think they simply have learned a hard lesson, equally dumb jurors have felt that a big company ought to have spent an additional 10 cents per product putting a label on it. It comes down to what would be reasonable, and whether something is reasonably forseeable. And of course, like McDonalds, once it has happened once, it is thereafter automatically now foreseable. Tort law is meant to protect people from reasonably predictable consequences. If a company makes a product that if used incorrectly may injure, and they can predict incorrect usage, then they have the warn the consumer. Like putting a label that something gets hot and can start a fire. Or that if you misuse a stepstool, you might fall. And so on. What you call common sense, unfortunately isn't all that common in our nation, and so companies are expected to conduct themselves at the consumer's level.

 

[Law2Doc]

So in, say, Britain with a no-fault legal system none of those things happen, right?

Oh, right. Those things all still happen despite not having some shyster lawyer advertising on TV about suing you. What doesn't happen is all those stupid unnecessary head CTs in the ED for someone who bumped their head. I can see virtually no advantages to our tort system for doctors or patients compared how the rest of the world does it. There is a huge, huge advantage for one group though... fortunately they write the laws.

Most of our tort laws have their genesis in British law, so it's really them to blame, not praise, for their system if you don't like ours. As for no-fault -- when you have socialized medicine this is a necessity -- you can't have doctors getting paid squat AND getting sued. We sort of have the same set up -- it is very hard to sue the government in the US. And in general tort law works on a contingency fee basis for the plaintiff's attorney -- they only make money if they prevail. But they can be fined for bringing frivolous cases (as that term is used in law, not on SDN). So lawyers tend not to take blatently bad cases.

As for attorney advertising, while this doesn't help things, this doesn't drive the boat. Negligence lawsuits were common before television was even invented. Unless you hung out at the courthouses though, you wouldn't know about it -- these days you do. The more "white shoe" attorneys as a group (constituting a majority of lawyers, BTW) have periodically pushed to ban lawyer advertising, as unseemly and damaging to the image of the profession. However the US Supreme Court has held that this is the only way some of the poorer members of the public know their rights and know they have access to lawyers, and so these have been protected by the courts as a public service. So most lawyers don't want the TV ads any more than you do.

The lawyers don't drive lawsuits any more than a car drives itself. A flashy car ad might encourage you to drive more, but it's still the plaintiff/driver who makes this all happen. Lawyers profit from litigiousness, but they don't create it. Doctors who are perceived as wealthy by the public, don't explain things well, make well publicized mistakes, don't befriend patients, have "House"-like personalities, etc are far more likely to drive a patient into "I'll sue you" mode than any lawyer TV ad. Honestly I've heard far more "I'm going to sue you" language in the hospital setting than in my legal career. The public doesn't trust doctors, hospitals, and has a lawsuit mindset. You can't really blame lawyers for that. Some of the ads do fuel this, but public perception of doctors comes from more of an image problem, ranging from the perception that all doctors are rich, to an inability to understand medicine, to notions that alternative medicine is actually medicine just as good as evidence based medicine and so on. The fact that the public eats it up when actors like Tom Cruise say psychiatry is a farce and Suzanne Somers says she cured cancer on her own, and Jenny McCarthy says vaccines gave her kid autism but she cured it, and Jillian Barberie went on her talk show and said whenever she feels a cold coming on she goes to her doctor to get a Z-pack, etc shows the public doesn't understand medicine any more than the *****s it exalts as celebrities. The public doesn't understand medicine. They feel like doctors work in the realm of magic, and prescribe pills for any cure, and if something goes bad, they caused it. Lawyers didn't create this perception, the public had it all along. They don't understand even the most basic aspects of medicine. They get bad advice from celebrities, they misinterpret stuff they read on the internet. And they come in to the doctors office, not trusting the doctor or their training.
When you as doctor fall short, you had better believe that there will be finger pointing. And lawyers simply benefit from this horrible image and PR problem, not be the cause of it.

How do you fix it? Not tort reform. When you take a group of people who already don't trust you, and say you are enacting a law to protect yourself from them, that doesn't fix the problem, just the consequences. The way to limit lawsuits, as has been shown in multiple studies, is to spend time talking to the patient. Make them understand what's going on. Make them trust you as a person. Befriend them. Those are the doctors who rarely get sued. The dude who sees them as piecemeal work to see in 15 minutes or less and wants tort reform to protect from the consequences is the one who gets sued.

 

[ChiDO]

How do you fix it? Not tort reform. When you take a group of people who already don't trust you, and say you are enacting a law to protect yourself from them, that doesn't fix the problem, just the consequences. The way to limit lawsuits, as has been shown in multiple studies, is to spend time talking to the patient. Make them understand what's going on. Make them trust you as a person. Befriend them. Those are the doctors who rarely get sued. The dude who sees them as piecemeal work to see in 15 minutes or less and wants tort reform to protect from the consequences is the one who gets sued.

This is an excellent point and has been brought up in our doctor/patient relationship class. We were shown data, that patients who like their doctor as a friend, were XXX% less likely to sue vs. those doctors who brush off their patients. Furthermore, they also showed data on how a doctor dresses and how the patient perceives their knowledge and how they trust them. We were shown data that interns dressed professionally (shirt + tie) were perceived as more competent doctors vs. attendings wearing scrubs/casual clothes.

But, I still believe there needs to be some sort of middle ground in this tort reform debate. I don't see the publics opinion of doctors being super rich changing anytime soon.

 

[JackADeli]

...shown data, that patients who like their doctor as a friend, were XXX% less likely to sue...

But, I still believe there needs to be some sort of middle ground in this tort reform debate...

Sure, if you think someone is a jerk you are more likely to sue them.... That is a red herring. It does not change the facts around numerous suits brought in the hopes of out of court court settlement when everyone, including the plaintiff's attorney knows NO malpractice has occurred. There is in many instances a "robinhood" approach.... the poor patient, it's not their fault they are unlucky, someone should do something..... those greedy insurance companies and doctors can afford to help..... It's crap. If attornies and plaintiffs were held accountable for bringing numerous claims against everyone within the vicinity, when no malpractice has occurred, we would have a great deal less lawsuits. As it stands, plaintiffs & attornies often see this as a shot at the lottery.

If a plaintiff was informed by the judge and at the time of filing signed a contract stating/acknowledging....

"I acknowledge that should a judgement return that finds the defendant met the standard of care and committed no act of malpractice, I will personally assume all legal costs associated with defending against the charges I am making"

I assure you people would think twice about filing.... even if their physician was a jerk.

 

[ChiDO]

"I acknowledge that should a judgement return that finds the defendant met the standard of care and committed no act of malpractice, I will personally assume all legal costs associated with defending against the charges I am making"

I assure you people would think twice about filing.... even if their physician was a jerk.

100% agree. If people are held accountable for their action, people would think twice about bringing frivolous lawsuits.

 

[Excelsius]

Have you guys read Blink by Malcolm Gladwell? He has an entire section dedicated to malpractice insurance where he makes a point that the probability for a doctor to be sued depends mainly on his patient interaction skills, and not his technical skills. In his example one patient sued her specialist even though her injury attorneys told her that the fault was with her primary doctor. Hubris does not allow a lot of docs to see the problem and they keep repeating the same mistakes.

I had a personal encounter with a UCSF optho who thought he was god. When I suggested a procedure in a conversation, he became very defensive and even though admitted that the procedure was fine, he referred me to a PA in another hospital because he said he doesn't do those procedures. I didn't like this and after talking to the PA found out that the given optho actually does the given procedure. I was not happy about that since I would much rather have a much more experienced doc do the procedure on such a sensitive area. Anyway, the procedure went great, but had it failed even a bit, I would be suing the optho doc for not doing the procedure himself and referring me to someone else. After this incidence I switched my optho and found out from the nurse that I am not the first one to do that. This doctor is going to be sued in the future, multiple times. I wouldn't care if he lost a case where he wasn't at fault. If you're going to treat your patients with disrespect, GFO of this field, I don't care how technically able you are. Guys like these are the reason that doctors are disliked. And what good are your skills if you don't really care about the patient? So the argument "good doctor, but bad communicator" is out the door. They are intricately intertwined. It's like knowing every single detail about fixing engines but never listening to an engine to decide what is wrong and needs fixing. An oxymoron.

 

[JackADeli]

...probability for a doctor to be sued depends mainly on his patient interaction skills, and not his technical skills. In his example one patient sued her specialist even though her injury attorneys told her that the fault was with her primary doctor...

That is exactly the point!!! If you do not like a physician or feel a physician does not meet your personability standards, you report him/her to hospital administration and/or licensing board. You do NOT just declare malpractice when no malpractice has occurred. You do not sue the party that did NOT commit malpractice while leaving your "friend" that did commit malpractice off the suit. An attorney that carries a suit knowing the wrong person is being sued is unethical. This "malpractice" suits because a patient or families' feelings got hurt actually hurts other patients and other doctors.... even the plaintiff's doctor friends.

...Anyway, the procedure went great, but had it failed even a bit, I would be suing the optho doc for not doing the procedure himself and referring me to someone else. ...I wouldn't care if he lost a case where he wasn't at fault...

Again, this is a problem with the system and why tort reform is needed. A Physician is not obligated or enslaved to do the procedures you want. Both parties have the right to decline proceeding forward with the plan of care (Exceptions being emergencies to some degree). There is a contractual interaction. If you meet with a physician (i.e. physician "A") and he/she and you do not have a meeting of the minds and agree with proceeding, you are not entitled to malpractice compensation because physician "A" did not perform the procedure and physician "B", who you did contract with, had a complication!!! Your scenario is ludicrous.

Physicians are not robots and they are not slaves.

We all have different personalities and patients have different personalities. You can find rave reviews of specific physicians everywhere with competing reviews declaring them to lack compassion, etc... You have people saying they will walk out of a physician's office if they wear a cross or religious symbol while others will not enter a physician's office if they know the physician lacks a particular "faith". A patient's right is to shop for a physician. A patient does not get to demand a specific physician and then demand the physician change who they are for the patient and/or perform procedures/care the physician feels is innapropriate. It's like all these antibiotics being given for the flu because the patients demand it.

JAD

 

[NotAProgDirector]

Part of the problem with our medmal system is the lack of a good definition of malpractice. The way I see it, medmal cases tend to fall into one of several types:

1. The physician clearly made a mistake. Wrong site surgery would be the classic example.

2. A bad outcome occurred from a procedure. Often, this is a known complication of the procedure, but doesn't happen to everyone. A pneumothorax from a central line is an example.

In #1, it's clear that the doc made a mistake and the tort/medmal system is relatively well suited to address it.

In #2, which probably encompasses the vast majority of suits, the tort system does not work well. A patient gets a PTX from a central line placement, is this malpractice? Maybe -- perhaps the doc was distracted, or maybe didn't use ultrasound, etc. (although when something like US becomes part of the "standard of care" is another problem with defining malpractice). Or, maybe this was just a complication that was impossible to predict. However, the jury will often be told "If only someone else had done the procedure, the PTX would not have occurred". And, that might be correct, but it's not clearly malpractice.

Bad outcomes harm patients physically and financially. I worry that the medmal system has shifted from compensating patients for the actions of negligent physicians to compensating patients for poor outcomes regardless of cause.

 

[JackADeli]

...I worry that the medmal system has shifted from compensating patients for the actions of negligent physicians to compensating patients for poor outcomes regardless of cause.

Yep, "Robinhood Fever". Juries and patients believe they are just tapping into this cost-free pot of gold. They don't understand the implications or resulting loss of care to others when physicians can not financially/viably practice within a community any longer.... while the attornies, then just run for public office

 

[Excelsius]

That is exactly the point!!! If you do not like a physician or feel a physician does not meet your personability standards, you report him/her to hospital administration and/or licensing board. You do NOT just declare malpractice when no malpractice has occurred. You do not sue the party that did NOT commit malpractice while leaving your "friend" that did commit malpractice off the suit. An attorney that carries a suit knowing the wrong person is being sued is unethical. This "malpractice" suits because a patient or families' feelings got hurt actually hurts other patients and other doctors.... even the plaintiff's doctor friends.Again, this is a problem with the system and why tort reform is needed. A Physician is not obligated or enslaved to do the procedures you want. Both parties have the right to decline proceeding forward with the plan of care (Exceptions being emergencies to some degree). There is a contractual interaction. If you meet with a physician (i.e. physician "A") and he/she and you do not have a meeting of the minds and agree with proceeding, you are not entitled to malpractice compensation because physician "A" did not perform the procedure and physician "B", who you did contract with, had a complication!!! Your scenario is ludicrous.

Physicians are not robots and they are not slaves.

We all have different personalities and patients have different personalities. You can find rave reviews of specific physicians everywhere with competing reviews declaring them to lack compassion, etc... You have people saying they will walk out of a physician's office if they wear a cross or religious symbol while others will not enter a physician's office if they know the physician lacks a particular "faith". A patient's right is to shop for a physician. A patient does not get to demand a specific physician and then demand the physician change who they are for the patient and/or perform procedures/care the physician feels is innapropriate. It's like all these antibiotics being given for the flu because the patients demand it.

JAD

Yes, it is unethical for a lawyer to take the case, but it happens all the time. And this is not just limited to doctors. Just take a look at collision injury. Here is a classical example: some time ago I was involved in a hit-and-run. Someone hit my car and flew away on the freeway while my car spun out of control and came to rest. I did not hit any cars and came to rest in the middle lane. All the cars stopped. In the carpool lane, a car stopped, but the car behind him did not and hit that car. So the guy who hit that car from behind sued ME for $200K even though there were no injuries, he was at fault for speeding, he was at fault for hitting another car from behind, and I was not even involved in the accident! I drafted a letter about the ethics of his lawyer to the state bar. It's a ridiculous claim, but it still has wasted my time. So I am not sure you can enforce justice only in the malpractice arena. You'd have to change the entire ethics regulations for attorneys.

I agree in general with your last point, but in my case I think I was correct. Yes, a doctor is not obligated to perform a service. And had my optho been straightforward enough to refer me to another optho, that would be great. I did that myself later anyway. However, he 1.Sent me to a PA informing me first and finding out whether it was ok with me. I thought that I was going to see another optho and didn't find out until the day of the procedure that it was PA and had wasted weeks waiting for the appt. 2. He lied to me that he does not perform the given procedure. You bet I would take this to court and likely win. If you think that treating a patient with such disrespect is ok, then you might come across this same problem in the future yourself. Again, it is completely ok to refuse service and refer to another DOCTOR, but don't f-ing brush a patient off to a PA and lie to him just because your ego was hurt and you don't want to admit your personal vendetta by calling up another doctor and asking him to take your patient (would love to hear the reason why the patient is being referred!).