Young surgeons fleeing Pa.

Liability concerns prompt orthopedists schooled in Pennsylvania to practice elsewhere.

Issue: August 2003

The young orthopedist may be an endangered species in Pennsylvania, but some of the state’s more seasoned surgeons are sticking it out despite the tough malpractice liability climate, and are they trying to improve conditions for the future.

“Specialty physicians in Pennsylvania are like the white spotted owl, and without legislation, they will become extinct through attrition,” said Lewis Sharps, MD, a practicing Pennsylvania orthopedic surgeon and past president of the Pennsylvania Orthopaedic Society (POS).

Sharps’ sentiments are not exclusive to Pennsylvania, but the state does have some dubious distinctions. Only three orthopedic surgeons younger than 35 practice in Pennsylvania, and a recent American Medical Association survey showed nearly 75% of orthopedic residents who trained in the state between 1998 to 2002 moved elsewhere to start their careers.

Political realities

Sharps founded the POS political action committee in 1992. He said the past decade saw only a gradual increase in political activism by physicians until about two years ago, when interest increased dramatically as the medical malpractice liability issue moved to the forefront.

POS Executive Director Kathy DeWittie agreed that political activism by the group’s members has risen significantly and even included a recent rally at a downtown public park near Philadelphia City Hall.

“For the longest time we had to beg and plead for their involvement politically, but the past year, in particular, they have become incredibly motivated,” DeWittie said.

While the recent surge of political involvement has been encouraging, much more work is needed to ensure doctors properly represent their interests in national and state government.

“Physicians have been taken for granted. They tend to think that being in a noble profession means they’ll automatically be treated in a noble matter, but that’s not the case,” Sharps said.

Desired reform is possibly on the way in Pennsylvania but is still at least two years away from becoming reality.

Legislation workings its way through the Pennsylvania legislature could lead to a public referendum as early as 2005, according to the Pennsylvania Medical Society. Such a vote would allow state residents to decide if there should be a constitutional amendment to provide caps on non-economic damages with a dollar amount set by subsequent legislation.

Trial lawyers argue that the reforms suggested by physicians, such as caps on monetary awards for pain and suffering, are not viable answers. They describe caps as unfair to victims of medical mistakes and say such caps have not been effective in reducing liability insurance premiums.

Sharps said physician participation in politics is a must. He said there is an effort to add political education part of the medical curriculum.

“We’re trying to make academic centers include political action as part of their programs, because if they don’t, those programs may not be around in five years,” Sharps said.

Sharps described surgeons as being at a major disadvantage in the political arena.

“Physicians are not trained to understand the political process, while those in the legal profession are groomed on this material and understand the process intimately,” Sharps said.

Surgeons involved in the AMA survey cited the high cost of medical liability insurance and a litigious atmosphere as reasons for leaving the state. Hoping to address part of those concerns is the Positive Mutual Risk Retention Group, which last year became the first alternative risk insurance company founded under the federal Risk Retention Act.

The result of an effort that began three years ago, Positive Mutual Risk Retention Group is a physician-driven, professionally managed organization that operates under the same rules as any other insurance company.

Sharps, the president of Positive Mutual Risk Retention Group, said the group currently insures 117 physicians, includes a medical review board and emphasizes risk management.

The group’s risk management program includes risk management coordinators in each client’s office. The risk manager performs a variety of supporting tasks such as patient follow-up, and notifying the insurer and the doctors’ regarding any incidents that could lead to lawsuits.

“We do everything we possibly can to control risk, minimize litigation and costs, and make the patient’s experience as satisfactory as possible,” Sharps said.

While doctors often prevail in malpractice cases, any case filed is a case lost, Sharps said.

“Even if a case is successfully defended and dropped, it costs at least $35,000 to $55,000 to defend,” Sharps said.

The group hopes to offer more affordable rates over time as more physicians join and malpractice reform hopefully occurs.