There hasn’t been much discussion about serious tort reform in the current healthcare reform debate. That’s probably because most policy experts don’t believe it will make a significant dent in healthcare costs. I happen to believe that tort reform would be a huge boon for healthcare (just ask Ob/Gyns in Texas) and save a lot in defensive medicine practices and unnecessary testing, but even if I’m wrong and it wouldn’t result in cost-savings, there’s another issue at play: access to primary care physicians.
We all agree that we’re in the midst of a major shortage in primary care physicians. Many different solutions have been proposed – everything from “let the nurses do it” to forgiving medical school loans to physicians who choose primary care as a career. However, solving the PCP shortage isn’t just about recruitment, it’s about retention. And with up to a half of PCPs saying that practice conditions are so unbearable they’re planning to quit in the next 2 years – Houston, we have a problem.
It’s estimated that between 10-20 per cent of PCPs are working part-time currently. It’s hard to say how many physicians who are not practicing clinically might opt into part-time work if it were affordable/easy to do so. But let’s say that 30% of the PCP work force could consist of part-time staff in any given state.
Now let’s take a look at how two states compare with one another in terms of medical malpractice insurance rates, and how that would impact the ability of the local PCPs to practice primary care there. I’m making this comparison because it directly impacts me and what I’ve been through in the past few months.
Virginia has set a cap on medical malpractice payouts at a generous $2 million dollars. Washington, DC has no cap on pay outs. The result? Medical malpractice insurance is exactly 10 times higher in DC than Virginia. What does this mean for primary care? It means that medical malpractice insurance rates are so high in DC, that to afford to pay them and stay in business one would have to be a specialist or a full time, multi-physician PCP practice or part of a hospital system. That means that the 30% of the work force who are part-time private practice PCPs (who would potentially be happy to treat patients in the district), simply cannot afford to do so. It means that you cannot find a PCP in DC – unless you want concierge care at $900 for an initial visit.
Is medical malpractice reform important? I certainly believe so – and not just because it could reduce defensive medicine practices (or as KevinMD argues, improve timely patient compensation for the deserving), but because it could substantially improve retention of the few PCPs we have left in our healthcare system. Making it impossible for PCPs to afford to practice part-time, reduces our work force by (perhaps) as much as a third. Just ask the residents of Washington, DC if they can find a new PCP.
As for me, I’m scoping out office space just across the Potomac – in Virginia.