The high cost of medical malpractice insurance is a leading reason cited by new doctors for leaving Pennsylvania when their training is finished, according to a new survey. More than three-quarters of the medical residents surveyed said they planned to leave Pennsylvania, and almost half of those doctors said the cost of liability insurance was the reason for their departure.
Resident physicians in high-risk fields such as general surgery and emergency medicine named malpractice costs as the reason for leaving the state three times more often than any other factor. It outranked concerns such as quality of life, living near their families and salary. The survey, part of the Project on Medical Liability in Pennsylvania funded by The Pew Charitable Trusts, was published this month in Obstetrics and Gynecology.
"I'm leaving Pennsylvania the second my residency is finished," one resident said. "Why in the world would anyone want to practice in this state?" Another resident wrote in the survey, "I am very concerned about not being able to refer patients to sub-specialists in the state (neurosurgery, orthopedics). For the first time I am considering leaving the state, and moving my family, to Maryland, Virginia, or a nearby state because of malpractice issues. Why stay here for lower salaries and higher risk?"
Few previous studies have examined how the cost of liability insurance is affecting the plans of today's medical residents training for high-risk specialties. This study looked at the attitudes of doctors in the final or next-to-last year of their residencies as they were making career decisions.
The statewide mail survey gathered responses from 360 residents nearing the end of their training in anesthesiology, emergency medicine, general surgery, obstetrics, orthopedics, and radiology—specialties that are among those affected most by rising liability costs and pressures. The researchers also surveyed directors of 68 Pennsylvania residency programs in those specialties. The survey, by Michelle M. Mello, Associate Professor of Health Policy and Law at Harvard University's School of Public Health, and Carly N. Kelly, an attorney, found that malpractice insurance premiums were making young doctors leery of joining or starting practices in Pennsylvania.
The respondents answered the survey in 2003; the adjusted response rate was 83 percent for program directors and 49 percent for residents. About 26 percent of the respondents were residents in emergency medicine, 19 percent in general surgery, 17 percent in anesthesiology, 15 percent in radiology, 12 percent in orthopedics and 11 percent in obstetrics and gynecology. About a quarter of the residents grew up in Pennsylvania and 34 percent attended medical school in the state.
One in three residents said they would leave the state after completing their residency because of the lack of affordable malpractice insurance. Residency program directors reported that the proportion of young doctors in their training programs planning to leave the state had increased dramatically since 1999. Seventy-one percent of program directors said they had seen a decrease in residents willing to stay in Pennsylvania compared to three to five years ago, when malpractice insurance costs in the state started to rise. Directors also said residents are more concerned about professional liability today than they were three to five years ago, with 53 percent describing their current residents as very concerned about malpractice and 40 percent as somewhat concerned.
"Everything about Pennsylvania other than the state of malpractice and litigation would encourage me to stay and practice here," wrote one resident. "I like Pennsylvania, but it's not worth it."
Mello and Kelly conclude: "An environment of mounting liability costs in Pennsylvania appears to dissuade substantial numbers of residents training in high-risk specialties from remaining in the state to practice after residency." Pennsylvania ranks 41st out of 50 states in the percentage of physicians under the age of 35, according to data compiled by the Pennsylvania Medical Society in 2003. In 1985, it ranked 16th. A shrinking supply of young doctors may have long-term implications for the availability of specialist care in the state, Mello said.
Much stronger language was used by some of those surveyed. "I wish I had never come to Philadelphia, 'City of the Lawsuit,'" one resident wrote. "I cannot believe I have dedicated my entire life to medicine just to be sued twice during my residency. I warn all students that I meet not to become a doctor, not to go into surgery, and above all, not to go to Philadelphia."