In early February of this year, the Des Moines Register editorial staff ran an article attempting to confirm what this blog has been arguing since its inception: efforts toward so-called tort reform have accomplished very little when it comes to increasing the number of doctors practicing in a given state.
The Register’s article begins by explaining that Iowa governor Terry Branstad has made it a priority to keep doctors working in the state–Iowa ranks 46th in the number of internal medicine doctors, 47th for pediatric doctors, and last in the country when it comes to the number of emergency medicine doctors. Part of this project involves valuable and worthwhile initiatives like a loan forgiveness program and additional funds to support residencies for young doctors, but he has also voiced his support for “efforts to reform medical malpractice litigation,” which the Register points out “includ[es] a cap on non-economic damages [like awards for pain and suffering] in medical malpractice lawsuits.”
The authors of the article claim that measures like these are ineffective, arguing that while issues of tort reform are important to politicians, they have very little impact on the number of doctors in a state. This assertion finds support when we consider Texas, whose legislature passed draconian tort reform laws in 2003. According to a 2012 study from the University of Texas, Northwestern University, and the University of Illinois, researchers “found absolutely no evidence that tort reform saved money.” Interestingly enough, rather than lowering costs for patients, Medicare costs in Texas have actually risen one to two percent faster than the national average.
The Des Moines Register story describes a survey conducted by researchers at the University of Iowa, who, in an effort to “cut through the conjecture about why some physicians leave” the state, contacted more than 200 physicians to ask them why they left. Of the 220 doctors to respond to the survey, only one said the most important factor in his/her choosing to leave Iowa was professional liability exposure. The vast majority, about eighty percent of responders, said their decision was based on “practice factors,” specifically “attitudes/values/relationships within the practice.” An assistant dean at the University said, “Those explanations for physician departure [liability, increased government reimbursements] are extremely common misconceptions.”
The article goes on to assert that despite the relatively low number of doctors in Iowa, the state’s “overall supply of physicians increased 54 percent, compared with a two percent increase in Iowa’s population.”
Civil justice blog ThePopTort.com adds that researchers in New York state came up with similar findings in a survey they conducted. The Center for Health Workforce Studies “found that the main reasons physicians leave that state are: proximity to family; inadequate salaries; and visa issues.” They also established that less than three percent of non-primary care physicians and one percent of primary care physicians leave due to the cost of malpractice insurance, making this “dead last on the list of possible reasons for leaving New York state.”
These findings further support the idea that the state in which a doctor chooses to live has very little to do with the medical liability laws in that state, despite what politicians may say.
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