Medical Malpractice Crisis Affecting Patient Care - Mixture of Financial, Market Pressures Fray Physician - Patient Relationship and Impact Health Care Quality
New study on medical malpractice released by The Project on Medical Liability in Pennsylvania; funded by The Pew Charitable Trusts.
PHILADELPHIA, PA (PRWEB) July 7, 2004 -— The medical malpractice crisis
gripping Pennsylvania has sown widespread discontent among doctors in high-risk
specialties, affecting the quality of health care their patients receive,
according to a new study released today by The Project on Medical Liability in
Pennsylvania and funded by The Pew Charitable Trusts. Malpractice concerns could
be harmful to the physician-patient relationship, as the interplay between
financial and market pressures changes how physicians approach their work, the
study says.
"Physician satisfaction is often neglected or discounted as
self-serving in policy debates," the authors say. "In this paper we outline a
framework for understanding why physician satisfaction matters for patient care
and what factors influence it. Professional dissatisfaction deserves policy
attention if it has damaging consequences for patients."
Nearly 40
percent of Pennsylvania high-risk specialists surveyed in 2003 were dissatisfied
with the practice of medicine, twice as high as the national rate in 1999.
Studies have shown that satisfied physicians tend to be more attentive to their
patients and have higher levels of satisfaction among their patients. But
dissatisfied physicians have been linked to riskier prescribing practices or
engaging in "defensive medicine" when treating patients.
"Our findings
suggest that the malpractice crisis in Pennsylvania is decreasing specialist
physicians' satisfaction with medical practice in ways that may affect the
quality of care. The relationship may be cumulative, with an acute malpractice
crisis acting as a 'last straw' among the physicians who are most affected by
it," the report's authors conclude.
The report, "Caring For Patients In A
Malpractice Crisis: Physician Satisfaction and Quality Of Care," is part of a
special section published in "Health Affairs" containing several other articles
showing the complexity of the medical malpractice crisis.
According to
the American Medical Association, about two-thirds of U.S. states are now in the
midst of a malpractice crisis or showing signs of trouble. Nowhere is the
problem more acute than in Pennsylvania, where several insurers have left the
market and premiums for coverage through the remaining insurers have increased
dramatically. To investigate the effects of the malpractice crisis on patient
care, the authors conducted a series of interviews with representatives from
Pennsylvania physician groups, hospitals, and insurers, followed by a mail
survey of 824 Pennsylvania physicians in high-risk specialties (emergency
medicine physicians, general surgeons, neurosurgeons, OB/GYNs, orthopedic
surgeons, and radiologists).
KEY FINDINGS
Pervasive Job
Dissatisfaction
Nearly 40 percent of the Pennsylvania high-risk specialists
surveyed in 2003 were dissatisfied with the practice of medicine. OB/GYNs were
most likely to report dissatisfaction. Career satisfaction among Pennsylvania
high-risk specialists was much lower than a 1999 national sample—39 percent
compared to 19 percent.
Low Marks for Pennsylvania
Seventy percent of
specialists said that they would be very or somewhat likely to recommend their
specialty to someone graduating from medical school today, but only 15 percent
were willing to recommend practicing in Pennsylvania. Nearly half responded that
they were not at all likely to recommend Pennsylvania. Specialists who had
strong personal ties to the state (either grew up or attended medical school in
Pennsylvania) were no more likely than those who did not to recommend practicing
here.
Income Squeeze
Rising liability insurance premiums and static or
declining reimbursements are putting physicians in an income bind. Specialists
surveyed who felt heavily burdened by malpractice insurance costs were least
likely to report satisfaction with their practice. Asked to characterize their
current professional liability insurance premium levels, 40 percent of
specialists described their premiums as an "extreme burden," 40 percent said
that they were a "major burden," 12 percent called them a "minor burden," and 2
percent said that they were "not at all a burden."
Fraying Relations
with Patients
Liability pressures may affect physicians' satisfaction and the
quality of care by impinging upon the physician/patient relationship. Just over
half of surveyed specialists denied that malpractice concerns made them less
candid with their patients, but a sizable minority felt that they did.
Physicians who felt "wounded" by the malpractice system and those with high
premium burdens were significantly more likely to report such changes in patient
relations. Three-fourths of specialists agreed with the statement, "Because of
concerns about malpractice liability, I view every patient as a potential
malpractice lawsuit."
Limited Autonomy
The malpractice crisis may
also be affecting physicians' satisfaction by eroding their sense of control.
Survey reports indicated that the liability environment impedes specialists'
perceived ability to deliver needed services in the way they would like.
Ninety-one percent of specialists surveyed said that the malpractice system
limits doctors’ ability to provide the highest-quality medical
care.
Cutting Back on Care
Many specialists surveyed reported that
their practice or hospital was taking steps to reduce overhead costs, and nearly
two-thirds reported that their practice or hospital would likely reduce the
number of clinical staff over the next two years because of liability costs.
Nearly three-fourths indicated that their practice or hospital would likely
reduce the number of administrative staff, and a similar percentage reported
that their practice or hospital would cancel or delay capital improvements
because of liability costs.
OUTLOOK
According to the report,
rising liability expenses in a severe malpractice crisis impose costs on
patients. Some costs are economic—state governments may divert tax dollars
toward subsidies for malpractice insurance premiums, and health insurance costs
may increase if provider reimbursement is raised in response to increased
overhead. But other costs come in the form of lower quality and availability of
health services. As the human face of such changes, physicians'
behavior—particularly their anxieties and discontent—should become a critical
policy focus, the report recommends.
State legislatures typically focus
on three strategies to respond to a malpractice crisis: insurance subsidies,
stricter insurance regulation, and reforms to the tort liability system.
Overall, these reform strategies are responsive to physician dissatisfaction,
the report says, but their efficacy as a cure for the tort crisis and protection
for recurring crises is open to question. The core objective of such reforms
should not be to restore physicians' job satisfaction, but to improve the
malpractice system’s performance in compensating patients and promoting
high-quality care. If a byproduct of reform is higher professional satisfaction,
it's the patients who stand the most to gain, the report says.
The full
report and other research by the Project on Medical Liability in Pennsylvania
may be found at www.medliabilitypa.org
About The Project on Medical
Liability in Pennsylvania:
The goal of the two-year, $3.2 million Project on
Medical Liability in Pennsylvania is to provide Pennsylvania policy makers with
objective information about the medical liability system; to broaden
participation in the medical liability debate to include new constituencies and
perspectives; and to focus attention on the relationship between medical
liability and the overall health and prosperity of the Commonwealth. The Project
is working with leading health policy experts from across the nation and will
continue to publish both original research based on new data and expert
analyses. The Project will generate information from a broad range of
perspectives, without promoting the agenda of any of the stakeholders in the
debate.
The other articles in this special edition of "Health Affairs"
examine the following:
William Sage, from Columbia Law School, proposes
overhauling the structure and financing of malpractice liability insurance. Sage
attributes much of the current crisis to a widening gap between first-party
health insurance and third-party malpractice insurance. He urges Medicare and
Medicaid to play a major role in the medical liability system of the
future.
Carol Liebman and Chris Hyman of Columbia Law School examine a
program of medical error communication and mediation-based dispute resolution
that can improve patient care as well as reduce malpractice litigation. The
measure can be adopted voluntarily by hospitals and physicians even if political
consensus on legislative reform is lacking.
In a critical review of
recent proposals for "medical courts" and "expert screening panels," Catherine
Struve, a professor at the University of Pennsylvania Law School, suggests
simpler, more effective ways to help judges and juries make better-informed
rulings with respect to both liability and damages.
In a study not part
of the Pew research, Harvard's David Studdert and colleagues review a sample of
high-end jury verdicts that were subject to California's cap on noneconomic
damages. They conclude that the cap is unfair to patients who suffer grave
injuries involving pain and disfigurement.
The
researchers for this report are Michelle M. Mello, an assistant professor of
health policy and law, Department of Health Policy and Management, Harvard
School of Public Health. David Studdert is an associate professor of law and
public health at the Harvard School of Public Health. Catherine DesRoches is a
research assistant in that department. Jordon Peugh is a senior research manager
at Harris Interactive in New York City, where Kinga Zapert is a vice president.
Troyen Brennan is a professor of law and public health, Department of Health
Policy and Management, Harvard School of Public Health, and a professor of
medicine in the Department of Medicine, Harvard Medical School. William Sage is
a professor of law at Columbia Law School in New York City.
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Source : http://www.prweb.com/releases/2004/7/prweb139402.htm