Thursday, July 3, 2008

Malpractices - Maine Notes: Physician Concerns under the Radar

Kennebunkport, Maine – This evening I spoke to a female obstetrician-gynecologist in her early forties, a family friend, about the current practice climate. Our conversation, in the context of a casual family gathering, wasn’t formal or even focused on problems of the system. This report consists of snatches of her casual observations of what’s happening out there. I would like to share with you some of her passing thoughts.

• The malpractice climate remains a critical issue among practicing doctors. Critics may say malpractice is only a small part of overall health costs, but high malpractice premiums often dictate choice of specialty and discourage doctors from practicing in litigious states, where those premiums may exceed $100,000 per year. Total malpractice costs may not be that high, but the economic toll of “defensive medicine” cost society dearly.

• A malpractice suit against a physician, who has typically spent 11 to 15 years preparing to serve society, can be psychologically devastating. In the OB world, the greatest fear is a suit triggered by an “imperfect” baby, said by many lawyers to be due to doctor negligence and often an easy case for them to win before a jury confronted with a disabled child.

• Many physicians are cynical about health reform, no matter who wins the election. Physicians feel both parties are beholden to well-heeled special interests, which have incentives to retain the status quo.

• The fact that ½ of medical school graduates are now women, is, in some respects, changing practice and physician marriage relationships. Some women physicians work part-time while growing number of others work full-time and have “house-husbands,” who care for the children, prepare meals, and clean house, while the woman works.

• More and more hospitals “own” practices. Doctors in “owned” practices may feel compelled to act in the financial interests of the hospital, ordering more hospital-based tests and procedures, thus driving up the total cost of care and losing their ability to act independently. Being “owned,” in other words, may change how one acts and practices.

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