Carol Ritter, M.D.: Ask the doctor (if … he’s still in)

Carol Ritter, M.D., The Examiner

BALTIMORE – Skyrocketing insurance premiums made the plight of Maryland physicians the center of state legislators’ attention in 2004.

With premiums threatening to bankrupt their businesses, Gov. Robert Ehrlich Jr. convened a special session of the legislature that December. The result, HB2, subsidized rate increases temporarily.

The bill expires in 2008, raising the question: Was this a short-term crisis or evidence of a deeper pathology requiring long-term structural reform? Ask your doctor.

If HB2 had solved the problem, doctors would be returning to Maryland to work, perhaps even to those parts of the state where many of our 780,000 uninsured live. But that’s not happening. Involuntary attrition thins the ranks of Maryland physicians. Doctors continue to retire early, relocate or restrict their practices to less risky procedures. Doctors typically leave quietly yet retain their Maryland licenses, making exact numbers hard to pinpoint. But two years post-HB2, recruiting new doctors to group practices and hospitals remains difficult.

The average age of general surgeons in Maryland is 62. No new general surgeon has set up practice in Baltimore County in the past 10 years.

The number of OB/GYNs in the state has dropped by more than a third since 2004, while another third expect to stop practicing obstetrics in 2008. Anesthesiologists and radiologists are moving to states with lower malpractice rates and higher reimbursements — as Maryland is one of the worst states in both respects.

In addition, medical school graduates avoid certain specialties out fear of the emotional and financial impact of lawsuits. What does this say about the state of our health care delivery system? Like osteoporosis, structural problems with our tort and financing systems threaten to fracture our once strong stream of physicians. Just ask your doctor.

Critics of malpractice reform blame the 2004 crisis on insurers. They assert that poor investment choices during a volatile stock market era challenged their ability to accommodate a spike in lawsuit payouts. They point to rates stabilizing this past year as proof the crisis is over. But they ignore trends. A neurosurgeon is sued an average of five times in a career, and a lawsuit will likely embroil an OB before he or she finishes training. These facts do not relate to stock market cycles. Instead, we suffer from a cycle of lawsuits that shrink access to health care and push costs upward. Just ask your doctor.

So while the current debate centers on reforming the tax code and making health insurance mandatory for everyone, having health insurance does not guarantee having access to a doctor.

One third of cases clogging emergency rooms nationally are non-emergency visits by people with insurance.

The long waits in the emergency departments and doctors offices, followed by the quick seven minute HMO-style visit, are symptoms of a system in an access crisis: Insurance or not, there aren’t enough doctors to go around. Just ask your doctor — if you can.

Maryland’s malpractice system functions on blame and greed creating a win/lose lawsuit lottery that pits patients against doctors. Defensive medicine drains $800 Million dollars from Maryland’s health care system annually.

A culture of needless lawsuits wastes time, money and lives and kills incentive for doctors to train in high risk specialties — targets for potential multimillion dollar judgments. Only insurance companies and trial lawyers win in this system; the losers are the citizens of Maryland who find their access to health care cut off.

The altruistic heart and soul of medicine is yet another victim of this crisis in Maryland. Johns Hopkins’ East Baltimore Clinic and GBMC’s Baltimore Street Clinic both closed their doors last year.

Practicing in a highly litigious setting can be professional and financial suicide for private physicians and hospitals alike. A simple solution would be an extension of the Good Samaritan law implemented in other states, such as that which relieved volunteers in New Orleans from liability risk. Ask a doctor what it would take for them to volunteer in a free clinic.

It will take a concerted effort from all involved to create a cure for our ailing system. Patients, you need to speak out to your elected leaders. Elected leaders, don’t forget to ask your doctors to help in finding a cure. Addressing structural problems with a cosmetic treatment is no solution. Let us not find ourselves in 2008, when the HB2 subsidy expires, with Maryland citizens once again crying, “Where’s my doctor?�

Dr. Carol Ritter is a solo gynecologist in Baltimore County who stopped practicing obstetrics in 2004. Her efforts as an activist to promote malpractice reform include producing a documentary, “If the Bough Breaks.�
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