It's the stupid lawsuits that make medical care so dear to the pocketbook and the wait so long to see specialists. Howie's neurologist told us yesterday that in just a few years' time, the number of practicing neurosurgeons in the U.S. has dropped from 5000 to 3000. I'm sure it's high malpractice premiums, the insurance plans dictating what care their patients can receive, and the risk of lawsuits that did it.
I may be opening a kettle of fish that I don't want to open, but what your neuorsurgeon told you actually isn't true. It's an urban legend, perpetuated by well-meaning people, but it just isn't true.
Here's an excellent article from the American Association of Neurosurgeons regarding a study of the current number of neurosurgeons in the US from 2000. It is VERY difficult to estimate the number of neurosurgeons in the US at any one time. And, neurosurgeons have long been concerned that there are TOO MANY neurosurgeons in the country, while... patients who face long waits to see a neurosurgeon are obviously concerned that there are too few.
I realize that this article was written in 2000, but the point remains quite salient. Remember, it is in any professional's economic interest to remain well-booked over a long period of time. If an expert has loads of downtime, he or she probably can't maintain a practice for long in the local area (certainly not at the level of compensation he or she would prefer) and will need to relocate, etc. Check out the "trends influence the debate" the author references. Malpractice insurance isn't much of an issue: reimbursement rates through managed care, however, IS a big influence on the number of neurosurgeons in the US. Moreover, according to the study, the number of Board-certified neurosurgeons in the US remained steady at 3500 (!) from 1990 to 2000.
Locally, there was a good deal of fanfare when one of three neurosurgeons in the only area practice left to go back to his home country. It was widely rumored that he left because of the cost of malpractice insurance; however, that small practice was able to replace him within four to six months with another skilled and experienced neurosurgeon. I suppose it's possible that our local guy was just... homesick?
Regarding medical malpractice suits more generally, loads of politicians have bandied around the idea that medical malpractice suits are the main cause of the rising cost of health care and it just isn't the case. Malpractice suits are VERY hard to win (honestly!), and the general impact of awards on the overall industry costs is minimal:
http://www.factcheck.org/article133.html
http://www.washingtonpost.com/wp-dyn...-2005Mar9.html
Malpractice insurance rates have risen over the last few years as the stock market tanked. In the 1990s, with the stock market pulling double digit gains, insurance companies could make money even when paying out 100% of premiums in attys fees, admin costs and awards over time b/c of the market. That has not been true since '99, and has affected insurance rates for every industry, every class, everywhere (some more than others, of course).
Are there better ways to handle medical malpractice issues? Yeah, absolutely. The current system does nothing (really) to deter mistakes by physicians, and the cost of suit, likelihood of recovery, and strict standard of negligence mean that loads of people injured by avoidable medical mistakes are never compensated. And... anyway, who on EARTH would take the deal? Michael Kinsley wrote a great story for slate in '03 called the "Lawsuit Lottery," which I thought was really spot-on.
(Admittedly personal story: my aunt's breast cancer was visible on her mammogram for four years before the radiology group reading the mammograms caught it and notified her PCP. Essentially, they should have been comparing the mammograms each year and noticed the obvious changes. They did not. She sued. And won: eventually, but only after investing a substantial amount of her own money in the suit. Had she not had the $ to invest in tracking down appropriate experts, compensating them, and the like, she would not have been able to prevail. Even after prevailing, her managed care program sent her back to the same group for her follow-up mammograms. She had to pay for her own mammograms thereafter, since she obvious didn't trust them to review. Eventually, that breast cancer (10 years later) returned and killed her. Would it have been different had that radiologist done the comparisons he said he did? Had she rec'd treatment 2 or 3 years sooner? Maybe - who knows? But wow - how can you compensate someone for that? It's IMPOSSIBLE to do so. Here's 200,000. So sorry you're going to die (maybe), 30 years before you might've! Every wild "malpractice story" seems ridiculous until it happens to you or someone you know - but even if you DO know someone: would you take that deal? Pas moi.)
There are
no fault systems for medical malpractice issues in several countries, that generally work better than the current system. More injured people are compensated, more errors detected, for less $:
http://www.slate.com/id/2113103
Anyway, I'll get off my malpractice soapbox now. I really blame politicians for all the misinformation out there. Unfortunately, the reality is more complicated and less sexy than: too many frivolous lawsuits.
This isn't to say that there aren't frivolous lawsuits; there are. Personally, I think those large-scale small-award class actions are the most offensive (e.g. - the Blockbuster litigation). I think that the states' attorneys general are the more appropriate enforcers of consumer protection issues - although it would be nice if there were some federal consumer protection advocate with the power to bring suit. There *was* some big class action reform instituted this year - I think a stricter definition of "class," but I don't know the specifics or how that will play out.
Oops. More soapbox. I'll *really* get off the soapbox now.
Peace.
Anyway, as far as I can tell, she filed a complaint w/the state medical board. She didn't sue. I don't think she could win a lawsuit. I can't imagine what her damages would be and can't believe that anyone would take her case (unless he/she really just wanted on t.v.).
Okay! /soapbox!
