Why hasn’t the malpractice crisis been fixed yet?
States don’t have authority over the national commercial insurance companies that control the medical malpractice market. While the New Jersey Department of Banking and Insurance got greater regulatory control over medical malpractice matters last year, it sets neither rate schedules nor individual premiums, and it can’t interfere with an insurance company’s investments or the rate of return it’s allowed to earn. According to Peter Hartt, assistant director of the state Division of Insurance, the 2004 Medical Care Access and Responsibility and Patients First Act lets the department order a rate rollback for any insurer whose rates don’t comply with the law; requires insurers to certify financial solvency; and requires them to report malpractice claim settlements, judgments, and arbitration awards.
Why is it so hard to see my doctor or get a referral?
Primary-care physicians are the pivotal players in the managed-care and patient-care delivery systems. They keep patient’s medical histories, refer them to specialists, and help to get pre-certifications for tests and procedures. Simultaneously, they usually make ends meet, as many other doctors do, by seeing a high volume of managed-care patients. The latest survey of doctors, from 2001 to 2004, was sponsored by the Department of Banking and Insurance. “The biggest red flag in the survey is that New Jersey has become so low in the true generalists of primary care and so heavy with specialists,” says Joel C. Cantor, director of the Rutgers University Center for State Health Policy. In the face of a growing patient demand, there was a 2.7 percent aggregate loss of ob-gyns. The most familiar primary-care specialties, internal medicine and family practice, posted gains of 2.1 and 4.3 percent, respectively, or about 16 doctors in each discipline each year.
General-practice medicine, the Marcus Welby model that Cantor calls a fading specialty, dropped 5.9 percent, leaving just 313 doctors in the state.
Why do doctors complain about government interference?
The Legislature enacted malpractice relief to protect doctors in 2003 and 2004 but levied new taxes on them by the end of 2004. Now dermatologists, plastic surgeons, and others pay the standard 6 percent sales tax on elective cosmetic procedures performed in their offices. A 3.5 percent gross-receipts tax has been levied on procedures performed in freestanding doctor-owned health centers, including surgicenters, physical therapy centers, and diagnostic imaging facilities that do CAT scans and MRIs. Starting this year, doctors are required to contribute $75 annually to the state’s new malpractice premium subsidies for high-risk doctors.
Do we have a doctor shortage?
While the survey revealed no dramatic exodus of doctors, Cantor adds that “it may be too early to have detected” the total fallout from the malpractice and healthcare crises. That said, the state’s patient-care doctors went from 19,314 in 2001 to 20,217 in 2004, an average gain of about 1.5 percent a year. Geriatric specialists jumped by 32.3 percent; pediatric subspecialties, including emergency medicine, were up 24.2 percent; and surgery lost doctors in three high-risk categories: general (down 2.4 percent); neurological (down 2.1 percent), and ophthalmologic (down 2.2 percent).
Why does our crisis seem worse?
Chalk it up to a variety of local factors, such as the buzz over medical errors (real or perceived), a litigious society, and juries that award huge damages. Even if the state’s premium rates hadn’t hit the roof, many New Jersey doctors and hospitals would still be dissatisfied with the managed-care mess and the administrative complexities they face every day.
What’s the fuss? Don’t Doctors make a lot of money?
The snapshot of the New Jersey economy shows extraordinary wealth while some struggle to make ends meet, and it’s no different in the medical community. After at least fifteen years of medical education and training and a few more years building their practices and reputations, top cardiologists, plastic surgeons, radiologists, orthopedic surgeons, and neurosurgeons might hit mid-to-high six figures in annual gross salary and income; others make closer to $250,000. Some pediatricians in New Jersey take home barely $90,000 a year. A busy solo internist can have 5,000 patients and work 60 to 70 hours a week for $160,000 to $200,000 or more.