Changes In Physician Supply And Scope Of Practice During A Malpractice Crisis: Evidence From Pennsylvania

Mello, Michelle M.; Studdert, David M.; Schumi, Jennifer; Brennan, Troyen A.; Sage, William M.

doi:10.1377/hlthaff.26.3.w425

Cited by 27 publications

(20 citation statements)

References 12 publications

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“…Our ability to precisely observe when obstetricians exit the market may also explain why we found large differences in the physician labor supply not observed in most other studies. Our results for obstetricians are consistent with those of Mello et al (2007), who also used a data source that was more precise in capturing physician exit than the AMA Masterfile; however, with detailed physicianlevel data we also were able to describe physicians who were most likely to experience transitions following changes in malpractice premiums. By identifying the physician workforce specializing in obstetrics using state discharge data sets for Pennsylvania, Florida, and New York from the period 1998-2004, we show that rising malpractice premiums are associated with an increased rate of exit and a reduced rate of entry for obstetricians.…”

Section: Discussionsupporting

confidence: 84%

Malpractice Premiums and the Supply of Obstetricians

Polsky¹,

Marcus²,

Werner³

2010

INQUIRY

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Using longitudinal data on practicing obstetricians from 1998 to 2004 derived from Pennsylvania, Florida, and New York hospital discharge data, this study finds that rising malpractice premiums are associated with an increased rate of exit and a reduced rate of entry for obstetricians. In Pennsylvania and Florida, where premiums rose by an average of 20% per year for four years, the combined effect of more exits and fewer entries was associated with a decline in obstetrical labor supply of 80 physicians, or 5.3% of the supply of obstetricians.The medical malpractice environment has experienced several periods of great volatility over the past 30 years. The most recent crisis, which started in 2000, upset a decade of stability in premiums. It was characterized by average premium hikes of 15% per year, with particularly large premium increases in some geographic areas and in high-risk specialties such as neurosurgery and obstetrics (Rubin 2001;Guadagnino 2001), resulting in abrupt shifts in the cost structure of some physician practices. Although this raised concerns that the availability of medical services may be reduced in certain communities, little evidence exists to support these claims.This study uses rich new data to examine the direct relationship between the growth of malpractice premiums and the size and composition of the physician workforce specializing in obstetrics. The primary data sources for this project are statewide hospital discharge data sets from 1998 through 2004 from Pennsylvania, Florida, and New York. We first identify physicians practicing obstetrics in each state and each year by affirming whether hospital records indicate they performed deliveries in that year. Then, by linking physician information over time, we precisely determine the year when each physician stopped or started his or her obstetrical practice. We show that rising malpractice premiums increased the rate at which practicing obstetricians dropped their obstetrics practice and simultaneously reduced the rate of entry for new obstetricians.

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Section: Discussionsupporting

confidence: 84%

Malpractice Premiums and the Supply of Obstetricians

Polsky¹,

Marcus²,

Werner³

2010

INQUIRY

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“…First, these results from Florida cannot be generalized to other states, which may have different malpractice reform environments. Second, the dataset excluded outpatient procedures and deliveries, which might account for possible shifting of care by obstetrician-gynecologists to outpatient settings, but evidence of such a shift is limited (Mello et al 2007). Other variables that were excluded due to data limitations include malpractice premiums and physician income, which are assumed to be time invariant in the model.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Malpractice Liability Claims on Obstetrical Practice Patterns

Gimm

2010

Health Services Research

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Objectives. This paper examines whether malpractice claims have any impact on obstetrical practice patterns (C‐section rates) and physician delivery volume. Data Sources. Secondary data from the 1992–2000 Florida Hospital Inpatient Discharge File, the Florida Medical Professional Liability Insurance Claims File, and the American Medical Association's Master File on physician characteristics. Study Design. The effects of malpractice claims on C‐section rates and physician delivery volume were estimated using panel data and a fixed‐effects multivariate model. Data Collection. Variables were constructed from each data source and merged into a single panel dataset using consistent physician identifiers. Principal Findings. I did not find evidence that physicians changed their practice patterns by increasing C‐section rates in response to malpractice claims. However, physicians performed six fewer inpatient deliveries 3 years after the closing of a malpractice claim, after controlling for individual‐ and market‐level characteristics. Physicians with high malpractice awards of U.S.$250,000 or more performed 14 fewer deliveries on average. Conclusions. Malpractice claims led to a small reduction in physician delivery volume, but they did not have a significant impact on C‐section rates.

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“…These effects, either alone or in combination, may be barriers to sustainable emergency care networks. Malpractice pressures have been shown to cause disruptions in the supply of physicians and alter their scope of practice 40,41 . Current literature has documented breakdowns in the availability of patient care as a result of these disruptions and alterations in physician behavior 42 .…”

Section: Recommendation 2: Identify Medical–legal Framework That Supmentioning

confidence: 99%

Research Priorities for Administrative Challenges of Integrated Networks of Care

Pilgrim

Hilton

Carrier

et al. 2010

Academic Emergency Medicine

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In 2006, the Institute of Medicine (IOM) advanced the concept of ''coordinated, regionalized, and accountable emergency care systems'' to address significant problems with the delivery of emergency medical care in the United States. Achieving this vision requires the thoughtful implementation of wellaligned, system-level structures and processes that enhance access to emergency care and improve patient outcomes at a sustainable cost.Currently, the delivery of emergency medical care is supported by numerous administrative systems, including economic; reimbursement; legal and regulatory structures; licensure, credentialing, and accreditation processes; medicolegal systems; and quality reporting mechanisms. In addition, many regionalized systems may not optimize patient outcomes because of current administrative barriers that make it difficult for providers to deliver the best care. However, certain administrative barriers may also threaten the sustainability of integration efforts or prevent them altogether.This article identifies significant administrative challenges to integrating networks of emergency care in four specific areas: reimbursement, medical-legal, quality reporting mechanisms, and regulatory aspects. The authors propose a research agenda for indentifying optimal approaches that support consistent access to quality emergency care with improved outcomes for patients, at a sustainable cost. Researching administrative challenges will involve careful examination of the numerous natural experiments in the recent past and will be crucial to understand the impact as we embark on a new era of health reform.

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Changes In Physician Supply And Scope Of Practice During A Malpractice Crisis: Evidence From Pennsylvania

Cited by 27 publications

References 12 publications

Malpractice Premiums and the Supply of Obstetricians

Malpractice Premiums and the Supply of Obstetricians

The Impact of Malpractice Liability Claims on Obstetrical Practice Patterns

Research Priorities for Administrative Challenges of Integrated Networks of Care

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