In the movie Network, television anchorman Howard Beale (played by the late Peter Finch) famously exclaims, “I am mad as hell, and I'm not going to take it anymore!” When it comes to malpractice insurance rates, physicians across the country are getting more than mad. They are acting to save the physical and fiscal well-being of their clinical practices. My hometown of Kansas City is just one city affected by skyrocketing insurance rates. Because of the imaginary line that splits the Kansas City metropolitan area between Missouri to the east and Kansas to the west, all neurosurgeons on the eastern side of the metroplex are leaving Missouri and shifting their hospital and clinical practices to the state of Kansas. The only neurosurgery practice in Missouri between St. Louis and the state of Kansas will be located 120 miles to the east of Kansas City in Columbia, Missouri. Why? Over the matter of a measly sum of $240,000 per year in Missouri versus $80,000 in Kansas for a single year of malpractice insurance coverage. How many occupations in America, let alone the world, require a professional to pay $240,000 in order to go to work on January 1 of each year?
Neurosurgery isn't the only specialty affected, either. The birth of a child may be the single most significant event in which a physician has the privilege of participating. Unfortunately, malpractice rates in Kansas City are interrupting this relationship as well. Missouri obstetricians pay $160,000 per year for insurance, while the rate for Kansas obstetricians is $25,000 per year. As the situation in Kansas City demonstrates, both patients and hospitals join physicians as victims of such astronomical rates. When a group of eight OB/GYNs left their hospital in Missouri to join a competing hospital 1 mile away in Kansas, the Missouri hospital was forced to all but close its labor and delivery department, and the Kansas hospital, which had recently opened and was struggling financially, hit the jackpot when its monthly deliveries jumped from 50 to 160 per month. Kansas beats Missouri again.
I learned of another oddity across state lines from a personal friend who is a plastic surgeon practicing in both Kansas and Missouri. He revised his plans to buy a new home when he learned that, if he moved his personal residence to the state of Kansas, yet changed nothing regarding his practice of medicine and surgery in the state of Missouri, he could reduce his malpractice premium from $60,000 to $20,000 annually. Talk about an easy decision!
How do the above anecdotes relate to this month's cover focus? They illustrate a familiar cause-and-effect relationship enacted throughout the country. When such a disparity exists between states' medical insurance rates, physicians will relocate to the more practice-friendly areas. One solution to this troublesome reaction is caps on malpractice judgements. Limits to financial pain and suffering awards exist in several states, and limits to punitive damages for medical malpractice are under discussion and review in several others. As would be expected, and probably appropriately so, no states are likely to limit awards for economic damages (including medical bills, lost wages, and other associated costs). In this edition of Cataract & Refractive Surgery Today, our distinguished contributors debate another potential solution to the national medical liability crisis of the new millennium, one that physicians themselves can implement. Steven J. Dell, MD; Guy Kezirian, MD; Lee T. Nordan, MD; and Catherine Greaves, JD, discuss the merits of a “Contract for Medical Services,” as well as its implications, shortcomings, and current utilization. This controversial topic and its applications to the practice of medicine is fascinating for ophthalmologists to consider. We hope you enjoy this intriguing edition of CRSToday.