Concern Is At A Premium Liability Insurance Costs Take Toll On OB/Gyns

BY GEORGE O’BRIEN

Dr. Howard G. Trietsch won’t be delivering any babies after Jan. 1.

The 15-year veteran, who has delivered thousands of babies in the Pioneer Valley, told The Healthcare News that he made the decision to drop obstetrics and focus on the gynecological services side of his practice with Baystate Ob/Gyn.

Actually, he said the skyrocketing cost of liability insurance for ob/gyns in Massachusetts made the decision for him. And he’s not alone.

Indeed, malpractice insurance premiums approaching — and in some cases exceeding — $100,000 are forcing many ob/gyns to drop obstetrics, take early retirement, or leave the state. Trietsch said he chose his course because he wanted to stay in this area and isn’t ready to retire. Baystate Ob/Gyn, which is based in East ongmeadow but has several satellite offices in the region, has hired three new ob/gyns, he said, to not only make the deliveries he will no longer handle, but also divide the practice’s overhead among more people.

What’s happening at Baystate Ob/Gyn is being repeated at practices across the region, said Ronald Burkman, chairman of the Ob/Gyn Department at Baystate Health System, who said there is now a crisis in this important field of medicine.

By his count, eight of the region’s 50 ob/gyns have made the decision to quit obstetrics, retire, or relocate since last July — decisions that have resulted directly or indirectly from the insurance rate hikes — and another four or five will take similar steps in the next six months.

That’s 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the ob/gyns in the Pioneer Valley, he said, adding that such an exodus will result in serious access issues for area women. The problem has already visited the Ware area, where the two ob/gyns affiliated with Mary Lane Hospital have left the state, leaving that area without anyone to deliver babies.dministrators within the Baystate system, which includes Mary Lane, are scrambling to find physicians to fill those vacancies, said Burkman, but for now, most women in that area must travel to Baystate to deliver their babies, and this has been a major inconvenience.

“We’ve had a couple of close calls already, and winter’s just getting started,” said Burkman, referring to women who have barely made the commute in time to deliver in the hospital. “And this is just one example of how access is going to be impacted. This is a huge issue for this region and the Commonwealth as a whole.”
While what’s happening in Ware might sound like an extreme case, it could be a harbinger of things to come in other communities across the Commonwealth unless something is done to stem the tide of defections from the ob/gyn field, said Burkman. Legislation has been filed that seeks hard caps on non-economic damages from incidents of malpractice, he said, adding quickly that such a measure will likely face a long, difficult road to passage.

The Healthcare News looks this month at what might happen to the ob/gyn field in the meantime, and what it means for area women.

Birth of a Notion

Dr. James Wang, one of three physicians and two nurse midwives working at Women’s Health Assoc. in Westfield, is another long-time obstetrician who is giving up the practice of delivering babies.

Like Trietsch, he said it no longer makes economic sense for him to do so. “The liability insurance rates are going at a rocket-ship pace to the moon,” he said. “This is a difficult decision for me … I’ve dedicated a major portion of my adult life to delivering babies safely, but I don’t really have a choice.”

Unlike a company faced with rising costs of doing business, a physician cannot pass along the higher insurance premiums to patients — those prices are fixed. So physicians have to either eat them — which many simply can’t afford to do, despite public opinion to the contrary — or get out of the business. In his case, like Trietsch, Wang chose to isolate his work on gynecology, which is not subject to the same explosive rate increases.

Those spiraling malpractice rates — which have gone up across the board in Massachusetts but especially for ob/gyns because of the high-risk nature of their work — have resulted from a number of factors, said Trietsch. For starters, some insurance companies have given up on medical malpractice, he said, listing St. Paul as the latest casualty. Competition usually drives costs lower, he noted, adding that contraction has the opposite effect.

Meanwhile, several recent large Worcester, have made insurance companies especially skittish about obstetrical coverage. The number of awards hasn’t gone up, Trietsch stressed, but the awards have, with many damaged-babies cases now seeing damages well in excess of $1 million.

The quotes for recent new policies tell the story about what’s happening in this field. For most ob/gyns, rates will at least double, said Trietsch, going from $30,000 to $40,000 to more like $75,000 to $80,000. But rates vary depending on factors ranging from experience in the field to the number of damage claims on a physician’s record, he said, adding that he has heard anecdotally about some quotes for new policies well in excess of $100,000 a year.

What does that mean for the average obstetrician? At the going rate of about $2,000 per delivery, doctors must deliver 50 babies just to pay for their malpractice insurance, said Burkman, adding that most can’t deliver more than 150 a year. And they have many other expenses, of course, including, for recent graduates, hefty student loans.

That’s why many practicing obstetricians are leaving the field, and why many young people will be thinking twice about getting into it, he said.

“As students hear about this, as they hear obstetricians grousing about not being able to make ends meet and dropping out of the field, they’ll be less likely to choose this profession,” he explained, adding that early reports show a significant drop in the number of resident applicants in ob/gyn.

Stand and Deliver

For existing physicians, the choices facing them are often agonizing. “They’re not happy about this,” said Burkman. “They spent four years training for this, and they love to do it, but they have to give it up because they can’t afford the insurance. How crazy is that?”

But while the crisis in obstetrics is forcing many physicians to give up a practice they love, the real issue facing society is access to quality care, said Wang.
He said women will have to wait longer to get appointments, and when they get one they will probably have less time to spend with the physician because that doctor will be facing larger volumes of patients. And in too many cases, women will not be seeing the doctor of their choice or one familiar with their history.

And many of the doctors who are leaving obstetrics are those who are most experienced, said Wang, because they’re older and closer to retirement age. The loss of such experience is incalculable, he said, noting that the bottom line is that quality of care will certainly be impacted.

Burkman concurred, citing the case of Scranton, Pa. as one example of what could happen here. At one time, that city, the third-largest in Pennsylvania, had 25-30 obstetricians. Within the next few months, after more liability polices are renewed — or not renewed, as the case may be — there may be four or five left.

“People in a city that large now have to drive maybe 100 miles or more to deliver a baby,” he said. “We’re not there yet, but if we get to $200,000 in liability costs, like they did in Pennsylvania, we’ll be there overnight.

“The system is clearly broken,” he continued, “and we have to do something to fix it.”

That ‘something’ could be tort reform in the shape of legislation, supported by the Mass. Medical Society, that would cap non-economic damages (pain and suffering, for example) at $500,000. The state already has a cap, said Burkman, but juries can easily override it and award higher damages, he said.

California imposed a cap several years ago, and other states have since put them effect, he said, adding that such legislation, while it makes sense to the medical profession, is opposed by trial lawyers and other groups. Thus, while health care groups are hopeful for some reform, they know it may not happen overnight.

Wang told The Healthcare News that he has thought about leaving the state and finding a greener pasture in which to continue delivering babies. But he’s not sure there is one. “I’m pretty sure the problem would just follow me wherever I went,” he said. “That’s why I’d prefer to stay, make a stand, and try to improve our situation here.”

For that to happen, many constituencies, including lawmakers, the business community, and the public at large, must understand that the issue isn’t about doctors, said Burkman, but about access and quality of care. If enough people understand that, he said, then maybe a resolution to the crisis can be reached.