Opinion Medical Students Are Not Immune To Liability Crisis

The words are heartfelt — and strong.
“I have stood by the bedside of sick and dying patients. I have witnessed the mixture of raw emotions — fear, exasperation, desperation, sadness, and grief — evident in the eyes of patients and their families. There are the moments you devote every ounce of energy, knowledge, and compassion you can muster to care for your patient. For me, this is what being a physician is all about. However, a litigious juggernaut is corrupting this relationship. Practicing medicine is slowly becoming a defensive algorithm where standards of care are being dictated by a laundry list of legalese.”

Those disheartening words belong to Martin Palmeri, a fourth-year medical student at the Brody School of Medicine at East Carolina University. They were taken from a letter Palmeri wrote to Time magazine in response to a request for comments from medical students on whether America’s medical liability climate is causing them to reassess their future specialty or location of practice. For Palmeri, the crisis has done far more than that: it has caused him to change his course of study entirely.

“When I entered medical school, I was interested in obstetrics and gynecology and tailored my extracurricular activities and studying toward that end,” Palmeri said. But after hearing one too many disconcerting stories of ob/gyns retiring early or dropping obstetrics from their practice due to medial liability woes, he has switched his career sights to internal medicine.

Palmeri is not alone. According to a new American Medical Association (AMA) survey — the first of its kind — of nearly 4,000 medical students from 45 states and the District of Columbia, America’s medical liability crisis is causing a majority of them to seriously consider whether they want to practice a high-risk specialty or apply for a residency in one of the 19 states currently in crisis.

Thandeka Myeni, a second-year student at the Medical College of Georgia, said medical liability is a hot topic among students, who are constantly hearing stories of physicians having to close their practices because they are unable to afford the cost of malpractice insurance.

“My first year of medical school, I was considering ob/gyn, and while that remains a possibility, right now I’m leaning towards ophthalmology,” Myeni said. “The fact that ob/gyns have some of the highest malpractice premiums in the medical industry does figure in. Your whole paycheck can’t be dedicated to repaying student loans and malpractice premiums.”

The survey found that 96{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of students indicated the issue of medical liability is a crisis or a major problem. Half of the respondents indicated the current medical liability environment was a factor in their specialty choice, and 39{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said that environment was a factor in their decision about a state in which they would like to complete residency training. In addition:

• 69{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of students whose professors discussed the liability situation said the professors also discussed defensive medicine, including increasing unnecessary or excessive care;
• 61{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of students are extremely concerned that the current medical liability environment is decreasing physicians’ ability to provide quality medical care; and
• 48{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of students in their third or fourth year of medical school indicated that the liability situation was a factor in their specialty choice.

“These survey results will be an important benchmark to gauge how the crisis continues to affect patients’ access to medical care,” said AMA President Dr. Donald J. Palmisano. “The students’ responses underscore the need for America’s lawmakers to listen. Fix the crisis now. Enact meaningful medical liability reform legislation.”

The AMA strongly urges the U.S. Senate to support a vote on legislation — the Patients First Act of 2003 — which was introduced earlier this year. Similar legislation already has passed the U.S. House of Representatives.

As Palmeri put it, “It is disheartening to come into medicine with so much enthusiasm and have it tempered because of tort issues.” The AMA could not agree more.

Daniel Blaney-Koen is field communications manager for the American Medical Association.