"No beginning physician could afford to cover the liability risks of today, alone"

A town loses it’s orthopedic surgeons to retirement. They could not recruit others, which causes this OB to lament:

I arrived at the office from the hospital at noon on a January day and began to look at the mail on my desk. On the top was the bill for my liability insurance coverage for the coming year, necessary for defense against lawsuits. The amount was a startling increase, very close to my take-home pay the previous year. I wasn’t willing to play the game, to let corporate structure tell me how, as a trained professional, where, when and under what circumstances I might practice medicine.

Comments are moderated before they are published. Please read the comment policy.

  • Medicine Man

    I really do believe it depends on what state (i.e. how much are the insurance premiums) and what specialty. I’m a beginning physician in private practice, covering my own malpractice in Internal Medicine, and still surviving. It’s not easy, but I’m determined to win the battle. My malpractice, however, is way lower than an orthopoedic surgeon’s.

    Who knows? Maybe they’ll eventually win, and I’ll go to Wall Street.

  • Medical Spa MD

    I receive numerous inquiries every month from physicians wanting to leave the pressures and tactics of insurance malpractice and third party payers. And it’s docs you might not suspect. (Although the obgyn’s are looking for a way out.) It’s also cardiologists and even a number of anesthesiologists..

    Cosmetic medicine can’t hold them all. I don’t know where the system will finally break but it could.

  • Anonymous


    good, if people are under financial pressure, or are motivated by financial reward, I believe this is a very positive thing.

    perhaps if the system breaks, ailments will be dealt with

    scarcity, credentialing, safety?
    these issues must be addressed !

  • Anonymous

    This story is bogus, Kansas is one of, if not the best as far as malpractice is concerned states in the union. The problem is no young surgeon wants to live in Emporia Kansas.

  • Anonymous

    I’m not an orthopod, but I would want any town where I worked to support me in keeping my practice at the state of the art to which I would hope to be trained in residency. Taking over in a town where the retiring doctors have not made the most of available resources or have not kept pace with changes in their fields can add challenges where in other places best practices are supported and understood. It is unclear what the circumstances are in Emporia, but generally failure to attract is evicence of insufficient support either at the outset of practice or once a practice is established after institutional support is withdrawn.

    Hospitals in rural areas will frequently subsidize practice startups. That is essential, but equally important is the belief that once the support is withdrawn that the community has the referral volume and the paying patient base to sustain a private practice. Unfortunately, this is not always the case. If the area has a heavy burden of poorly compensated care, the long-term viability of a startup can be at issue, no matter how robust the startup support. Federal law prohibits hospitals from recruiting on terms that are not at least nominally structured as loans, and Stark laws require that they make an effort to secure repayment of those loans, even on lenient terms.

    Hospitals may want specialists available to maintain a particular designation for receiving trauma in the emergency department, to which may be attached significant governmental subsidies. Securing the specialists for that purpose may make a great deal of sense to the hospital, but the long term viability of any particular specialty practice may not be as much an issue for them.

    Then too is the call issue. If you are the only orthopedist around then you become on call de facto 27/7/365 even though they may only nominally write your name on the call schedule
    ten days a month. That becomes a hardship, particularly if call responsibilities add a lot of uncompensated care to your practice.

  • Anonymous

    Retiring doctors and their financial requirements and expectations differ significantly from a younger doctor. The older doctors have bought and usually paid for their homes (and probably more than one), their children are grown and their educations paid-for, and their retirement funds nicely funded. In all liklihood, they bought their educations at costs dramatically different to today’s and have long paid that and their practice startup costs. Often they did all of these things at higher net per unit work reimbursements than are typically paid today.

    If they don’t appreciate these differences, their offers may not reflect the needs and expectations of these new doctors, and hence may not be sufficiently competitve.

  • Anonymous

    I agree the problem probably is hospital support. To get an orthopod in this day and age, especially in Kansas, they are going to have to pay through the nose. Employed position, full loan repayment,a big signing bonus and someone that likes rolling hills is what its gonna take. They have to realize that they will make it on the back end. They may lose money on him or her, but how can you be a hospital if you can’t even take care of a hip fracture? As far a call is concerned, if you are the only show in town you can negotiate it to whatever you want as far as the ER is concerned. Its covering your patients when you leave that becomes a problem.

  • Anonymous

    You don’t have to pay back any loans if they are structured on a time basis. The hospitals use Stark as an excuse more often than not.

  • Anonymous

    You don’t have to pay back the loans as long as the back end service work-off is met. Usually that service is started after the initial period of support. In a growing community with a reasonable insurance covered population, that is usually not a problem. But if it is a poor rural area hospital with a large cachement of other poor rural communities, the picture can be radically different.

    The other issue is spousal satisfaction with the community. Even married doctors won’t bite, if their spouses don’t like the opportunities for work, or the schools are sub-par or some other aspect of the community is not desirable. I would be reluctant to work in any community where the employment base depended on a single employer of any kind. The potential for significant economic disruption by a plant closing or corporate buyout is just too threatening.

Most Popular