Patients lose again: Radiologists pull out of a hospital due to malpractice insurance concerns

Lawsuits more easily defensible on other jurisdictions is cited as one reason:

Woodlawn-based Advanced Radiology will stop providing services to St. Agnes Hospital in southwest Baltimore and American Radiology Services, based in Pikesville, will terminate services to Good Samaritan Hospital in northeast Baltimore.

St. Agnes is the only city hospital served by Advanced, which also contracts with Franklin Square Hospital, Greater Baltimore Medical Center and St. Joseph Medical Center in the county.

In 2005, the practice’s malpractice premiums were five times what they were in 2000, said Dr. Robert Stroud, president of Advanced Radiology and a practicing radiologist.

“Baltimore City juries tend to be more sympathetic to the plaintiffs,” he said. “Lawsuits are more easily defensible in other jurisdictions.”

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  • Anonymous

    I’m sure the good doctor has done an exhaustive study of the issue.

  • View from the Trekant

    I would agree that there are multiple things driving what doctors lump into malpractice concern, as the comment on the neurosurgeons who will not cover the ER notes.

    For example, ER patients tend to be poorer, less insured, more drug seeking, less socially connected and much less compliant as a group. This is not neccesarily true statement about any one person who uses the ER, but is a fair assessment of group characterists.

    Who wants to get out of bed at 2 am for that if you can avoid it?

    Radiologists, however, tend to have the Golden Goose. They often have higher income, shorter hours and usually have a stranglehold on vital hospital services with an exclusive contract.

    When THEY can’t make it, when THEY go to the tremendous expense to pack up and leave, that is a very, very worrisome sign. I will bet that any state that is losing them due to malpractice costs will also have lost a lot of less financially viable services already(primary care, peds, OB).

  • David

    It’s conceivable that this is simply a business decision. Unless I missed it, the article said nothing about radiologists being unable to “make it” due to malpractice concerns, only that it was more expensive for them to do business there. If they can take the same resources and put them in other localities, making the same (or even less money), and reducing their malpractice liabilities to make it worth it, that seems like a good business decision to me.

    Yes, it’s at the “expense” of patients, but even if the medical malpractice landscape looked spectacular for doctors, you’re still going to have differences between localities encouraging these types of moves.

    It’s too bad the market can’t work properly here. In theory, with a scarcity of providers (or an increase in provider costs), you should see prices go up to compensate. Instead, providers/doctors simply leave.

  • Rich, MD

    Anon 10:10 –

    Maybe they are leaving because of perceived issues which are not, in fact, the cause of their increased premiums. Maybe they are. Maybe Kevin studied it, maybe not. But regardless of what you think about it, or Kevin thinks about it, or I think about it, they ARE leaving.

    They have drawn their conclusions, and acted upon them, and whether they arrived at them reasonably or not, they have acted. To ignore them because you (or Kevin, or anyone who points out this article) think the process at which they arrived at their conclusions is incorrect is to remain ignorant to the most important fact: they have left, and the void will need to be filled.

  • Anonymous

    Absolutely they are leaving. However, the radiologist in question is arguing that “plaintiff friendly juries” are the cause of their malpractice. Unless one knows a lot more about their insurance company, the verdicts in the region, etc., then that statement cannot be made, at least with any confidence.

    Belief does not equal fact.

  • BenGlassLaw

    The “malpractice issue” was, of course, one small commment in a long article. While perceptions may have played a part it looks from reading the article that the market is filling the gap. There is opportunity presented for other entrepreneurs.

  • Rich, MD

    Belief does not equal fact.

    I absolutely agree. But ignoring the FACT that they are leaving because their reasoning may be incorrect is not helpful to anyone. If the prerequisite to a serious discussion/debate on the issues is agreement on the issues, than there is no point.

    Those that write here that Doctors don’t know what they are talking about, and Doctors who write that lawyers, consumers, etc don’t know what they are talking about, all keep falling into the same trap.

    Both sides of the debate are highly polarized. They both believe that their view is the correct position, to the extent that anyone who disagrees must be either ignorant or crazy, and therefore anything they have to say on the matter is suspect.

    This post is a case-in-point. The doctors are leaving. They say because of the malpractice climate, etc. You argue that their premise is incorrect, or someone implies that Kevin chose the article because he feels a certain way, or in some way someone distracts from the point because the premise in incorrect. And the post is dismissed, or a dismissive comment is made (a la Anon 10:10).

    Unfortunately, though, the fact that they are leaving is not theory or belief, it IS fact. One that is ignored (by posters like Anon 10:10) because the premise of their resoning is believed to be faulty. But it is not found faulty because anyone has discussed or debated the issue, but because they are doctors, and though the article doesn’t state that they fully investigated the issues around their decision, it doesn’t say that they didn’t. But they’re Doctor’s, and therefore their conclusions are suspect.

    The opposite claim could be made, too; the Doctors are not immune to this behavior. Until people with differing views on this issue can respect the views of the other, even when there is disagreement, there can be no productive debate. Of course, those hospiltals are still without radiologists.


  • Anonymous

    No one is disputing the fact, but right now policy proposals are being bandied about based on the faulty REASONING.

    Which is why the reasoning matters. I think we can all agree that if in fact the market needs more radiologists, then we should figure out how to attract them. But that should be based on an accurate analysis of the reasons they aren’t there.

  • DJS

    The “MARKET” needs more radiologists? You call healthcare (the medical industrial complex) a market? Sure it’s a market, like Unemployment is a market and disability is a market… The radiologists in my community make $350K a year, working comfortable hours, no overhead, providing hedge reports that affect clinical care minimally. But they drive the imaging market that hospitals love and “need”. Why don’t we digitize all images and have them read in India for a fraction of the cost and faster turnaround?
    BECAUSE, medicine is a guild, not a market, and guilds control the services,,,It’s like the middle ages folks. We( I am an MD) are in the last great guild.
    The malpractice excuse is just that.

  • Anonymous

    “Why don’t we digitize all images and have them read in India for a fraction of the cost and faster turnaround?”

    Nighthawk anyone? Believe me the rads lobby will fight this one tooth and nail but eventually we will have CTs read more frequently by overseas radiologists likely under the guidance of a US trained radiologist. It is already happening.

  • Anonymous

    Nighthawk uses american radiologists who choose to live overseas but are board certified in the states.

    Obviously the number of american radiologists who pursue this path is very, very small. 99% of american radiologists choose to work, guess where, in the USA

    So the nighthawk model is not a true outsourcing threat because only americans living abroad do the images.

    ABR rules strictly state that images taken in the states must be read by a radiologist licensed in the states. So that eliminates all the Indian rads docs.

    Until the ABR rules are changed, outsourcing is not an issue. Nighthawk is not true outsourcing IMHO

  • Gasman

    Well of course it is a business move David. It is not about them not being able to make ends meet in their previous situation. Most people will stay put. There are substantial up front costs to picking up a business, a period with low cash flow possible missteps. It takes a pretty good incentive to walk away from your known problems to step into a situation where you don’t know the problems yet, but merely hope the reward is adequate to cover your efforts and risk.

    But in the end this is good. The market needs to make the correction here. If liability exposure with the premiums associated are high and the reimbursement from the patient population low then docs should pick up and leave. The capitalist model allows all needs to be met. One merely has to pay market price for what is wanted.

  • Anonymous

    “ABR rules strictly state that images taken in the states must be read by a radiologist licensed in the states. So that eliminates all the Indian rads docs.”

    Watchout change is coming…

  • Anonymous

    “The market needs to make the correction here. If liability exposure with the premiums associated are high and the reimbursement from the patient population low then docs should pick up and leave. The capitalist model allows all needs to be met. One merely has to pay market price for what is wanted.”

    Agreed wholeheartedly. But does anyone really believe that the physician in question has actually studied med mal verdicts (and more importantly actual payouts) in both jurisdictions, rates of returns of the insurers, etc. to reach the conclusions he’s stating?

  • Anonymous

    Actually, we have no way of knowing why they are doing it. We don’t know their annual receipts, their premiums, the verdicts in Baltimore, etc. Hell, we don’t even know who their carriers are and how much they will save as a percentage of their income.

    And people take that kind of risk all the time. Larger in fact.

  • Okulus

    True, they don’t know. This could be nothing more than the culmination of a number of eyeballed factors, maybe rising operating costs, maybe declining reimbursement, maybe a general dislike of the facility by the partner members, maybe all of them. I really doubt that the decision came down to a detailed analysis with modeling of the numbers and a comparison to neighboring facilities based on the same calculations. It is more likely a situation where mostly everyone agreed that the practice would generally be better off working those hours at a different facility that happened to need a group to provide coverage.

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