States that enacted malpractice reforms saw an increased supply of physicians, according to a study in the June 1 issue of the Journal of the American Medical Association.
“Debates about medical malpractice have recurring themes, with tort reformers emphasizing the threat that liability crises pose to the cost and availability of medical services and tort defenders emphasizing the importance of liability to medical quality,” wrote the authors, led by Daniel P. Kessler, PhD, JD, of the Stanford University Graduate School of Business, the Hoover Institution, and the National Bureau of Economic Research, all in Stanford, CA. Referring to malpractice crises, they added, “Even between such crises, however, malpractice climate remains one of many factors determining how many physicians enter the medical profession, what specialties they choose, and where they practice.”
The researchers used data from the American Medical Association's Physician MasterFile on the number of physicians in active practice in each state for each year from 1985 through 2001, an article published in Quarterly Journal of Economics, data on the number of residency programs and the number of residents per capita in each state from the National Graduate Medical Education Census, and data on state managed care enrollment from InterStudy Publications. They identified the effect of state malpractice laws by comparing the change in physician supply in states that altered their laws between 1985 and 2001 with the change in supply in states that did not, the authors wrote.
The authors categorized reforms as “direct” if they included caps on damage awards, abolition of punitive damages, abolition of mandatory prejudgment interest, and collateral source rule reforms, and “indirect” if they included caps on attorney contingency fees, mandatory periodic payment of future damages awards, joint-and-several liability reforms, statute of limitations reforms, and patient compensation funds, the authors wrote.
Physician supply in states enacting direct reforms grew by 2.4 percent more during the study period than did supply in nonreform states, the authors wrote. Direct reforms had a greater influence three or more years after their adoption, 3.3 percent, they continued. Trends in physician supply differed by specialty. For example, direct reforms increased growth in the supply of emergency physicians by about 11.5 percent, the authors wrote.
In an accompanying editorial in the June 1 issue, Peter P. Budetti, MD, JD, of the College of Public Health at the University of Oklahoma Health Sciences Center in Oklahoma City, discussed the studies on defensive medicine and tort reform that were published in the issue. “Each study provides insight into attitudes toward malpractice and even toward practicing medicine, and underscores the need for new approaches to both tort reform and the patient safety movement,” he wrote. “Perhaps the foremost lesson emerging from the work of Studdert et al and Kessler et al is that medicine's 30-year pursuit of piecemeal tort reform has had some results, but not all the consequences have been positive and serious problems with the quality of medical care have not been ameliorated.”
Dr. Budetti is serving as a paid expert in a lawsuit against a number of health maintenance organizations in which his contribution is focused on issues related to medical necessity and also is performing malpractice-related research funded by the Henry J. Kaiser Family Foundation.