Although West Virginia hospitals find it easier to recruit doctors since lawmakers passed medical liability insurance changes last year, concerns remain over potential court challenges, specialty shortages and high insurance rates.
"Overall the climate has improved," said Wheeling (W.Va.) Hospital CEO Donald Hofreuter, M.D. "At least we were getting physicians to come to the area to look at our facility, whereas before we were sort of on a list that 'that's not the place to go.' "
Since the 2003 changes -- which included noneconomic damage caps between $250,000 and $500,000, depending upon the injury -- Wheeling Hospital has recruited four family physicians and one ear, nose and throat specialist, while a neurosurgeon also came to the area, Hofreuter said.
City Hospital in Martinsburg, W.Va., has nearly one physician interview a week compared to two or three a quarter last year, said hospital recruiter Carol Joseph.
"It's improved dramatically," said Donald Jansen, M.D., City Hospital's chief medical officer. "We find that when physicians are calling, we're able to say, 'Now we have tort reform,' that really now looks much more favorable."
But some hospitals say the improvement isn't necessarily due to the legislation, while others report little change in attracting physicians.
United Hospital Center in Clarksburg, W.Va., recruited 20 doctors in 2003, compared to the usual eight to 10, said David Bailey, physician services director. Bailey attributes the change to medical liability insurance problems spreading nationally.
But the state still suffers from a "stigma" over medical liability insurance, said Kirk Paine, physician recruitment director at Bluefield (W.Va.) Regional Medical Center. "The physician recruitment atmosphere has not gotten much better over the last couple of years," Paine said. "We have seen the situation stabilize, in terms of the number of physicians leaving or reducing their staff status, but overall, recruiting is still a very challenging thing."
Bluefield Regional spokesman James Shott said one concern is that the legislation has not been tested in the courts.
The state Supreme Court refused in June 2003 to hear a petition concerning the effective date of the new rules. There have since been no direct constitutional challenges to the law, said Justice Elliott "Spike" Maynard.
West Virginia has about 3,200 doctors practicing in the state. They are covered by the state Board of Risk and Insurance Management, which will turn doctor liability coverage over to a physician-run mutual insurance company this year; or by commercial carriers, including Medical Assurance.
Hospitals still face shortages in specialties including urology, neurology, general surgery, pediatrics and ear, nose and throat. Parkersburg, W.Va., lost its only endocrinologist last year, said Jason Landers, Camden-Clark Memorial Hospital's physician recruitment director. While recruitment has improved, it's still difficult to attract endocrinologists because the area has no partner to offer potential candidates, Landers said.
High insurance rates, especially for surgical specialties and obstetrician-gynecologists, escalate the problem, doctors say.
"Rates are based on the past, not the future," said Ron Stollings, M.D., West Virginia State Medical Association president. "So until we have a time period of experience with the new tort reform, then our rates are not going to likely to go down."