Marc Bowles says he knows where to send physicians who are looking to avoid lawsuits. "If they are looking to get away from litigious states there's two things that matter: tort reform and small town," said Bowles, vice president of physician searches for Dallas-based Delta Medical Consulting, a physician-staffing firm.
A study published online last week by the journal Health Affairs backed up Bowles' assessment. The findings, largely culled from already available county data, show that counties in states with malpractice caps on noneconomic damages had a greater per-capita increase in the number of physicians, and that the increase was greatest in rural counties in those states. The results of the study, which examined all states, are in contrast with a similar study released by the Government Accountability Office in 2003.
The GAO study found that physicians' closing their practices because of a fear of litigation wasn't widely affecting access to healthcare services. The GAO study cautioned against extrapolating the findings across the country, however, because it relied on interviews with doctors in only five states.
The National Rural Health Association, which represents rural hospitals, has lobbied in support of malpractice caps. In February, association President Hilda Heady testified at a House Committee on Small Business hearing that caps help reduce the price of malpractice premiums. Rising premiums have made it even more difficult to staff physicians in underserved rural areas, she said.
Caps could be used as a policy tool to attract physicians to areas that have trouble recruiting, said William Encinosa, the author of the Health Affairs study and a senior economist for HHS' Agency for Healthcare Research and Quality. "It seems to be more effective (for recruiting) in states that have lower, tighter caps," Encinosa said.
According to the study, a national $250,000 cap on noneconomic damages, which President Bush endorsed, could increase the supply of physicians in rural areas. The study found that states with a $250,000 cap saw more physician growth in rural areas than states with a larger cap. There was no significant increase in doctors in states that had caps greater than $250,000.
The study broke down information on surgeons and OB/GYNs, two groups that have seen increases in malpractice premiums. States with a $250,000 cap had a 5.5% greater increase in surgeons and a 5.4% greater increase in OB/GYNs per female resident ages 15 to 44 in rural counties than states with no caps.
Bowles said, however, that the rural findings may not be directly attributed to the caps. About 60% of the physicians whom Bowles helps relocate end up moving to rural communities. One selling point is -- caps or no caps -- there are fewer lawsuits because the communities are smaller and physicians often see patients outside the office.
That interaction strengthens the physician-patient relationship, which makes it less likely that patients will consider litigation, he said.
Other regulations such as physician-review boards that examine complaints before they go to court also can help attract physicians, said Arnold Thomas, president of the North Dakota Healthcare Association, which represents hospitals in the state.
Still, tort reform doesn't mean doctors are moving in droves to work in rural areas, which many view as remote places that offer limited choices.
"We haven't seen an influx of physicians," said Janet Lasick, chief executive officer of Northeastern Rural Health Clinics, a community health center based in Susanville, Calif.3/4a state that's had malpractice caps since 1975. Lasick is currently looking to add a physician. "It's tough to recruit," she said.