<p>You can count with your fingers the number of doctors that are members of Congress. You need a calculator to count the number of lawyers. As far as medical malpractice goes, lawyers and doctors interests are at odds which each other. The issues are different in each state and that’s why I think that some federal cap is in order.</p>
<p>For instance, in Florida insurance companies have the final word about settling a case or going to trial. There are many cases where the doctor has not been negligent and wants to fight the lawsuit, only to find that the insurance company is settling for 100K. From that point on, this becomes a stain on the physician’s record. Every time the physician applies for privileges to a hospital, etc, he will need to declare the settlement and some people may make the wrong interpretations.</p>
<p>Most neurosurgeons and OB/GYNs do not carry malpractice insurance in some parts of Florida (the costs may be over 90-100 k per year). In addition, most feel that if you carry malpractice insurance you are a magnet for frivolous law suits which the insurance companies will end up settling the case instead of fighting them. In many cases, just replying to the letter of intent to suit with an additional “My client does not carry malpractice insurance” is enough to get the plaintiff’s lawyer to back off.</p>
<p>I heard that doctors/nurses who work for a hospital are often asked NOT to carry any insurance for themselves, but the hospital carries the insurance. So, if somebody wants to sue them, he/she needs to sue the hospital, which has more resources/clout than individual doctor or nurse would have. I really do not know what the details are though. But I think the general idea is that if you want to defense yourself or run a business cheaply, we need to belong to a larger organization which can defend you. Oh, boy! Isn’t a union like this?! (In the business world, it works similarly: the bigger one often wins unless it runs into a trouble with the anti-trust law.)</p>
<p>MyOpinion, you didn’t explicitly answer the question in the section of my post that you quoted. So is your answer ‘no’?</p>
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<p>Well, just because a politician used to practice law doesn’t make him automatically side with trial lawyers associations on political issues. A ton of Republican politicians are former lawyers and they tend to side with doctors on this issue. I don’t think this shows that the trial lawyer lobby is more powerful than the medical lobby. You’d need to provide another argument.</p>
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<p>If the issues are unique to each state, why wouldn’t you want each unique set of problems to be dealt with at the state level? Did you mean the opposite?</p>
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<p>Correct me if I am wrong, but it seems to me that this is an issue with the insurance companies wanting to control where their money is going, and not lawyers. I don’t think that this is relevant to the original argument about whether doctors or trial lawyers have the more powerful lobby.</p>
<p>However, if you want to claim that the doctor lobby is at odds with the insurance lobby and that the insurance lobby is more powerful, then I find that argument a lot more plausible. Insurance companies have a lot of clout.</p>
<p>I don’t want to discuss your last paragraph because it gets into the merits for and against each side of the medical malpractice issue. I don’t want to talk about that: I only wish to discuss the players in this issue and who has the upper hand.</p>
<p>mcat2, it is actually the opposite. For physicians to obtain hospital privileges they have to show to the hospital proof that they carry malpractice insurance or that they can “assume” financial responsibility in the event of a lawsuit. The more parties to share the blame, the lower the financial blow for any of them but the more money the trial lawyers may have access to. Just think back of my example about settling these lawsuits. Lawyers try to name as many physicians and/or nurses as possible (regardless of their degree of involvement with the care of the patient) because they can collect more money from the quick settlements that the insurance companies usually go for. In many cases, those initial settlements help the lawyers finance the rest of their lawsuit! It becomes just another strategy of the game.</p>
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<p>The fact that tort reform has never been tackled by congress (in spite of the malpractice crisis and the outcry from doctors all over the country) ) is an example of powerful lobbying by trial lawyers. The fact that Obamacare failed to address the issue is another example. President Obama suggested (and the Democrat majority) that there was no clear proof that the malpractice crisis * increased* the costs of healthcare. Well, if as a physician I need to make at least 100k to pay for my malpractice insurance (without ever been sued!), who do you think is going to be giving me the money to do that? Now add all the unnecessary expensive tests that I will be ordering as I practice “defensive” medicine to cover my *ss and you have a pretty hefty sum of money.</p>
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<p>Some states like Texas have been successful passing tort reform. Others, like Florida, not so lucky. Some states seem to be more “trigger suit happy” than others. The effectiveness of the lawyers lobby at the state level may have something to do with that. A federal tort law reform would be necessary to eliminate all the disparities between the states. </p>
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<p>Of course the insurance companies want to control their money. The problem is that their practices just encourage more frivolous lawsuits and play right into the lawyers hands. The insurance companies would rather settle a case for 50K than spend 100K defending a case that is winnable by the physician. Malpractice lawyers know that. </p>
<p>The malpractice crisis has multiple players: patients, doctors, insurance companies and lawyers. The worst hand is held by the doctors. There is no doubt.</p>
<p>Lawers will move the whole issue in a “right” direction according to Government intentions. If the new law is nort repealled, we will have government run system, private insurance industry will go.</p>
<p>However, this discussion IMO does not belong on CC and I am sure will be locked down soon. It is also completely futile.</p>
<p>MyOpinion, you didn’t explicitly answer the question in the section of my first post that you quoted. So is your answer ‘no’?</p>
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<p>Why would this issue be dealt with more appropriately at the national level? Some states really don’t have a malpractice insurance issue. Minnesota doctors enjoy low malpractice insurance rates.</p>
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<p>According to this link, Florida passed law that places caps on awards in malpractice cases in ~2003.</p>
<p>Can you name a state where there are high malpractice insurance rates and law hasn’t been passed to combat this issue?</p>
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<p>How is this system the fault of the trial lawyers lobby? Do they actively push for this type of system? Unless you can answer those questions, I still maintain that this is a battle with insurance companies and not lawyers.</p>
<p>silence_kit,
There is a malpractice crisis in the country and some states are more affected than others. This is widely acknowledged and recognized. But ALL states are affected. Politics vary from state to state and that is why I think uniform Tort Reform at the national level is necessary. </p>
<p>The term “defensive medicine” is exactly the result of a practicing style that physicians have adopted in order to protect themselves against frivolous lawsuits. The costs are outrageous. How is this system the fault of the insurance companies?? Insurance companies are not responsible for this practicing style. Unscrupulous lawyers and a certain “mentality” from the patient population are to blame.</p>
<p>You need to re read the Florida link that you posted. The cap is ridiculously high (most experts suggest there should be a 250k cap for non economic damages) and it has not deterred the filing of frivolous lawsuits. And Tort Reform is not just about “caps” anyway.</p>
<p>The malpractice issue is very complex. But interestingly, we are the only country that is facing such a problem. We have gained a well deserved reputation around the world for using lawsuits as a way of making a quick buck. Are the insurance companies as institutions to be blamed? I don’t think so. I think WE THE PEOPLE, and our lawyers are.</p>
<p>I think unless you answer the questions I posed in my previous posts, which are honest questions and not ‘gotcha’ questions, I am finished with this discussion. You are ignoring my points and changing the subject. I don’t want to read your ramblings about how lawyers extort money from doctors, especially since you haven’t supported these claims with evidence. </p>
<p>In my mind, you still need to answer:</p>
<p>1) What are other issues other than the malpractice issue where doctors’ interests are in conflict with lawyers’ interests?</p>
<p>2) Regarding the medical malpractice issue, overall are doctors’ interests being ignored in state laws? Are there states which have failed to pass legislation in an attempt to combat this issue? I think you need good answers to these questions before you point to the lack of federal law on this issue as a sign that the doctors’ lobby has lost.</p>
<p>3) Regarding florida insurance companies wanting to settle and not fight malpractice suits in court and doctors have no say in the matter: why is the trial lawyers lobby at fault for this system and not insurance companies?</p>
<p>haha i’m gonna break my own rules. but not really because the discussion this promotes will help steer the discussion back to where I want it to be.</p>
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<p>Can you show this? I’m interested in what you have to say about this.</p>
<p>Question to people who actually are doctors (not MyOpinion) and would know this stuff: is this what is typically done? As someone who doesn’t know how things work, it seems to me that the hospital taking care of insurance makes more sense because then they have more bargaining power with the insurance companies and can get lower rates. But I don’t really know.</p>
<p>This link suggests that what mcat2 said is correct.</p>
<p>This is the key sentence. If you are a hospitalist or directly employed by the hospital, then you will be covered by the hospital. However, most physicians work in a group practice and have hospital privileges but are not directly employed by the hospital.</p>
<p>If you are a hospitalist or directly employed by the hospital, what is the current average salary? Is it much lower than when you as a (say, newly minted) physician work in a group practice and pay hospital privileges?</p>
<p>Depends on the policy of the group. Different groups will have different rules that you must abide by when you first join.</p>
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<p>Generally, it’s lower but you also work substantially less. Being a hospitalist also allows you to do teaching, research, and, in general, stay more involved in the academic medicine-side of things more so than if you join private practice. </p>
<p>I had drinks with one of my former attendings who is a hospitalist. He says he makes six figures and has 26 weeks of vacation. In addition, he gets a bonus depending on the quality of teaching and the RVU’s he generates per year. I doubt he’s making 300,000 a year working 26 weeks. But, if you have a strong interest in teaching residents/medical students, in doing research, and would also like to enjoy life, becoming a hospitalist at an academic hospital is an attractive option if you are willing to sacrifice a little salary. For others, they may simply work as a hospitalist for a few years after residency before applying for fellowships in cardiology, gastroenterology, whatever.</p>
<p>However, Hospitalists are not the only doctors who are employed by hospitals. Radiologists, anesthesiologists, pathologists and emergency medicine doctors usually have to sign contracts with a hospital (if they belong to a specific group, then the group signs the contract) becoming to some degree “hospital employees”. As part of a contract, the hospital may offer “malpractice insurance” as an added benefit. All this means is that the hospital is paying the premium, but they are not under the Hospital’s malpractice insurance.</p>
<p>Some physicians call them RAPE specialties (acronym) because they frequently are at the mercy of the hospital administration and lack the independence of non hospital based physicians.</p>
<p>I would also add, that one of the most attractive aspects of academic medicine is that university hospitals are somewhat “protected” against malpractice lawsuits. The same goes for the Veterans Administration Hospitals. I know several physicians who have made the transition from private practice to academic medicine because of it.</p>