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News :: Health
Are Physicians Leaving Illinois for Other States? Current rating: 0
18 Jul 2005
During the past year, some physician groups and health insurance officials have stated that physicians are leaving Illinois for other states because of the high cost of medical malpractice insurance. However, an analysis of data from the American Medical Association and the U.S. Census Bureau reveals that this isn't true.

Some physician groups and health insurance officials have made the claim that practicing physicians are leaving Illinois for other states that have lower medical malpractice premiums – particularly Wisconsin and Indiana. This claim has been published in various newspaper articles and local news programs throughout the state during the past year. A typical example of this type of article can be found in the News-Gazette, "Malpractice Forums Talk about Reform," which was published earlier this year (March 5, 2005). This claim was part of an attempt by physician groups and health insurance officials to convince members of the public and the Illinois state legislature that caps should be placed on jury awards in medical practice cases. Otherwise, they asserted, the cost of medical malpractice premiums would spiral out of control and physicians would leave the state in droves.

As a result of this publicity and their lobbying efforts, these physician groups and the health insurance industry were successful in convincing the state legislature to pass a law that places a $500,000 cap on jury awards in medical malpractice cases. However, is it really true that physicians were leaving Illinois and becoming more scarce? This claim is easy to evaluate because the American Medical Association (AMA) publishes the number of patient care physicians in each state, while the U.S. Census Bureau publishes the population of each state. By dividing the number of patient care physicians by a state's population in a given year, it is possible to estimate the per capita supply of such physicians in different states.

The table below displays the patient care physician to population ratios for the USA, Illinois, Indiana, and Wisconsin from 1991 to 2003.


Patient Care Physician to Population Ratios
Year USA Illinois Indiana Wisconsin
1991 1:502 1:499 1:668 1:567
1993 1:485 1:478 1:639 1:545
1995 1:466 1:456 1:601 1:517
1997 1:444 1:433 1:562 1:485
1999 1:447 1:437 1:565 1:484
2001 1:437 1:430 1:537 1:465
2003 1:421 1:418 1:508 1:438
For example, 1:502 in the USA column means that there was one patient care physician for every 502 persons in the USA during 1991.
Sources: Physician Characteristics and Distribution in the US, 1993-2005 Editions, American Medical Association; U.S. Census Bureau

From this table, it is clear that the per capita supply of patient care physicians has increased during this time period in the United States and all three states. Thus, patient care physicians are not leaving Illinois in droves and becoming more scarce. On a per capita basis, the percentage change in patient care physicians from 1991 to 2003 was +19.2% for the USA, +19.4% in Illinois, +31.% in Indiana, and +29.5% in Wisconsin. It seems likely that these increases have been driven in part by the high incomes of physicians in the United States, which attracts immigrants from abroad with medical degrees. The per capita supply of patient care physicians in Wisconsin and Indiana has increased to a greater extent than in Illinois and the nation generally, which may be the result of the below-average costs for medical malpractice insurance in these two states.

Even though the costs of medical malpractice insurance are above average in Illinois, this state has managed to keep pace with the rest of the nation in its per capita supply of patient care physicians. Contrary to the claims of some physician groups and health insurance officials, there is no crisis in the supply of physicians within the state. Thus, this aspect of their argument for caps on jury awards in medical liability cases appears to be an inappropriate scare tactic.

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Re: Are Physicians Leaving Illinois for Other States?
Current rating: 0
19 Jul 2005
Very nice analysis. Have to ask why the newspapers,
etc. who spent so much ink reporting this line of stories
didn't try to do likewise to check the claims of physician
flight.

To play devil's advocate, I might suggest another
slice of potential statistics. Does the AMA tabulate
numbers of doctors per state by specialization?
I think the claims were that some types of practice,
e.g. Ob/Gyns and neurosurgeons, were facing especially
high insurance rates and were especially liable to flee IL.
If their statewide numbers aren't rapidly shrinking either,
it's bad news for the insurance propagandists.
Re: Are Physicians Leaving Illinois for Other States?
Current rating: 0
20 Jul 2005
To respond to Stuart's comment:

To some extent, the AMA reports number of doctors by specialization per state, but this involves limited categories and the information that is available may be inconsistent across different states.

Of course, to offer a counter-argument, those specializations with higher-than-average malpractice insurance rates (orthopedic surgeons, obstetricians, neurosurgeons, etc.) can expect to pay relatively higher rates across all states.

It was my impression from looking at this data that the number of doctors in all specializations increased in Illinois to a similar degree. The one specialization that increased the least on a per capita basis in Illinois was adult psychiatry. Rather curiously, psychiatrists pay less for medical malpractice insurance than practically everyone else in the medical profession.

Also, no information about neurosurgeons was available in the AMA data -- there are so few of them that they were placed in the "other surgeons" category.

If I have the time, I may re-examine the data for those specializations that pay higher-than-average premiums for medical malpractice insurance to see what comes up.
The thing to remember...
Current rating: 0
21 Jul 2005
...Is that malpractice payout caps are simply a scam by insurance companies to increase profits, and by physicians to enable the use of more profitable drugs and methods without regard for results.

Last I heard, in no state that has enacted malpractice caps has there EVER been a corresponding decrease in malpractice insurance premiums. It's an utterly fraudulent argument from the git-go.
Re: Are Physicians Leaving Illinois for Other States?
Current rating: 0
21 Jul 2005
This isn't very useful data if it isn't parsed out by specialty. And while specialties with higher malpractice rates (esp. obstetrics-gynecology) can expect to pay higher rates anywhere, rates vary widely by state.

Malpractice claims aren't the sole reason for increasing malpractice insurance costs - insurance companies have found that by increasing malpractice insurance rates they can recoup losses from their other insurance products - but to say that the problem doesn't exist at all or isn't impacting physicians and where they choose to practice isn't correct either.
Re: Are Physicians Leaving Illinois for Other States?
Current rating: 0
22 Jul 2005
And have the population of Illinois been rising?

I agree with Geo, this analysis doesn't illuminate much beyond politics.
Re: Are Physicians Leaving Illinois for Other States?
Current rating: 0
22 Jul 2005
> And have the population of Illinois been rising?

This data is on a per capita basis, so it takes into account the population increase.
Re: Are Physicians Leaving Illinois for Other States?
Current rating: 0
22 Jul 2005
You'd have to break it down by high-risk, high-malpractice specialties, namely OB-GYN and neurosurgery. I've heard anectodally that there are no neurosurgeons to cover most of southern Illinois. That might not mean much to you until you realize that neurosurgeons are called on for emergency head trauma. If your local neurosurgeon leaves for another state, you have no local coverage for head trauma emergencies. No local coverage means transferring to another hospital, delay in treatment, risk in transport...and does indeed impact medical care.
Now whether malpractice rates will correspond to caps is another issue altogether. But don't take this aggregate data to mean that all is well in Illinois and that there is no crisis.
Re: Are Physicians Leaving Illinois for Other States?
Current rating: 0
23 Jul 2005
> If your local neurosurgeon leaves for another state, you have no local coverage for head trauma emergencies. No local coverage means transferring to another hospital, delay in treatment, risk in transport...and does indeed impact medical care.

Yeah, imagine what it's like to have no health insurance at all, like more and more people. In that case it doesn't matter how many neurosurgeons there are in your state--if you have a serious neurological condition it's going to go untreated, or you're going to go bankrupt.

At the risk of belaboring the obvious, there are lots of factors other than the cost of malpractice insurance that are affecting the cost of health care.

For instance the cost of prescription drugs. If Republicans and Democrats are so concerned about the cost of health care I would expect them to exert much more influence than they have to bring the costs down. But that means standing up to the pharmaceutical industry, who contribute huge sums of money to Republican and Democratic political campaigns.

Health care is fundamentally unlike other industries because the better health care gets, the less people need it. In a free-market model the health care industry, perversely, *requires* a stream of unhealthy people. That stream is unlikely to grow as fast as the economy, especially if the general health of the population is increasing, so prices have to rise. Perhaps it's time to drop the free-market model for health care.
Re: Are Physicians Leaving Illinois for Other States?
Current rating: 0
27 Jul 2005
Geo: "This isn't very useful data if it isn't parsed out by specialty."

Some people think that physicians are becoming more scarce as the result of misleading news stories. The fact that they have become more abundant on a per capita basis is good news for health care consumers -- otherwise more people (including those with good health insurance) could find themselves on long waiting lists to see many kinds of physicians, or perhaps denied access to such physicians all together.

Through the years, I've seen news stories that claim or imply that physicians are becoming more scarce, that general practioners are becoming more scarce, that emergency room physicians are becoming more scarce, and more recently that neurosurgeons are becoming more scarce.

As recently as last week, the News-Gazette published an article in which it was implied that the CEO of Provena-Covenant was forced to resign in part because he was unable to attract new physicians to the hospital, even though he tried "very hard" to do this. And yet, if you look at the facts, Illinois has a record per capita supply of physicians. So much for the myth that physicians are becoming "scarce."




Scott: "I've heard anectodally that there are no neurosurgeons to cover most of southern Illinois."

Yes, this is a typical example of the kinds of stories that circulate in the mainstream press. When people read or hear such stories, it leads them to believe that neurosurgeons are becoming scarce, which may not be true.



Scott: "You'd have to break it down by high-risk, high-malpractice specialties, namely OB-GYN and neurosurgery."

And why is it necessary to judge the supply of physicians in an entire state on the basis of a few high-risk high-malpractice specialties? Are you saying that general practioners and low-risk specialists are unimportant and we can disregard their per capita supply? Why focus on only the worst case scenario?

I'm willing to grant you this much: It is quite possible that the per capita trends for some medical specialities may be different from the general trend that has been described in my article. However, that doesn't mean the general trend in per capita supply of physicians is unimportant -- quite the contrary.

However, I've already acknowledged the desirability of examining some of the subtrends among medical specialties in my response to Stuart Levy above. As a matter of fact, I've already done this and will publish a second article about this topic at this website within a day or two.