Earlier, I published an article called "Are Physicians Leaving Illinois for Other States?" at this website. This analysis revealed that the per capita supply of physicians has increased in Illinois, as well as in the USA, Indiana, and Wisconsin, during the years 1991-2003. This finding contradicts allegations that physicians are becoming more scarce in Illinois because of the above average cost of medical malpractice insurance in this state. It has been suggested that the per capita trends for high risk medical specialties should be examined because physicians in such groups are more likely to be adversely affected by the high costs of malpractice insurance, and they will migrate to states where these costs are the lowest. Examples of medical specialties with higher-than-average costs for malpractice insurance include neurosurgeons and obstetricians. Generally, physicians practicing surgery and other invasive procedures have more expensive malpractice insurance than physicians who don't. I've completed an analysis of the per capita supply of physicians in various areas of medical specialization. The results of this analysis are reported in the set of tables for the USA, Illinois, Indiana, and Wisconsin below:

Because some physicians are not actively involved in patient care, my analysis considers only patient care physicians as reported by the American Medical Association (AMA). I also exclude Federal physicians, who provide care to veterans and members of the Armed Services. Each physician-to-population ratio (RATIO) is calculated by dividing the number of patient care physicians in a state (or nation) by the population of a state (or nation) in a given year. The trend data refers to the change in the per capita supply of physicians from 1993 to 2003. The per capita trend (TREND) is calculated as follows: TREND = RATIO (2003) / RATIO (1993) – 1.00. Thus, in the table for Wisconsin above, the per capita trend for pediatricians is (1/8,140) / (1/5,488) – 1.00 = +48%. In this formula, subtraction of 1.00 is performed only after the indicated divisions are carried out.

I will now describe the results of this analysis. The per capita supply of physicians for non-surgical specializations has significantly improved in the USA, Illinois, Indiana, and Wisconsin during 1993-2003. However, the per capita supply of physicians in surgical specializations has been stagnant or experienced lower growth, particularly in the USA and Illinois. The growth in the per capita supply of physicians is somewhat better in Indiana and Wisconsin, probably because these two states have lower-than-average costs for medical malpractice insurance. Overall, this analysis supports the hypothesis that above-average costs of medical malpractice insurance can inhibit the per capita supply of physicians in high-risk specializations (e.g., those that practice surgery). The data also supports the hypothesis that states with below-average costs of medical malpractice insurance are more likely to attract physicians in high-risk specializations than states with average to above-average costs.

Some exceptions to the general trends above should be noted: the per capita supply of plastic surgeons has experienced strong growth in the USA and all of the above states, possibly because of strong demand characteristics for their services. However, there has been little improvement in the per capita supply of psychiatrists in the USA, Illinois, and Wisconsin; Indiana has experienced a somewhat better growth rate in psychiatrists. Among the various medical specializations, there has been a slight decline in the per capita supply of General Surgeons in the USA, Illinois, and Indiana; even in Wisconsin, the per capita supply of General Surgeons was stagnant during 1993-2003. In contrast, other surgical specializations did not experience any contraction in the per capita supply of physicians in the geographic areas that were examined, although their growth rates were usually lower than average.

Conclusions

With the exception of General Surgery, Illinois did not experience any contraction in the per capita supply of physicians. Therefore, physicians are not becoming more scarce, even in high-risk specializations (except as already indicated). However, the per capita supply of high-risk specialists (surgeons) has increased very little in Illinois, whereas the per capita supply of low-risk specialists (non-surgeons) continues to improve substantially within the state. In this regard, the per capita trends in Illinois are very similar to the per capita trends in the USA overall, even though Illinois has above-average costs for medical malpractice insurance. Wisconsin and Indiana have experienced somewhat better growth in their per capita supply of physicians in both low-risk and high-risk specializations, probably because of the lower-than-average costs of medical malpractice insurance in these states. However, even in Wisconsin and Indiana, the growth in per capita supply of high-risk specialists (surgeons) has been lower than the growth of low-risk specialists (non-surgeons). It had been suggested that the per capita supply of neurosurgeons and obstetricians would experience the poorest growth rates, however these two groups differed little from other high-risk specialists. Because high-risk specializations (surgeons) usually exhibited the lowest per capita growth rates, there is evidence that the high cost of medical malpractice insurance may impede the supply of such physicians, causing distortions in the medical marketplace. Exactly how such distortions are realized is still unclear.