The doctors' anger about malpractice has mainly been directed at the lawyers--another case of two guilds at each others throats--because lawyers take malpractice cases on a contingency fee gamble. This, says the doctor, gives the lawyers a stake, not in justice but in a huge award, from the jury. The lawyers counter-claim that the contingency fee is the only way the average man can get a lawyer to take his case. That's true if the lawyer can smell a killing, but the average small butchery will never see the light of justice. Doctors have also made much of the idea that malpractice cases force them into “defensive medicine;” too many tests and a reluctance to do anything, no matter how desirable for the patient that carries any risk of an eventual lawsuit. Spencer Klaus reports a study that showed defensive medicine to be much less prevalent than the doctors claim, and over testing, which as noted earlier is a real problem, is more likely not to be defensive but rather the doctor's aggressive response to all that free money flowing in from Medicaid and Medicare.
One healthy effect of the malpractice boom may be to motivate doctors to do that which they've always refused: discipline their fellow physicians. The old tacit understanding which let the other fellow bury his mistakes in silence begins to break down when his malpractice suit comes home to roost on your insurance premiums.
Avoiding the medical care we don't need does not, of course, guarantee us the care we do need. The chronic shortage of primary-care doctors makes most people grateful to get a scrap of the physician’s time. If we are to be more demanding of our doctors, there must be an adequate supply of them.
The supply of the types of doctors is not controlled by the medical schools but by the number of residencies available in each specialty, and that is determined by the teaching hospitals.
Even the projection of an increased supply of doctors depends on the U.S. continuing to rob other countries which for years have been supplying the nation the doctors denied it by the AMA. As recently as 1973, almost ½ of all newly licensed doctors were graduates of foreign medical schools. The majority were from countries short of doctors who were lured here by better pay and amenities. The AMA didn't mind during the halcyon days of doctor shortage. Its members would get suburban practices while Pakistanis worked night shifts in city hospitals.
Saturday, October 16, 2010
Of malpractice, shortages of primary care physicians, and such
More notes on medical care in America: