New docs staying, but leery


West Virginia’s medical malpractice controversy hasn’t drivenoff young doctors, according to data compiled by the state. During the past two years, just as many recent West Virginiamedical school grads chose to stay and practice in-state after their
residencies as in the 1990s.
The percentage has hovered around 36 percent to 40 percentsince 14 years ago, long before the current malpractice debate.Some doctors and medical students say malpractice problems andthe accompanying increase in insurance costs are bound to change that soon.They point out that the doctors surveyed in 2001 and 2002 finished medicalschool and applied for residencies before the medical malpractice controversyhit. Those doctors might have opted to stay here regardless ofmalpractice insurance costs, because they put down roots here during theirresidencies.
Young doctors who are finishing medical school right now, andwho haven’t applied for residencies yet, are more likely to balk at staying in-state, they say.“I’m undecided, and honestly, my decision is based on theproblem with malpractice right now,” said Jennifer Knight, who is in her finalyear of medical school at West Virginia University.
She has applied to 25 residency programs, including two in WestVirginia. In March, she will find out where she has been accepted.The Doddridge County native said she’ll have to decide: “Am Iwilling to go into an environment where I have to pay more, versus anotherstate where I have to pay less?”The malpractice effect — or the dot-com effect?Every year since 1997, state higher education authorities havelooked at six years worth of West Virginia medical school graduates who havecompleted their residencies, to see whether they’re still practicing in WestVirginia.For example, in 1997, they looked at everyone who graduatedbetween 1987 and 1992. By 1997, 36 percent of those people who had completedtheir residencies were still practicing medicine in West Virginia.In 1998, graduates from the years 1988 to 1993 were studied,and so on. This year, the percentage that stayed in-state was actually higherthan last year’s — 39 percent versus 38 percent — and the sheer number of youngdoctors remaining in the state is higher than ever.But, Knight said, “That doesn’t realistically show what myclass is going to do.”Last fall, Charleston Area Medical Center saw fewer medicalschool grads apply to its residency programs. It still filled all of its slots,though. At WVU’s Ruby Memorial Hospital in Morgantown, the pool of residencyapplicants didn’t dwindle — but doctors there get their malpractice insurancethrough the state, so it’s not a big issue.Also last year, the dean of Marshall University’s medicalschool noted that fewer people were applying to West Virginia’s medical schoolssince 1996. The malpractice controversy contributed to that, Dean CharlesMcKown said.But medical-school applicants have been more scarce all overthe nation since 1996, and the American Medical Association blames that on thehigh-tech boom. Now that that industry has gone bust, more college students aretaking the Medical College Admission Test, and the AMA predicts a 4 percent to6 percent jump in medical school applicants nationwide.Young doctors might actually stay in West Virginia, Knightsaid, because they don’t know what they missed.“They don’t understand what it was like to pay $5,000 inmalpractice [premiums] five years ago, and now be paying $65,000,” shesaid. “What we’re left with are new graduates who are willing to pay the money,maybe because they don’t know any better.“We see the change in experienced doctors ... they’re leaving,or deciding to retire, or cutting back on the services they provide.”Knight currently is on rotation in Orlando, Fla.“Ironically enough, Florida is in the same boat West Virginiais in,” she said. “Doctors are leaving Florida. Groups of physicians who havepracticed for years and years and years are just losing their malpractice[insurance]. Their practices are going defunct.”The doctors who remain are losing the colleagues they relied onfor second opinions and consultations, or to treat patients who are beyondtheir expertise.“They say, ‘Who do we refer to?’” Knight said. “I don’t knowthat I want to be practicing in a state where my colleagues are all fresh andnew. I’d rather they were seasoned.”Students rely on ‘limited information’Steven Artz, a Charleston endocrinologist who teaches for WVU,said he had dinner one night with a group of young residents.“Some are actually finishing this year,” he said. “They toldhim they feel ‘unwanted’ in West Virginia, and they’re worried they won’t beable to afford malpractice insurance.“This current crop’s not staying,” Artz said. “It’s verydisconcerting to have the results of all this work we’ve done turn out to beexporting physicians to other areas.”Unfortunately, Knight said, she and her classmates are relyingon “limited information” as they decide where to begin their careers.“Students are focused primarily on finishing their education,”she said. “It’s difficult to stay informed about what’s going on.“As far as the current status of malpractice, my information ishearsay from doctors I’ve worked with in the community, andprofessors.”Knight is one of the most active, involved students you’llfind: She’s a regional trustee for the American Medical Students Association,representing 20 medical schools in five states and Washington, D.C. She hasspoken at the Legislature’s “White Coat” lobbying day for doctors.But even she hasn’t been able to keep up with the changes inCharleston Area Medical Center’s trauma status, for example.Among students, “Word gets out quickly that [CAMC] lost itstrauma-center status,” Knight said. “Word that it’s been reinstated doesn’t getaround so quickly. As I’m applying for residencies, I’m thinking, ‘Oh, theylost it.’”In March, Knight will attend the AMSA National Convention,where the organization will pass resolutions on malpractice and tortreform.Florida’s doctors, like West Virginia’s, are pushing mainly forlimits on the amount of money a victim can win in a malpractice suit, Knightsaid.Knight’s not so sure that’s the main problem.“We, as physicians, need to educate our patients about thedifference between malpractice and maloccurrence,” she said — maloccurrencebeing an unfortunate result of treatment, but one that was not the doctor’sfault. “I, as a physician, am OK with someone being compensated if there’snegligence involved in their health care ...“I think the problem is, we have too many frivolous lawsuits.One or two $1 million or $2 million lawsuits — that’s nothing compared to thefrivolous lawsuits.”To contact staff writer Tara Tuckwiller, use e-mail or call348-5189.
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