New docs staying, but leery
West Virginia’s medical malpractice controversy hasn’t driven
off young doctors, according to data compiled by the state.
During the past two years, just as many recent West Virginia
medical 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 percent
since 14 years ago, long before the current malpractice debate.
Some doctors and medical students say malpractice problems and
the accompanying increase in insurance costs are bound to change that soon.
They point out that the doctors surveyed in 2001 and 2002 finished medical
school and applied for residencies before the medical malpractice controversy
Those doctors might have opted to stay here regardless of
malpractice insurance costs, because they put down roots here during their
Young doctors who are finishing medical school right now, and
who 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 the
problem with malpractice right now,” said Jennifer Knight, who is in her final
year of medical school at West Virginia University.
She has applied to 25 residency programs, including two in West
Virginia. In March, she will find out where she has been accepted.
The Doddridge County native said she’ll have to decide: “Am I
willing to go into an environment where I have to pay more, versus another
state where I have to pay less?”
The malpractice effect — or the dot-com effect?
Every year since 1997, state higher education authorities have
looked at six years worth of West Virginia medical school graduates who have
completed their residencies, to see whether they’re still practicing in West
For example, in 1997, they looked at everyone who graduated
between 1987 and 1992. By 1997, 36 percent of those people who had completed
their 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 higher
than last year’s — 39 percent versus 38 percent — and the sheer number of young
doctors remaining in the state is higher than ever.
But, Knight said, “That doesn’t realistically show what my
class is going to do.”
Last fall, Charleston Area Medical Center saw fewer medical
school 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 residency
applicants didn’t dwindle — but doctors there get their malpractice insurance
through the state, so it’s not a big issue.
Also last year, the dean of Marshall University’s medical
school noted that fewer people were applying to West Virginia’s medical schools
since 1996. The malpractice controversy contributed to that, Dean Charles
But medical-school applicants have been more scarce all over
the nation since 1996, and the American Medical Association blames that on the
high-tech boom. Now that that industry has gone bust, more college students are
taking the Medical College Admission Test, and the AMA predicts a 4 percent to
6 percent jump in medical school applicants nationwide.
Young doctors might actually stay in West Virginia, Knight
said, because they don’t know what they missed.
“They don’t understand what it was like to pay $5,000 in
malpractice [premiums] five years ago, and now be paying $65,000,” she
said. “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 Virginia
is in,” she said. “Doctors are leaving Florida. Groups of physicians who have
practiced 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 on
for second opinions and consultations, or to treat patients who are beyond
“They say, ‘Who do we refer to?’” Knight said. “I don’t know
that I want to be practicing in a state where my colleagues are all fresh and
new. 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 told
him they feel ‘unwanted’ in West Virginia, and they’re worried they won’t be
able to afford malpractice insurance.
“This current crop’s not staying,” Artz said. “It’s very
disconcerting to have the results of all this work we’ve done turn out to be
exporting physicians to other areas.”
Unfortunately, Knight said, she and her classmates are relying
on “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 is
hearsay from doctors I’ve worked with in the community, and
Knight is one of the most active, involved students you’ll
find: She’s a regional trustee for the American Medical Students Association,
representing 20 medical schools in five states and Washington, D.C. She has
spoken at the Legislature’s “White Coat” lobbying day for doctors.
But even she hasn’t been able to keep up with the changes in
Charleston Area Medical Center’s trauma status, for example.
Among students, “Word gets out quickly that [CAMC] lost its
trauma-center status,” Knight said. “Word that it’s been reinstated doesn’t get
around so quickly. As I’m applying for residencies, I’m thinking, ‘Oh, they
In March, Knight will attend the AMSA National Convention,
where the organization will pass resolutions on malpractice and tort
Florida’s doctors, like West Virginia’s, are pushing mainly for
limits on the amount of money a victim can win in a malpractice suit, Knight
Knight’s not so sure that’s the main problem.
“We, as physicians, need to educate our patients about the
difference between malpractice and maloccurrence,” she said — maloccurrence
being an unfortunate result of treatment, but one that was not the doctor’s
fault. “I, as a physician, am OK with someone being compensated if there’s
negligence 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 the
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