The number of doctors in West Virginia has increased yearly, contrary to reports by the state MedicalAssociation that doctors are fleeing the state in reaction to medical malpractice costs. "A crisis is looming. West Virginia is losing her doctors," is the rallying cry by Medical Association doctors.Between 1990 and 2000 the state saw a 14.3 percent increase in its
umber of doctors, while the state's entire population for the same period grew at only 0.7 percent.
Dr. John Holloway, president of the Medical Association, points to colleagues in Wheeling as examples of doctors leaving the state. One of those doctors is neurosurgeon Dr. Fred Payne, who stopped operating in May. He said the high cost of medical malpractice insurance forced him out of business. "The premiums just got too high - it was killing me. I was always hopping around looking for a better deal," he said. "Doctors here are crawling under rocks looking for relief." In the past eight years Payne has accumulated more medical malpractice lawsuits than almost any other doctor in the state. An examination of insurance and court records shows Payne, with 10 lawsuits, is tied for third place with another doctor. The 10 patients who sued Payne for negligence cited in court documents harm ranging from extreme pain to permanent disablement. The Gazette obtained this information from medical malpractice reports filed with the tate Board of Medicine. Two other Wheeling neurosurgeons recently left town or retired, Payne ays. Payne's former colleague, Dr. Paravesh Asli, ranks close behind Payne with nine lawsuits in seven years for negligence. Asli retired in 1998. Insurance companies paid out-of-court settlements to patients in all but one of the lawsuits against Payne and Asli. A third Wheeling neurosurgeon, Christopher Marquart, packed up and moved to Michigan last fall, Payne said. This was three months after patient Patricia Cameron sued him for negligence. In court documents, Marquart admitted drilling into the wrong side of Cameron's head during an operation. It was his third lawsuit, including one in which a jury ruled against him and ordered him to pay $1.8 million to a patient after he performed surgery that caused multiple cerebral aneurysms and cardiac arrest. Former Medical Association president Phil Stevens points to another Wheeling doctor, Michael Lawson, as an example of doctors hopping across borders to avoid being sued. But Lawson, a gynecologist, says he moved his practice across the Ohio River to beat the 2 percent provider tax West Virginia imposes on doctors' incomes. Lawson lives in Wheeling and treats patients at Wheeling hospitals, but he has set up an office in St. Clairsville, Ohio, where patients' visits are recorded. Stevens said he didn't know how many other doctors use the same tactic. Charleston lawyer Richard Lindsay says the people of West Virginia are better off without those doctors who leave because of malpractice. "No one has been able to tell me the name of one doctor who has left the state because of the cost of malpractice premiums," Lindsay said. "I would bet the real reason that doctor has left is because he has been sued a lot - and for good reason. "If he has left the state because he is a bad doctor it means our ystem has weeded out a physician who was doing more harm than good." Lindsay says the Medical Association is employing scare tactics in claiming that West Virginia is losing its doctors. "They're using medical malpractice as the 'boogey man' - it's the worst type of lie," he said. "If you look at the reasons why doctors leave, lots of reasons come into play. "Sometimes, it has to do with the deals hospitals like CAMC cut with them." Lindsay said he has heard that CAMC has a reputation for "low-balling" physicians during salary negotiations. Dr. Richard Harris, a CAMC primary care physician specializing in geriatric medicine, knows colleagues who retired early and left the state - but not because of medical malpractice. "I know a few who did so well in the stock market they retired to Florida," he said. "I do know there's a lot of grumbling over medical malpractice, increased paperwork, government oversights, low reimbursements and all sorts of other things, but we need every doctor we can get regardless of how much pressure and heat is put on us." The Sunday Gazette-Mail examined records from the state Board of Medicine and the U.S. Census Bureau. In the past 10 years the state has gained more than 440 doctors with active licenses who practice in the state. D.O.s or doctors of osteopathy are not included in these umbers. The Board of Medicine keeps track of M.D.s only. According to U.S. Census information, 3,017 M.D.s were practicing medicine in West Virginia in 1990. That number grew to 3,525 in 2000, according to state Board of Medicine records. Year 2000 Census data on physicians practicing in the state is not yet available, but records from West Virginia University's Office of Health Services Research show the number of doctors even higher, at 3,546. Using Board of Medicine numbers, the state now has 195 doctors for every 100,000 people in the state, an increase from 1990 when there were 172 doctors per 100,000. Though the overall number of doctors continues to rise, ome counties are lacking doctors because many physicians do not want to practice in rural or poverty-stricken areas. "As a whole, West Virginia is competing with larger and nicer places like Chapel Hill, the Mayo Clinic or Cleveland Clinic," said Linda Atkins, director of health care provider recruitment at the West Virginia Department of Health. "Despite the fact that it's extremely difficult to recruit doctors to rural areas - where the pay is less and there are fewer amenities - we have been more successful than ever before at placing doctors in previously underserved areas." In 2000, 70 percent of the state's licensed M.D.s were based in eight of West Virginia's 55 counties. The numbers coincide with population density and whether there is a hospital in the county. Kanawha County led with 664 doctors, making up 19 percent of the total. Second was Monongalia with 14 percent, followed by Cabell with 12 percent. Ohio, Raleigh, Wood, Mercer and Harrison are next in that order. Although overall numbers have increased and some shifting between counties has occurred, these rankings are the same as they were in 1996. One difference is that in 1996, one county (Wirt) had no physician, whereas in 2000 all counties had at least one physician. Despite the change in Wirt, which now boasts one doctor, most counties that were medically underserved in 1996 remain that way today. But the numbers are improving, said Dr. Robert D'Alessandri, dean of the WVU School of Medicine. Though the number of applicants to the school has decreased in recent years - from 1,400 in 1991 to 850 in 2000 - the number graduating and going into residency programs has remained steady at around 85 per year. "We're not too concerned about the drop in applicants, because we're accepting the students at full capacity every year," he said. "And we're eeing a steady increase in the quality of the applicants in terms of GPA and MCAT scores." D'Alessandri said some students may be discouraged from applying to medical school because of disgruntled doctors in the state. "Doctors here are very vocal about their unhappiness over issues like medical malpractice and the provider tax, and that is picked up by tudents and they look for other professions," he said. Despite this, more graduates are remaining in the state than ever before, to do their residency and to set up permanent practice, D'Alessandri said. "Because of our Rural Health Education Program, 40 percent of our graduates remain in the state today, compared with 32 percent a few years ago." D'Alessandri is also encouraged by a trend of more students wanting to go into primary care, rather than big-ticket, urban specialties like eurosurgery. Even so, a look at numbers of specialists in the state shows most have increased slightly or remained stable over the past three years - with the exception of the Wheeling neurosurgeons. To contact staff writer Martha Leonard, use e-mail or call 348-1254.