Comments

Health Affairs encourages readers to engage in discussion via comments on our Web site.

• To RESPOND to a particular article: Click on the link "Submit a response to this article" in the box at the top right-hand corner of the article.
• To READ responses to a particular article: Click on the link "View responses" in the box at the top right-hand corner of the article.

Comments to:

Marc A. Rodwin, Hak J. Chang, and Jeffrey Clausen Malpractice Premiums And Physicians’ Income: Perceptions Of A Crisis Conflict With Empirical Evidence Health Affairs, May/June 2006; 25(3): 750-758. [Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]

Comments:Submit a response to this article

Comments published:

Medical Malpractice Crisis

Daniel L. Icenogle   ( 16 May 2006 )

Malpractice Premiums And Physicians’ Income: A Physician's Perpective

Arvind Cavale   ( 27 June 2006 )

Was Rodwin And Colleagues' Paper Really Peer Reviewed?

Joseph M Purpura   ( 29 January 2007 )

Medical Malpractice Crisis 16 May 2006
Daniel L. Icenogle, ER medical director Vernon Memorial Healthcare Send comment to journal: Re: Medical Malpractice Crisis dan{at}icenogle.net Daniel L. Icenogle	The study reviews medical malpractice premium data from 1986 to 2000 and demonstrates no significant increase in medical malpractice premiums nationwide during that period. However, prior to 2000, the problems with increasing premiums and a lack of availability of coverage was spotty both geographically and specialty-wise. For example, obstetrics in Mississippi was a particular problem area in the 1990s (and since). However, for the much greater part of the country now having malpractice coverage difficulties, the problems have arisen only since 2000. For example, anyone familiar with the issues in Illinois knows that the situation, which has become dire in Cook County and surrounding counties, has developed only since 2002 or so. While it may be that the AMA has a deserved reputation for crying wolf in this and other issues, to say that there is no problem today because one did not exist six years ago is short-sighted.
Malpractice Premiums And Physicians’ Income: A Physician's Perpective 27 June 2006
Arvind Cavale, Physician Send comment to journal: Re: Malpractice Premiums And Physicians’ Income: A Physician's Perpective Arvind.Cavale{at}perfectserve.net Arvind Cavale	After reading this article with interest, I would like to point out the potential flaws in the reasoning, data collection, and analysis from the perspective of a physician in practice for a total of 10 years in three different states. (1) Comparing liability insurance premium costs as a percentage of total practice costs is erroneous because while non-liability insurance costs will almost automatically increase as a practice grows and matures, it is not automatic that liability insurance costs should increase as well, especially if a particular physician has an "incident-free record." However, medical liability rates have not followed this logic in the past 10 years. (2) The data collection is from 1986 to 2000, but the most significant increases in premium costs have occurred from 1999 to 2005. (3) While the authors noted probable causes for progressive decreases in physicians' net revenue generation, the psychological impact of massive increases in liability insurance premiums on the nature of physicians' practices has been totally ignored. For example, OB-GYNs had to give up delivering babies to keep flat premiums. In other words, they gave up almost 50% of their revenue, yet kept paying the same amount of premiums. Clearly, this increases the premium cost:revenue ratio dramatically, which was omitted in the analysis. Although I applaud their efforts at producing this paper, it would really serve the public in general, and the health care community in particular, if the authors made a more concerted effort at analyzing the data in a more practical manner.
Was Rodwin And Colleagues' Paper Really Peer Reviewed? 29 January 2007
Joseph M Purpura, Assistant Clinical Professor Northwestern University Feinberg School of Medicine Send comment to journal: Re: Was Rodwin And Colleagues' Paper Really Peer Reviewed? j-purpura{at}northwestern.edu Joseph M Purpura	It is inconceivable that the half-decade-old data end-point presented in this piece was not strategically chosen to support the authors' hypothesis regarding what they consider the flawed "conventional wisdom" on the professional liability crises around the nation. As the authors must have known, or should have known, with the current steady downturn of physician reimbursement and the continual rise of expenses of all types, the percentage of overhead allotted to professional liability insurance premiums may remain the same, but its impact on practice viability--rather than physician income--changes dramatically: in many cases, the numbers simply don't work anymore. Thus, the loss of physicians continues in high-risk specialties, in lawsuit-friendly venues, to early retirement and so on. Also, as recruitment of medical students into these risk-exposed specialties suffers, so do our communities. That is the crisis at hand. And any unbiased pre-publication reviewer of this purported scientific piece should have called the authors on it.