Thursday, December 23, 2010

Looking into the numbers about doctors leaving Illinois

In a recent post about the ATRA "Judicial Hellholes" report, I mentioned that the report contained some claims about the impact of Lebron v. Gottlieb Memorial Hospital, 237 Ill.2d 217, 930 N.E.2d 895 (2010). Specifically, ATRA claims (p. 11):
This ruling invites, once again, an increase in medical claims, along with the higher insurance premiums for doctors that such cases precipitate. In fact, a study conducted in the wake of the high court’s decision to strike down limits on noneconomic damages calculated the impact to be an immediate 18% jump in physician medical malpractice insurance premiums. Over time, and depending on the volume of claims and award amounts, this number may grow much higher.

Ultimately, such increases in the level of new litigation and insurance premiums will affect residents’ access to affordable health care as physicians scale back practices, particularly in high risk areas, or opt to move their practices to states with reasonable limits on liability. A recent survey found that half of Illinois medical students plan to practice in other states. As reported by the Chicago Sun-Times, 7 out of 10 of those choosing to practice elsewhere cited the state’s anti-doctor liability climate as a factor in their decision.
It may not be possible for a mere blogger to investigate the reasons underlying increases in medical malpractice premiums or even to verify the extent of any increases that have taken place.

However, it was widely reported that many Illinois medical students plan to practice somewhere other than Illinois. Carolyne Krupa's December 3 article for cited a recent study by the Northwestern University Feinberg School of Medicine as the source of these statistics. It occurred to me that some other statistics in 2010 Illinois New Physician Workforce Study might provide some context and, perhaps, some insight into these figures.

As reported, the Northwestern study did find that, of medical students planning to practice outside of Illinois, some 67.6% did state that the medical liability environment was either a "very important" or an "extremely important" factor in reaching their decisions about where to practice (Table 8, p. 22). But is a perception that Illinois provides a 'hostile' medical liability environment really driving prospective physicians away from Illinois? Table 6 (p. 20) provides some food for thought:

(Click to enlarge.)

More than a quarter of the study respondents came to Illinois medical schools fully intending to leave as soon as they finished their studies. Only 9.3% of the respondents said they had planned to remain in Illinois at one time but have since changed their minds. Interestingly, fully one in five respondents said they could not find an acceptable job in Illinois.

Although the study notes (p. 8) that "[p]hysician supply is a top strategic priority for healthcare organizations," and cites "projections that physician shortages will reach crisis proportions in some places in the United States if something is not done to reverse the downward trend," the study also recognizes that there is, at least, a perception among study respondents that the Chicago and Cook County markets are saturated (p. 37): "[S]everal of the respondents noted that the high number of physicians in Cook County and Chicago impeded their abilities to find a position they desired, and lowered their potential compensation." (And respondents reported that doctors leaving Illinois are receiving higher salaries than those who are staying. See, Table 44, p. 48.)

A 'hostile' medical liability environment was not the only reason cited by young doctors for leaving Illinois (pp. 15-16):
Many of the respondents indicated they plan to leave Illinois to return to a home state or to be near family or friends. However, malpractice insurance rate concerns were mentioned repeatedly as a reason to practice outside of Illinois. Respondents emphasized extreme displeasure regarding the costs of employment in their fields in Illinois. Specific reasons for practicing elsewhere included the high costs for medical malpractice insurance, but also included what they perceived to be oversaturation of the Chicago market, low salaries in relation to the high cost of living and insurance rates, and intense demand from employers regarding work hours and productivity. Funding structures are another concern of new physicians. Some indicated discouragement with the pay structure of Illinois’ Medicaid program.
Other factors that influenced study respondents to set up shop outside Illinois included (p. 23):
Lower cost of living, higher reimbursement for physicians, lower income taxes, better compensation elsewhere, a more physician friendly environment, better opportunities for foreigners, cultural issues, research opportunities, and easier licensing restrictions are all factors that weigh in on respondents’ choice of location for practice. A few indicated that specifically Chicago and Illinois politics are driving them out of the state. Others said they wished to be able to practice medicine in an environment where the physicians are not practicing defensive medicine.
One of the more interesting facts that emerges from the Northwestern study is that most Illinois medical students aren't from Illinois in the first place. According to the Northwestern study (Table 3, p. 17), only 36.9% of Illinois medical students graduated from an Illinois high school. Of these Illinois 'natives,' 74.4% plan to remain in Illinois to practice. Meanwhile, 36.8% of medical students who went to high school outside of Illinois plan not to return to their places of origin. In other words, Illinois keeps three of four Illinois kids who stay in-state for medical school, but only one of three kids who come to Illinois from somewhere else.

If we're interested in keeping more Illinois medical graduates in Illinois, one logical response to this information might be to recruit more Illinois natives to our medical schools.

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