While state legislators debate insurance changes and malpractice limits in an effort to keep more physicians in Illinois, the numbers do not show that doctors are actually leaving.
In fact, state figures indicate that there has been a steady increase in the number of doctors licensed by the state in recent years–even in high-risk specialty fields in which doctors reportedly were leaving Illinois in search of lower insurance premiums.
There are 9,000 more doctors licensed to practice medicine in Illinois than there were a decade ago, up roughly 30 percent to almost 40,000, according to state records.
Those figures, however, may still obscure a potential health access problem, because the totals do not reflect the fact that some specialists have remained licensed and in business but have stopped offering their higher-risk services in favor of those less likely to get them sued.
The figures also don’t highlight the harm to a medically underserved area when even a single physician closes shop.
Varied interpretations of the numbers are complicating budget negotiations at the Statehouse, where Gov. Rod Blagojevich has been holed up for weeks trying to reach an agreement on the state’s budget.
Several clout-heavy special-interest groups–among them doctors, hospitals, insurers and trial lawyers–have joined in a high-stakes debate that has helped to stall budget talks for weeks. Although Blagojevich and legislative leaders reached a breakthrough in those talks late Thursday, Republican leaders are still holding out the possibility that they will withhold their votes on the state budget until there also is a meaningful medical malpractice reform package to approve, putting the contentious reform issue at center stage in the next few days.
Thus far it is still unclear exactly how many Illinois doctors are retiring, leaving town or limiting services, and to what degree their decisions to do so are influenced by the skyrocketing cost of medical malpractice insurance.
The state’s Department of Professional Regulation tracks only the numbers of licenses issued, not the nature and volume of doctors’ practice nor the reasons for their departure.
While they may not be able to define the size and scope of the problem, Blagojevich and lawmakers steadfastly maintain that there is one.
“Regardless of what the statistics may bear out, it’s clear there is a crisis that needs to be addressed,” said Rep. Jay Hoffman (D-Collinsville), a lawyer who is representing Blagojevich in the closed-door discussions. “Doctors are leaving certain areas of the state, and that’s something we don’t want to happen.”
While the state does not keep tabs on the specialties in which those doctors are certified, an industry group reports that, in the two fields most threatened by rising insurance rates, there are actually more doctors eligible to practice in Illinois than there were five years ago.
More neurosurgeons
The number of neurosurgeons in Illinois dropped by six from last summer to this, but is up by 20, or 12 percent, from 1999. There now are 183 physicians certified to practice neurological surgery in Illinois, according to the Evanston-based American Board of Medical Specialties.
Similarly, the number of obstetricians in the state has dropped by 23 since last summer, but has climbed by 218, or 15 percent, since 1999. There now are 1,640 doctors certified to practice obstetrics and gynecology in the state.
Private health plans in the state are not noticing access problems to doctors in their networks. The state’s largest health insurer, Blue Cross and Blue Shield of Illinois, said its medical care provider networks have ample access to doctors and hospitals and their services for the more than 3.5 million people covered in its various plans.
In terms of doctors, Illinois Blue Cross spokesman Tony Rau said its network executives are “not aware of any great flight of physicians because of the malpractice issues.”
“We are basically about where we have been,” Rau added. “Even anecdotally, [we are] not hearing any evidence of that.”
Doctors and other would-be tort reformers think the statistics are misleading. For one thing, they note, the number of licensed physicians doesn’t necessarily show how many doctors are actually practicing in Illinois because some graduates of the state’s medical schools choose to be certified here but then depart for jobs out of state.
Also, many retired or semiretired physicians keep their licenses current even though they don’t intend to practice much or at all.
Perhaps more significantly, the numbers do not reflect the decisions by some physicians to cleave off high-risk services because they elevate the risk of lawsuits and therefore the cost of insurance.
For instance, some neurosurgeons have told state lawmakers that they intend to change their practices so that they are doing primarily spine surgery rather than higher-risk brain surgery.
And in an industry survey, some 22 percent of obstetricians around the country said they had decreased the amount of high-risk obstetric care they provided because of the risk of liability claims or of being sued. The 2003 survey, conducted by the American College of Obstetricians and Gynecologists, had a response rate of 45 percent.
In Illinois, the OB/GYN Crisis Coalition, an organization of obstetricians throughout the Chicago area, says its recent survey of 2,000 doctors around the state shows that more than 11 percent of them have stopped delivering babies in the last two years.
That translates into a loss of some 46,000 office visits for obstetrical and gynecological services during that period, the group estimates.
At Northwestern Memorial Hospital the academic medical center actually has more neurosurgeons and obstetricians than it did three years ago. Still, the hospital said it has an easier time recruiting doctors because of its nationwide reputation and desirable location, having built a new hospital five years ago, with plans in the works for a new women’s hospital scheduled by 2007.
And its reputation means more high-risk pregnancies are stressing the hospital and its physicians’ ability to take care of these women, Northwestern doctors say.
“The patients are drifting toward us because other facilities and other physicians are limiting their services,” said Dr. Lewis Blumenthal, an attending ob-gyn at Northwestern Memorial. “It’s a disaster that is happening in slow motion. I had a high-risk patient this week who came into my office who is 16 weeks pregnant and said she couldn’t get in to see anyone else.”
Regional differences
Also obscured by the statewide statistics is the fact that some regions suffer more from the loss of a doctor or two than do others. While particularly difficult to deal with in rural areas, the loss of a few doctors can also be acutely felt in the Chicago area.
In Will County, for instance, the pending decision by one neurosurgeon to eliminate brain surgery means there will be no one to do that work within a two-hour drive of a local car accident, according to one local lawmaker.
“Right now, they’re telling us that a head injury would have to be transported to a hospital in Chicago or Peoria,” said Rep. Brent Hassert (R-Romeoville), one of the GOP point men on medical malpractice. “My understanding is that the first two hours is critical in a major head trauma. By delaying that, you could really have some serious consequences.”
