“Note to the last obstetrician to leave Southern Nevada: Please turn out the lights.”
Letter to Gov. Kenny Guinn from the Clark County Obstetrics and Gynecology Society
I expressed my opinion last month on the crisis caused by Nevada’s physicians leaving the state, but since the problem is still in the headlines (as it should be), let’s revisit it again and get a little more personal this time. I am concerned about the problems facing Nevada’s doctors for several reasons — besides being someone who’s needed more than my fair share of healthcare over the years, I am also dependent on a healthy Nevada economy to make my living. So are most of my readers. In addition, I have a son who will be entering medical school in the fall, and I don’t want “Dr. Sean” to move back in with me because he can’t afford a home of his own as a physician.
This is a personal issue for a lot of Nevadans. Patients develop relationships with their doctors that grow over the years. They share problems, tragedies and triumphs together. A doctor who helps you through a terrifying bout with cancer or who supports you through a problem pregnancy can become closer than some of your own family members. Ending these relationships is not only emotionally wrenching for both doctors and patients, but it can have serious health consequences. You get the best care from someone who is familiar with your medical history, knows your personal quirks and cares about you and your family – that’s just common sense.
And what about the doctors who have to leave the state because they can’t afford to practice here any more? Their kids are uprooted from school, they have to sell their homes and relocate to a strange place and start to rebuild their practices and their lives all over again. It’s not just about dollars – it’s about people.
An April survey by the Nevada State Medical Association showed that 47 Las Vegas doctors are considering closing their practices. Another 12 had already shut down their offices, seven had retired early and four were in the process of closing up when the survey was taken. Larry Matheis, the executive director for the association, said he expects at least 100 doctors to leave the state or take early retirement by this fall. We’ve all read about the closing of emergency rooms. And who could blame young people for not wanting to choose a career in medicine, when they read every day about doctors fleeing the field because they’re losing money? Medical students already in the pipeline are avoiding specialty fields such as surgery and OB/GYN because of the problems in getting affordable malpractice insurance. This is bad news for a state with an ever-increasing population and a growing number of seniors.
The problem is not just with medical malpractice insurance, which has received most of the attention in the press. It’s also the other side of the income vs. outgo equation: reimbursements from health insurance companies, HMO’s, etc. According to the OB/GYN Society letter quoted above, “Insurance companies in Southern Nevada have drained all the profits out of obstetrics and gynecology. Obstetricians in Southern Nevada are now delivering babies at below cost, and this does not include the 18 years of [malpractice insurance] liability that follows the delivery.” One obstetrician I spoke with recently pointed out that reimbursements from health insurance companies had been insufficient to pay his expenses for some time, and he didn’t expect reimbursement rates to improve anytime soon. “I’m trying to think of ways to stay in Nevada and still make my practice work financially,” he said. “I think we should bite the bullet for a few months and stop accepting insurance. We’ll accept patients only on a fee-for-service basis. We’ll see a lot fewer patients, but that also means we can reduce overhead. We can cut back on office staff, and our malpractice insurance premiums will go down, because a lower patient count means less exposure to risk. If more doctors decide to do this, it will create the kind of public pressure we need to make insurance companies reevaluate their reimbursement rates. Labor unions are always very concerned about providing health benefits for their members. If their members can’t find a doctor to accept their insurance, maybe people will sit up and take notice.”
Obviously there’s no easy solution to the two-headed monster composed of soaring malpractice rates and lagging insurance reimbursements. If there were, somebody would have thought of it by now. As usual, it’s something we’ll have to deal with the hard way, and the first step should be to lobby our legislators for tort reform. Gov. Guinn’s stopgap measure to provide temporary coverage for doctors through the Medical Liability Association of Nevada has provided a little breathing room, and the doctors are forming a mutual insurance company that may help because it won’t have to earn profits for stockholders. But even a nonprofit insurance company has to balance its books by offsetting payouts with premiums. How many multimillion-dollar lawsuits will the new company be able to pay out before it runs into the same problem that caused the conventional insurers to stop covering Nevada physicians?
In addition to tort reform, we have to consider the issue of reimbursement rates to doctors. If we expect doctors to be reimbursed more so they will stay in Nevada, somebody has to pay for it. That means those of us paying for health insurance, both employers and employees, will have to brace for more rate increases. It’s not going to be easy, but it needs to be done. This is one issue that affects everyone in the state in an “up close and personal” way.
