Rising liability rates decimate neurosurgery

Specialists say 24 states and Washington, D.C., are facing a crisis-level shortage of neurosurgical care, especially in emergency departments.

By Tanya Albert, amednews staff. Oct. 14, 2002.

A new study puts some teeth behind what neurosurgeons have seen anecdotally: Ballooning medical liability insurance rates have led nearly half of them to consider scaling back their practice.

Surveys from more than 700 neurosurgeons in 48 states and Washington, D.C., found that 43% plan to or are considering restricting their practice so they can minimize their risks and lower their professional liability insurance rates.

Topic: Liability crisis
Region: West
Region: South
Region: States

"Based on this survey data, it seems that brain surgeons are no longer performing brain surgery," said Phoenix neurosurgeon Stephen M. Papadopoulos, MD, president of the Congress of Neurological Surgeons.

The study, conducted by the American Assn. of Neurological Surgeons, the Congress of Neurological Surgeons and the Council of State Neurosurgical Societies, includes responses from physicians in all states except Alaska and Vermont.

The survey found that, in addition to performing fewer services, another 29% of the neurosurgeons said they plan to or are considering retiring from practice and 19% plan to or are considering moving their practice.

"What this means for the public is that our patients may be denied crucial neurosurgical emergency medical treatment or they will have to travel greater distances -- even to other states -- to get the care they need," Roberto C. Heros, MD, AANS president and co-chair of the University of Miami's neurosurgery department said in a statement.

19% of neurosurgeons saw liability premiums increase more than 100%.

Mississippi and West Virginia physicians this year have seen patients lose the critical "golden hour" in which care is most optimally delivered, because neurosurgeons weren't available.

The reason neurosurgeons are becoming scarce, according to the study: The increase in medical liability insurance costs in an era in which salaries are not keeping up with inflation. The study found that 19% of neurosurgeons were hit with a more than 100% increase in rates between 2000 and 2002. That's pushed rates up to $300,000 per year for some.

About 50% of those who responded said they saw up to a 50% increase in rates; another 13% saw a 50% to 100% increase; 11% saw no change and 7% saw rates decrease.

The study said 24 states and the District of Columbia are in a "severe crisis," defined as having experienced a 50% increase in rates between 2000 and 2002 or an average premium now more than $100,000. The 24 states are: Alabama, Arkansas, Delaware, Florida, Illinois, Kentucky, Mississippi, Missouri, Montana, Nevada, New Hampshire, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Washington and West Virginia.