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New docs staying, but leery

West Virginia’s medical malpractice controversy hasn’t driven

off young doctors, according to data compiled by the state.

During the past two years, just as many recent West Virginia

medical school grads chose to stay and practice in-state after their

residencies as in the 1990s.

The percentage has hovered around 36 percent to 40 percent

since 14 years ago, long before the current malpractice debate.

Some doctors and medical students say malpractice problems and

the accompanying increase in insurance costs are bound to change that soon.

They point out that the doctors surveyed in 2001 and 2002 finished medical

school and applied for residencies before the medical malpractice controversy

hit.

Those doctors might have opted to stay here regardless of

malpractice insurance costs, because they put down roots here during their

residencies.

Young doctors who are finishing medical school right now, and

who haven’t applied for residencies yet, are more likely to balk at staying in-

state, they say.

“I’m undecided, and honestly, my decision is based on the

problem with malpractice right now,” said Jennifer Knight, who is in her final

year of medical school at West Virginia University.

She has applied to 25 residency programs, including two in West

Virginia. In March, she will find out where she has been accepted.

The Doddridge County native said she’ll have to decide: “Am I

willing to go into an environment where I have to pay more, versus another

state where I have to pay less?”

The malpractice effect — or the dot-com effect?

Every year since 1997, state higher education authorities have

looked at six years worth of West Virginia medical school graduates who have

completed their residencies, to see whether they’re still practicing in West

Virginia.

For example, in 1997, they looked at everyone who graduated

between 1987 and 1992. By 1997, 36 percent of those people who had completed

their residencies were still practicing medicine in West Virginia.

In 1998, graduates from the years 1988 to 1993 were studied,

and so on. This year, the percentage that stayed in-state was actually higher

than last year’s — 39 percent versus 38 percent — and the sheer number of young

doctors remaining in the state is higher than ever.

But, Knight said, “That doesn’t realistically show what my

class is going to do.”

Last fall, Charleston Area Medical Center saw fewer medical

school grads apply to its residency programs. It still filled all of its slots,

though. At WVU’s Ruby Memorial Hospital in Morgantown, the pool of residency

applicants didn’t dwindle — but doctors there get their malpractice insurance

through the state, so it’s not a big issue.

Also last year, the dean of Marshall University’s medical

school noted that fewer people were applying to West Virginia’s medical schools

since 1996. The malpractice controversy contributed to that, Dean Charles

McKown said.

But medical-school applicants have been more scarce all over

the nation since 1996, and the American Medical Association blames that on the

high-tech boom. Now that that industry has gone bust, more college students are

taking the Medical College Admission Test, and the AMA predicts a 4 percent to

6 percent jump in medical school applicants nationwide.

Young doctors might actually stay in West Virginia, Knight

said, because they don’t know what they missed.

“They don’t understand what it was like to pay $5,000 in

malpractice [premiums] five years ago, and now be paying $65,000,” she

said. “What we’re left with are new graduates who are willing to pay the money,

maybe because they don’t know any better.

“We see the change in experienced doctors ... they’re leaving,

or deciding to retire, or cutting back on the services they provide.”

Knight currently is on rotation in Orlando, Fla.

“Ironically enough, Florida is in the same boat West Virginia

is in,” she said. “Doctors are leaving Florida. Groups of physicians who have

practiced for years and years and years are just losing their malpractice

[insurance]. Their practices are going defunct.”

The doctors who remain are losing the colleagues they relied on

for second opinions and consultations, or to treat patients who are beyond

their expertise.

“They say, ‘Who do we refer to?’” Knight said. “I don’t know

that I want to be practicing in a state where my colleagues are all fresh and

new. I’d rather they were seasoned.”

Students rely on ‘limited information’

Steven Artz, a Charleston endocrinologist who teaches for WVU,

said he had dinner one night with a group of young residents.

“Some are actually finishing this year,” he said. “They told

him they feel ‘unwanted’ in West Virginia, and they’re worried they won’t be

able to afford malpractice insurance.

“This current crop’s not staying,” Artz said. “It’s very

disconcerting to have the results of all this work we’ve done turn out to be

exporting physicians to other areas.”

Unfortunately, Knight said, she and her classmates are relying

on “limited information” as they decide where to begin their careers.

“Students are focused primarily on finishing their education,”

she said. “It’s difficult to stay informed about what’s going on.

“As far as the current status of malpractice, my information is

hearsay from doctors I’ve worked with in the community, and

professors.”

Knight is one of the most active, involved students you’ll

find: She’s a regional trustee for the American Medical Students Association,

representing 20 medical schools in five states and Washington, D.C. She has

spoken at the Legislature’s “White Coat” lobbying day for doctors.

But even she hasn’t been able to keep up with the changes in

Charleston Area Medical Center’s trauma status, for example.

Among students, “Word gets out quickly that [CAMC] lost its

trauma-center status,” Knight said. “Word that it’s been reinstated doesn’t get

around so quickly. As I’m applying for residencies, I’m thinking, ‘Oh, they

lost it.’”

In March, Knight will attend the AMSA National Convention,

where the organization will pass resolutions on malpractice and tort

reform.

Florida’s doctors, like West Virginia’s, are pushing mainly for

limits on the amount of money a victim can win in a malpractice suit, Knight

said.

Knight’s not so sure that’s the main problem.

“We, as physicians, need to educate our patients about the

difference between malpractice and maloccurrence,” she said — maloccurrence

being an unfortunate result of treatment, but one that was not the doctor’s

fault. “I, as a physician, am OK with someone being compensated if there’s

negligence involved in their health care ...

“I think the problem is, we have too many frivolous lawsuits.

One or two $1 million or $2 million lawsuits — that’s nothing compared to the

frivolous lawsuits.”

To contact staff writer Tara Tuckwiller, use e-mail or call

348-5189.


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