Texas Tort Reform and Texas Doctors
Governor Perry of Texas is making the claim that the Texas 2003 tort reform lead to Texas having 20,000 more doctors.
I challenge him to document his numbers.
Here is the number of doctors registered to practice in Texas before and after the 2003 tort reform. The data is from the official state registry that is the only body with the authority to
license doctors to practice in Texas.
| http://www.dshs.state.tx.us/chs/hprc/PHYS-lnk.shtm |
The data clearly shows that the growth rate of the number of doctors practicing in Texas slowed from an average rate of 3.4% in the five years before tort reform to a rate of 2.4% in the five years after tort reform. The calculations does not use the data from 2003, the actual year tort reform was passed and a year that should be considered a transition year.. This official data directly contradicts Perry claim that tort reform increased the number of doctors practicing in Texas.
Doesn’t this data need to be compared to rates of change in adjacent states and/or nationally?
Besides that, tort reform would, I’m guessing in theory, only change the supply dynamics for those where torts are a “problem” in the first place – emergency medicine, ob-gyn, anesthesiology, neurosurgery – which we all know, given the differential in med mal frequency claims, are the specialties most likely to attract negligent doctors.
From dshs – it does look like there was a step function in licence applications after 2003 and another one in 2005.
http://www.dshs.state.tx.us/chs/hprc/NewPhys.pdf
“The number of new physicians doesn’t always indicate how many net new physicians we had each year (net=new physicians minus those who leave). The numbers of new active DPC physicians does not necessarily correspond to the numbers of new licensees (Table 1). For example, it has been reported that Texas has experienced a record number of new licensees since tort reform, instituted in Texas in 2003; however, the numbers of new active DPC physicians is inconclusive. The year with the highest numbers for both new physicians and the net increase of physicians was 2003, but the trend did not continue in the following years; 2004 had the lowest net increase for that decade, and while the numbers fluctuated, the total number of new DPC physicians for 2004, 2006, and 2007 are comparable to the number in 2002. A large increase was recorded in 2008, when HPRC began to include more physicians as DPC at the request of the Texas Medical Association. This number dropped off again in 2009. Physicians are required to renew their licenses every two years, and there does seem to be a two year cycle for the rises and falls of the numbers of new active DPC Physicians.”
Forget rates of growth! Does this table show only only abt 7000 more doctors since 2002? Not 20,000?
Not only this, but the Texas population has increased. The Tort Reform series I wrote here on AB showed that when you actually factor in population growth, the number of new physicians is really dramatically reduced.
Note that he hasn’t said anything about spending, which exploded AFTER tort reform in Texas.
Spencer,
Those 20K doctors include all the ones he ‘saved’ from leaving or quiting. Just like Obama ‘saved’ all those jobs…
Look Obama is not running as a blank slate this time and his performance has been dismal, even Carteresque.
Compared with Perry over these last 3 years he looks incompetant. And I don’t like Perry paticularly. But he has more executive experience than Obama did in 2008 and has a proven track record of growing jobs.
BUt I didn’t figure you would be carrying Obama’s water…
Islam will change
Michael,
And as I pointed out to you during that series, the Tort reform act did exactly what it was suppossed to do: Get money out of the hands of the lawyers. It succeded at its goal.
Islam will change
Buff:
You are on topic for the first sentence and the rest is off topic. The issue is tort reform . . . I believe and not the presidential election or Obama
I don’t know why, but the author left off 2010’s statistics. Last year, the total number of direct care physicians in Texas was 41,191. (http://www.dshs.state.tx.us/chs/hprc/tables/Direct-Patient-Care-Physicians-(DPC)-by-County-of-Practice—September,-2010/)
Though the last three year growth rate in physicians is greater than the previous three before the reform took place (3.5% vs 2.9%), the startling numbers come from new license applications and issuance. Around 2,100 new physicians were licensed in 2001 and 2002, a rate far too low to keep up with the population growth rate and retirements in their professions. Since 2007, an average of 3400 new licenses were issued, a increase of 62% over the period before the reform.
In fact, The New York Times had an article about the trend: http://www.nytimes.com/2007/10/05/us/05doctors.html
Darren:
1. There is no direct quote but an indirect reference:
“We’ve had the most sweeping tort reform in the nation,” he said, asserting that as a result of the law passed in 2003, there are 20,000 more physicians in Texas. http://www.realclearpolitics.com/articles/2011/08/15/off_to_a_rousing_start_in_iowa_perry_takes_aim_at_rivals_110950.html
In essence the numbers of doctors has been growing at a similar rate.
2. Not a part of the Texas discussion or a non sequitor.
3. Most states have capped rewards for non medical issues. From my last post on the topic:
“As far as malpractice lawsuits, most attorneys will not touch them unless there is a clear and concise case evident. Lawsuit cost hundreds of thousands of dollars in preparation which must come from either the pain and suffering or the medical costs awards or the patent’s pockets. Furthermore, most states cap “pain and suffering” awards between $250,000 and $500,000 (which are not indexed for inflation). Awards for medical treatments are not capped”
buff:
No, attorney’s will not toch a lawsuit if there is no basis for it as they only collect when they win.
Jed:
Tort reform has little impact on malpractice insurance which is driven by other issues in investment returns. I would also suggest defensive medicine is also more a factor of the services for fee cost modl than protection.
If you want tort reform, go to single payer or universal healthcare and dctors should police their ranks.
Umm, I understand that poor investment returns is the liberal talking pointthe med mal price increases in 1985 and 2001, but why, then didn’t medmal prices increase in 2009? Correlation is not causation is why.
The reality is that prices increase on inflections in loss cost trends and out of control jury awards is one of the things that causes such inflections. With tort reform in place, the risk to insurer balance sheets is lower, which is one reason why commercial prices, generally speaking, have been declining since 2005.
Defensive medicine is a reactive response to higher frequency and severity of torts, and separating the two is illogical.
Doctors should police their ranks, but perhaps my sarcasm was too subtle – please explain why frequency of medmal claims in the specific specialties I noted are higher than in dermatology, pediatrician, internal medicine, etc. Malpractice is negligence. Do you believe that ob-gyns attract a breed of person more prone to negligence than physchiatry?
If there were only a way to figure out how many incompetent doctors tort reform attracts.
This story on This American Life covers a nutjob doctor recruited to a small town in West Texas, Kermit. http://www.thisamericanlife.org/radio-archives/episode/437/old-boys-network?act=1
It was also covered in the Texas Observer:
http://www.texasobserver.org/cover-story/intent-to-harm
Michael – I understand the underlying logic for normalizing by population, but I’m guessing Texas has had much faster population growth over that tiem frame than the other states you show.
I had this data when the NY tTimes wrote their article.
I talked to the reporter who wrote the article.
He says that he was just quoting what some sources in Texas had told him.
He was not aware of this data on the number of doctors in Texas.
I believe that the reporter wa misinformed.
run,
You can go back to the intial discussion. But the bottom line was the Texas tort reform’s primary purpose was to move money from the hands of the lawyers to Doctors and insurance companies. In the big picture it did just that. You are correct in that in any specific lawsuit the lawyer has to win to collect. It just made it harder to win and made the payouts lower, thus reducing the ROI of the lawyers.
Islam will change
run,
My first line was actually my attempt at sarcasm. But this post combined with the one above it are all about Perry and the re-election of Obama. I thought that was fairly obvious.
Islam will change
m. jed,
That is correct. Texas is booming in this recession and has been for the past decade. Growth in the DFW metroplex over the last decade as been greater than Ohio and Michigan combined. Texas is picking up congressmen (At least 2).
Add to that a huge illegal population.
Islam will change
“This report only goes through 2008, but the data would suggest that this isn’t some panacea to physician recruitment.”
Why do you use data that is not up to date? The trend you site is from 2000-2008 and includes data from periods prior to the reform taking effect.
Using the same data source as the author above: In 2004, there were 154.8 physicians per 100k and it increased to 162.3 physicians per 100k in 2010.
The argument against Texas’s tort reform is not convincing from a statistical view. Maybe people who suffer in the medical system, but are shut out from just settlements would be a better route to take if you want to convince others that caps on malpractice lawsuits is a bad policy….
Texas Tort Reform: Just What the Doctor Ordered
2007
http://www.texaspolicy.com/commentaries_single.php?report_id=1683
Between 1996 and 2000, one of four Texas doctors was sued. In the 10 years following 1989, the average medical malpractice verdict skyrocketed from $472,982 to $2,048,541. The percentage of such awards attributable to non-economic damages, which are intangible injuries like pain and suffering, increased from 35.7 percent to 65.6 percent. Between 2000 and 2003, 13 of the state’s 17 medical insurance carriers pulled out of Texas.
Frivolous medical malpractice lawsuits were rampant. Even though 85 percent of these suits failed, doctors paid tens of thousands of dollars to defend against them. This, of course, was bad for patients, as increased litigation means less time and money on actual patient care.
Fortunately for doctors and patients, the reforms passed by the Legislature and approved by the voters capped medical malpractice non-economic jury awards at $250,000. For death-related cases, economic damages were capped at $1,600,000. The reforms also created stricter requirements for expert testimony and a tougher negligence standard for emergency medical cases.
Over the last four years, doctors and insurers have returned in droves, premiums are falling, and health care is more available and affordable.
The Pacific Research Institute’s “U.S. Tort Liability Index: 2006 Report,” an analysis of the tort systems of all 50 states, found that Texas has the best overall tort climate, ranking highest in categories measuring financial losses linked to frivolous lawsuits. Though the study gave the lowest possible marks for Texas in several categories, including the number of counties characterized as “judicial hellholes,” the overall tort climate in Texas is increasingly favorable to physicians, insurers, and patients.
Pre-reform, medical malpractice rates were rising 15-20 percent per year; post-reform, rates have fallen almost 40 percent. Texas Medical Liability Trust, the state’s largest medical malpractice insurance carrier, has reduced rates the last five years, with a cumulative 31 percent rate reduction and about $200 million in premium savings.
Moreover, at the time of the reforms, much of the state did not have certain specialists. For example, more than 150 counties lacked obstetricians. However, since the passage of Proposition 12, Texas added 195 OB/GYNs, 169 orthopedic surgeons, 554 anesthesiologists, 497 emergency medicine physicians, 110 neurologists, and 36 neurosurgeons.
Proposition 12 Produces Healthy Benefits
Texas Medical Association
http://www.texmed.org/Template.aspx?id=5238
Improving access to medical care is critically important to all Texans.
•This is especially true for children, pregnant women, the aged, the poor, those in an emergent condition and those in rural Texas.
Charity care has greatly increased since the passage of the 2003 reforms.
•Charity care rendered by Texas hospitals rose 24-percent in the six years following the passage of lawsuit reform as the state’s non-profit hospitals saw their charity care costs increase 36-percent. But for the 2003 reforms, this $594 million increase in charity care expenses would have left many Texas hospitals with the stark choice of turning away charity care patients or closing their doors altogether.
HB 4 (the 2003 medical liability reforms) has a track record of improving access to medical care.
•2001: Texas licensed 2,088 new doctors, the fewest in a decade.
•2008: Texas licensed 3,621 new doctors, the highest of number of any year on
record.
•Overall, Texas has enjoyed a 62% greater growth rate in newly licensed physicians in the past three years compared to three years preceding reform.
•Statewide, the physician growth has outpaced population growth by 84%.
•El Paso: Physician growth has more than tripled post reform.
•San Antonio: 172-percent greater than pre-reform.
•Houston: 124-percent greater than pre-reform.
•23,520 new physicians have been licensed in Texas.
•The greater growth rate in the Texas physician workforce has produced the opportunity for 2,052,000 more patient visits per year than would likely have occurred absent tort reform.
After years of decline, the ranks of medical specialists are growing.
•Texas has added 218 obstetricians in the past six years.
•Post reform: The number of obstetricians practicing in rural Texas has grown
by 27%.
•Twenty-two rural Texas counties have added at least one obstetrician since the passage of Proposition 12, including ten counties that previously had none.
•52 counties have seen a net gain in obstetricians since reform, including 23 medically underserved counties and 21 partially medically underserved counties.
•Post reform: gain 212 orthopedic surgeons. This represents a 15% increase in the number of Texas orthopedists in the past six years. ◦Forty-six Texas counties have seen a net gain in orthopedists since the passage of reforms including nine—Blanco, Burnet, Cherokee, Hopkins, Lavaca, Milam, Somervell and Starr—that previously had none.
◦Eleven of the counties that have added an orthopedist are rural and eleven are medically underserved.
◦Twenty-six counties that have added an orthopedic surgeon are partially medically underserved.
•Texas has added 48 neurosurgeons in the past six years. ◦Thirty-eight Texas counties now have a neurosurgeon including six counties-Brazoria, Hays, Montgomery, Lamar, Medina and Randall—that had none at the passage of HB 4.
◦Four of the counties that have added a neurosurgeon are medically underserved and two of those—Fayette and Lamar—are rural.
◦Seventeen of the 22 Texas counties that have added a neurosurgeon since the passage of reforms are partially medically underserved.
•Twenty-three rural counties have added at least one emergency medicine physician and 18 counties added their first ER […]
Tort Reform Shows Positive Results in TX and CA
Emergency Physicians Monthly
February 3, 2010
http://www.epmonthly.com/features/current-features/tort-reform-shows-positive-results-in-tx-and-ca/
In 2003, the Texas Legislature passed a tort reform bill which included a $250,000 cap on noneconomic damages for all physicians in a case. That same year the people of Texas approved an amendment to the Texas constitution “Authorizing the legislature to determine limitations on noneconomic damages,” thereby minimizing legal challenges to the legislative bill. The effect of this cap on noneconomic damages has been dramatic. Since 2003, every malpractice insurance carrier in Texas has reduced their premiums for physicians. Texas Medical Liability Trust, the largest carrier in Texas has reduced its average premium by over 50%. Claims and lawsuits in most Texas counties have been cut in half. Since tort reform was passed in Texas, the number of newly licensed doctors in Texas went from 2038 in the year before reform to 3621 in 2009. This has presumably had a positive effect on access to care. Charity care rendered by Texas hospitals rose 24% in the 3 years after tort reform, according to the Texas Medical Association. 76 Texas counties have seen a net gain in EPs since the passage of tort reform, including 39 medically underserved counties and 30 counties that are partially underserved.
Rate Cuts By Texas Medical Professional Liability Carriers
http://www.texmed.org/Template.aspx?id=4753
Since the enactment of House Bill 4 in the 2003 Texas Legislature and the voters’ approval of Proposition 12, every professional liability insurance underwriter in Texas has reduced its premiums for physicians. Roughly half of the state’s doctors are now paying lower liability premiums than they were in 2001. This is a timeline of rate cuts by Texas medical professional liability carriers.
Jan 1, 2004
Texas Medical Liability Trust implements a 12-percent rate cut; the first major carrier to implement a rate cut following the passage of Proposition 12.
Sep 20, 2004
Texas Medical Liability Trust announces a 5-percent rate cut, its second rate reduction since the passage of Proposition 12.
Feb 17, 2005
The Doctors Company announces rate cuts ranging from 9 to 14 percent.
Feb 17, 2005
American Physicians Insurance Company (APIE) announces 5-percent rate cut for two-thirds of its insured Texas physicians.
Mar 15, 2005
The Joint Underwriting Association (JUA) announces a 10-percent rate cut.
Just 16 months earlier the JUA sought a 36-percent rate hike; a rate increase rejected by then-Insurance Commissioner Jose Montemayor. The JUA subsequently froze its rates until the announced rate cut in March.
Apr 7, 2005
Medical Protective announces a 2-percent rate cut -its first cut since the passage of Proposition 12.
Early May 2005
The American Medical Association (AMA) takes Texas off its list of states in crisis. Texas is the only state ever to be removed from this list.
Aug 1, 2005
Advocate MD implements a 12-percent rate cut.
Aug 16, 2005
American Physicians Insurance Exchange (APIE) announces its second rate cut within the span of seven months -this, a 13-percent cut.
Sep 17, 2005
Texas Medical Liability Trust (TMLT) declares 3rd rate cut since the passage of Proposition 12: this, a $27.9 premium reduction -a combination of rate cuts, dividends and discounts for good claims experience. The $10 million dividend is the equivalent of a 5-percent rate cut.
Sep 23, 2005
Medical Protective announces 5-percent rate cut–its second announced cut within a six-month span.
Jan 2006
American Physicians Insurance announces an 18-percent rate reduction.
Feb 17, 2006
Medical Protective announces a 13-percent rate cut–its third announced rate cut within the span of 11 months.
Mar 23, 2006
The Doctors Company announces an 18-percent rate reduction, its second cut since the passage of Proposition 12.
May 2, 2006
Advocate MD files for a 19.9-percent rate decrease, its second rate cut since beginning operation in June 2004.
Sep 12, 2006
Texas Medical Liability Trust (TMLT) declares its fourth rate cut and second dividend on the eve of the three-year anniversary of the passage of Proposition 12. The latest is a $48 million reduction; including a $35 million dividend and a 7.5-percent rate cut.
Sep 13, 2006
Medical Protective announces a 10-percent rate cut, its fourth rate reduction since April 2005.
Oct 1, 2006
The Joint Underwriting Association (JUA) announces a 5-percent rate cut; their second rate cut in 13 […]
run75441 – Jed: Tort reform has little impact on malpractice insurance which is driven by other issues in investment returns.
Where are any facts to support your claim?
ORIGINAL STATEMENT: I can see a potential basis for the significant decline in the number of doctors active not in practice per year through FY 2010, and some share of FY 2003 new doctors practicing in the State of Texas.
CORRECTION: I can see a potential basis for the significant decline in the number of doctors active not in practice per year through FY 2010, and some share of post-FY 2003 new doctors practicing in the State of Texas.
MG,
As usual you bring the data and reality to teh spin. The bottom line: Tort reform worked:
“In 2003, the Texas Legislature passed a tort reform bill which included a $250,000 cap on noneconomic damages for all physicians in a case. That same year the people of Texas approved an amendment to the Texas constitution “Authorizing the legislature to determine limitations on noneconomic damages,” thereby minimizing legal challenges to the legislative bill. The effect of this cap on noneconomic damages has been dramatic. Since 2003, every malpractice insurance carrier in Texas has reduced their premiums for physicians. Texas Medical Liability Trust, the largest carrier in Texas has reduced its average premium by over 50%. Claims and lawsuits in most Texas counties have been cut in half. Since tort reform was passed in Texas, the number of newly licensed doctors in Texas went from 2038 in the year before reform to 3621 in 2009. This has presumably had a positive effect on access to care. Charity care rendered by Texas hospitals rose 24% in the 3 years after tort reform, according to the Texas Medical Association. 76 Texas counties have seen a net gain in EPs since the passage of tort reform, including 39 medically underserved counties and 30 counties that are partially underserved. “
Rest my case…BTW what laws did Obama lead in implementing while he was a State Senator? Or was he ‘present’ a lot?
Islam will change
Finally, you did not address my main point that the growth rate of doctors in Texas slowed after tort reform.
If you take the pre 2003 growth rate and project it to continue you can actually conclude that tort reform reduced the number of doctors in Texas below what it would have been without tort reform.
Spencer:
He won’t which makes his post(s) a non sequitor in nature
run75441 – “Spencer: He won’t which makes his post(s) a non sequitor in nature”
You just keep telling your lies. Dufus.