title: Effects of a malpractice crisis on specialist supply and patient access to care.
abstract: OBJECTIVE
  To investigate specialist physicians' practice decisions in response to liability concerns and their perceptions of the impact of the malpractice environment on patient access to care.
  
  
  BACKGROUND
  A perennial concern during "malpractice crises" is that liability costs will drive physicians in high-risk specialties out of practice, creating specialist shortages and access-to-care problems.
  
  
  METHODS
  Mail survey of 824 Pennsylvania physicians in general surgery, neurosurgery, orthopedic surgery, obstetrics/gynecology, emergency medicine, and radiology eliciting information on practice decisions made in response to rising liability costs.
  
  
  RESULTS
  Strong majorities of specialists reported increases over the last 3 years in patients' driving distances (58%) and waiting times (83%) for specialist care or surgery, waiting times for emergency department care (82%), and the number of patients forced to switch physicians (89%). Professional liability costs and managed care were both considered important contributing factors. Small proportions of specialists reported that they would definitely retire (7%) or relocate their practice out of state (4%) within the next 2 years; another third (32% and 29%, respectively) said they would likely do so. Forty-two percent of specialists have reduced or eliminated high-risk aspects of their practice, and 50% are likely to do so over the next 2 years.
  
  
  CONCLUSIONS
  Our data suggest that claims of a "physician exodus" from Pennsylvania due to rising liability costs are overstated, but the malpractice situation is having demonstrable effects on the supply of specialist physicians in affected areas and their scope of practice, which likely impinges upon patients' access to care.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA. mmello@hsph.harvard.edu
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Mello
authors.forename: David M
authors.initials: DM
authors.lastname: Studdert
authors.forename: Catherine M
authors.initials: CM
authors.lastname: DesRoches
authors.forename: Jordon
authors.initials: J
authors.lastname: Peugh
authors.forename: Kinga
authors.initials: K
authors.lastname: Zapert
authors.forename: Troyen A
authors.initials: TA
authors.lastname: Brennan
authors.forename: William M
authors.initials: WM
authors.lastname: Sage
mesh_terms: D002321:Career Choice; D002322:Career Mobility; D004470:Economics, Medical; D005260:Female; D005544:Forecasting; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000639:trends*; D006280:Health Workforce; D006801:Humans; D007351:Insurance, Liability; D007588:Job Satisfaction; D016365:Liability, Legal / Q000191:economics; D008297:Male; D008318:Malpractice / Q000191:economics / Q000706:statistics & numerical data*; D010414:Pennsylvania; D010563:Personnel Turnover; D011157:Population Dynamics; D011365:Professional Practice Location; D013038:Specialization; D013043:Specialties, Surgical / Q000191:economics; D011795:Surveys and Questionnaires