Sunday, October 7, 2007
Eric Turkewitz has posted (also at his own site) a rebuttal of sorts to the NYT piece I mentioned a couple of days ago. The short version is that, while doctor supply has increased (by my numbers [from the Texas Medical Board site], about 22% from 2002 to 2007, the time frame Eric reasonably uses), disciplinary proceedings have increased more, about 78%.
As commenters point out at the TortDeform post, there have been other factors in play, with apparently the TMB focusing on more enthusiastic enforcement. That could be, perhaps, reflected by the spread of enforcement actions. From the most recent announcement of 88 enforcement actions:
Actions included 11 violations based on quality of care; seven actions based on unprofessional conduct; five actions based on violation of probation or prior board orders; four actions based on inadequate medical records violations; three actions based on impairment due to alcohol or drugs; three action based on nontherapeutic prescribing; one action based on inadequate supervision; two actions based on violations of board rules; seven voluntary surrenders; four advertising violations; one action based an another state board’s action; one temporary restriction and 39 minimal statutory violations by 38 physicians. The board issued two cease and desist orders against unlicensed practitioners.
Unfortunately, a brief look at a 2002 press release doesn't include a comparable breakdown; at a glance,it seems to be not dramatically different in the distribution of reasons. (But, it's worth noting, the descriptions are a bit vague at times.)
In any event, as with most things, it's probably somewhere in the middle. It seems fairly evident that more doctors are in fact going to Texas, with the malpractice liability changes probably one of the reasons. But there are many reasons to live in Texas, and that presumably applies to doctors too. And, as Eric points out, the doctors choosing to practice there because of malpractice modifications may on average be somewhat less skilled -- but they may also (perhaps probably) be solid doctors who are tired of paying higher rates elsewhere, since many carriers don't base rates on experience with individual doctors.