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Thursday, December 20, 2007

Texas Malpractice Changes: Who's Coming to Texas?

Overlawyered today did a post about stories that shouldn't get away, and noted my discussion about the data regarding what has happened since Texas implemented changes in malpractice liability law in 2003.  That reminded me that I had in fact let that issue get away, even though I have some more data to share.

As a refresher, the NYT had an article noting a correlation between the 2003 changes and an increase in doctor supply in Texas.  It raises various interesting questions about cause-and-effect (and Tony Sebok argues that it's more fundamentally flawed).  One response was to note, as Eric Turkewitz did, that disciplinary proceedings are up fairly significantly in the same time period, suggesting that perhaps that the changes brought more doctors to the state, but not the ones you want.  It's also possible that the increase in discipline resulted from more intense scrutiny by the state regulators.

At the time, I did a quick look at the most recent quality of care violations and found no disproportionate number of new doctors in the mix (which, if the 2003 changes were to blame, you'd expect).  Since then, my research assistant went through all of the August 2007 disciplinary actions (not just those for quality of care, as I did before).  The spreadsheet is here: Download TexasDoctors.xls

Of the 87 or so (there are a couple of ambiguous ones) actions against physicians with licenses, five are from the period from 2003 to 2007 (six if you count the "temporary permit, which I wouldn't since one would expect someone coming to take advantage of the new law to stick around).  That's about 6%.

If I'm reading the various stats on the medical board's website right, there are about 58,000 Texas-licensed doctors (some out of state).  In the years 2003 through 2007, there were just over 13,000 doctors licensed in Texas.  So about 22% of doctors licensed in Texas were licensed from 2003 to 2007.  22 > 6.

Now, there may be some apples and oranges there, and the sample is still small -- and I still hope to get my assistant to do a more comprehensive look -- but it does not, at this point, look like the doctors licensed since the liability modifications represent a greater than expected proportion of disciplinary actions.  Indeed, thus far, in one month's sample, it looks like the contrary may be the case.


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Thanks for the work Bill. There are two other issues to consider: (1) How many of these doctors are actually practicing? Charlie Silver has written extensively on this --- the easiest "article" for me to find was via Tort Deform: (2) Are the new doctors the type of physicians for which there was a supposed shortage? There is a lot of anecdotal evidence that new doctors are coming to Houston, Dallas, Austin & San Antonio, all cities that already had plenty of physicians. Prop12 proponents sold Prop12 as a mechanism to address the problem of too few doctors in several rural areas of the state. That hasn't happened yet.

Have a great new year.

Posted by: Brooks Schuelke | Dec 20, 2007 7:43:44 AM


Indeed, those are the right questions in asking whether the changes did what they were supposed to do. I'm not sure they are necessary for evaluating whether the changes are doing other bad things -- i.e., bringing bad rogue doctors into the state. Even if half of the licensed docs aren't practicing (an unrealistically high percentage, I think), the relative proportions would still suggest (not definitively) that the disciplinary actions are not mostly due to recent doctors.

I'm not taking on the question of whether Prop 12 has increased supplies of the kinds of doctors in the underserved areas, at least not today.

Posted by: Bill Childs | Dec 20, 2007 7:51:15 AM

I will completely agree that the drastic increase in disciplinary actions is likely not due to the influx of doctors, but to a change in the system. Prior to 2003 or so, the statistics bear out that the Texas Board of Medical Examiners was practically worthless, particularly in terms discipline for quality of care issues (they were tougher on drug abuse, prescriptions, etc). 2003 brought a complete overhaul of the system.

However, there are still anecdotal stories of doctors being licensed here that have been unable to be licensed in other states or have even been suspended in other states. Are a higher percentage of these "questioned" doctors coming to Texas now than before? I don't know. Maybe rejected doctors have been seeking refuge in Texas for years.

The one real issue I have with your analysis is the 22% number. I have a hard time believing that 1/5 of our state's doctors have been licensed in the last 4 years. Practicing PI law in Austin, we get a pretty good exposure to physicians around town, and I know that not nearly that many docs are new docs. Having said that, I don't have a better way to come up with a good number.

While you're talking about this, the Fort Worth Star Telegram had an article in the last couple of weeks on this exact topic. You might find it interesting:

Take care.

Posted by: Brooks Schuelke | Dec 20, 2007 1:55:36 PM

All fair questions, and indeed, the 22% seemed unlikely to me too. But the numbers are as reported; maybe there's something I'm missing, but I haven't yet figured out what it is, if anything.

Posted by: Bill Childs | Dec 20, 2007 4:36:32 PM

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