By Doug Brunk
SAN DIEGO – Since the State of Texas implemented medical tort reform in 2003, the number of practicing physicians has increased by 19% per 100,000 population. In addition, hospitals in the state report improved ability to recruit physicians and expand patient services.
Those are key findings from an innovative study presented by Dr. Ronald M. Stewart at the annual Digestive Disease Week.
"Tort reform has been beneficial for all or almost all Texas physicians," Dr. Stewart said in an interview in advance of the meeting. "I have benefited from lower malpractice premiums and a more favorable liability climate in the state. However, the effect of tort reform in a region is probably not the primary driver for physician recruitment and retention. I believe it is permissive – providing the framework for growing physicians relative to the number of patients being served," he explained.
The data show that, in the decade from 2002 to 2012, the Texas population went from 21,779,893 to 26,403,743 – a 21% increase – and the number of Texas physicians rose by 15,611 – a 44% increase (46% in metro areas vs. 9% in nonmetro areas). This absolute change led to an increase of 30 physicians per 100,000 population (19% increase; P less than 0.01).
Nonmetropolitan Texas had a net increase of 115 physicians, but there was no change in the number of physicians per 100,000 in these areas.
Looking at trauma service areas (TSAs), the researchers found that 20 of 22 TSAs had an increase in both number of physicians and physicians per capita. Five had increases of greater than 50%. The increases were generally greater in the central Texas TSAs and TSAs with a larger population size.
"The central part of the state along the I-35 corridor where there are academic medical centers grew significantly," commented Dr. Stewart, professor and chairman of the department of surgery at the University of Texas Health Science Center, San Antonio. "In rural Texas, the absolute number of doctors increased, but per capita it stayed about the same."
For the study, Dr. Stewart and his associates used data from the Texas Medical Board, the U.S. Census Bureau/Texas State Library and Archives Commission, and the Texas Department of State Health Services to compare the rate of physician growth prior to and following tort reform, and the number of licensed physicians per 100,000 population from January 2002 to January 2012.
The information about hospitals was extracted from a 2008 survey by the Texas Hospital Association, which asked hospital and health system administrators from 10 health care systems and 10 independent hospitals to measure the impact of the state medical liability tort reform, which became effective on Sept. 1, 2003. The law includes a $250,000 cap on noneconomic damages in most medical malpractice cases.
The survey of hospital administrators asked how they used the funds saved from their reduced liability coverage costs, and 58% of respondents reported using the funds to expand patient safety programs, 51% used the funds to maintain/expand coverage or services for uninsured/underinsured patients, and 46% used the funds to subsidize various payment shortfalls such as Medicaid.
"Tort reform, as implemented in Texas, was associated with an increase in practicing physicians with resultant improved access to care," Dr. Stewart concluded. "We know that tort reform is beneficial to the physician and hospital, but these data support the notion that it really is better for the patient, too."
When asked to comment on the translatability of the study findings to other states, Dr. Stewart said that comprehensive tort reform "makes an area more attractive to physicians. This is speculation on my part, but I would guess that if you implemented tort reform in other states, it gives those states some degree of an advantage in retaining and recruiting physicians."
He went on to point out that improving access to medical care for patients "is not just about doctors per capita or numbers of doctors; it’s also about what doctors do with their practice. One of the reasons Texas implemented tort reform wasn’t just that we were not keeping pace with our population growth; it was also because physicians were restricting their practice to what they viewed as lower-risk malpractice areas. Our study provides evidence that tort reform has also led to improvements with respect to physicians expanding their care to perceived high-risk areas."
Dr. Stewart said that he had no relevant financial disclosures.