New York doctors are flying into a frenzy at the news reported in yesterday's New York Sun that Governor Spitzer's insurance commissioner, Eric Dinallo, is threatening to impose a $50,000 fee on every doctor in the state as a solution to the state's malpractice insurance crisis.
Leaders of the state's medical groups are warning that such a surcharge would force doctors out of business, and they are preparing advertising campaigns designed to warn the public of a potential shortage of physicians.
"We're petrified of this thing," a doctor of osteopathic medicine and the president of the Medical Society of the State of New York, Robert Goldberg, said. "There's no doubt that this is going to shutter practices."
"This is a disaster," the chairman of the New York chapter of the American College of Obstetricians and Gynecologists, Dr. Richard Waldman, said. "I feel like I'm watching Rome crumble."
"It will create havoc in the medical community," a neurosurgeon in Westchester, Dr. Ezriel Kornel, said. "Doctors are already up in arms," he said. "It is just going to be impossible."
Mr. Dinallo said in an interview the fee might be required by law to guarantee the solvency of the state's medical malpractice insurers. But he conceded, "We've built up such a mess" that the surcharge would be difficult to impose, and other solutions will be sought.
Any fee would follow a 14% increase in malpractice insurance rates that went into effect this summer. The rates, set by the Insurance Department, vary by county and specialty. Brain surgeons in Brooklyn currently pay $267,000 annually for malpractice insurance, while general surgeons in Manhattan pay $123,120 and obstetricians in Queens pay $180,490.
After this summer's rate increase, doctors warned that certain specialists would be forced to close their practices, and many now say they cannot afford an additional $50,000.
"That's a lot of money," the chairman of obstetrics and gynecology at Bronx-Lebanon Hospital Center, Dr. Magdy Mikhail, said. Calculating the cost of a $50,000 fee for each of his hospital's 33 attending obstetricians, he added: "The hospital won't be able to afford it."
In some specialties, doctors said their colleagues already have shuttered their practices. Following the rate increase in July, 215 gynecologists in New York stopped delivering babies, according to the New York chapter of the American College of Obstetricians and Gynecologists. Statewide, there are about 4,500 licensed gynecologists, including 2,000 practicing obstetricians.
The group plans to launch a $500,000 advertising campaign next month to warn the public about what they described as a looming shortage of obstetricians.
One Long Island obstetrician, Dr. David Bergman, said that in recent months he has become more selective in accepting new patients, particularly those with complex health problems. "Certainly there is a greater potential for a problem," said Dr. Bergman, whose insurance costs $174,000 each year. "It's very disheartening," he added. "It's a hard place to be right now because we're juggling trying to stay in business and trying to take care of these patients, yet you have employees, you have bills to pay and it has become much more difficult to continue to do this."
In a recent interview, Mr. Dinallo said he would consider a surcharge in order to protect the financial viability of insurance underwriters. Mr. Dinallo is co-chairman, with the state's health commissioner, Dr. Richard Daines, of a task force created this past summer by Governor Spitzer that was assigned to report by the end of this year on ways to slow increases in malpractice premiums. Mr. Dinallo said the surcharge would ensure that underwriters are able to pay claims and settlements.
One carrier, the Medical Liability Mutual Insurance Company, has a surplus of $200 million, down from $1.4 billion seven years ago. "It's a struggle for us," MLMIC's vice president, Edward Amsler, said. He said the physicians' insurance rates had been kept low for several years during the Pataki administration. "The doctors are now being stuck with this surcharge for rates that hadn't been adequately set. That's really the shame of it," he said.
One doctor who took part in the malpractice task force, Dr. Richard Peer, said physicians did not perceive Mr. Dinallo as the "enemy" for suggesting a surcharge. "The enemy is the system. We're just the victims here," he said.
But Dr. Peer, a past president of the state's medical society, said he was concerned about the state's ability to attract young doctors. "How do you recruit the next generation of doctors to come into New York and practice when they are faced with those kinds of expenses?" he asked. "Who would come to New York with that hanging over their head?"