More than half of the doctors in a survey by the Westchester County Medical Society are contemplating leaving the county and practicing medicine elsewhere.
In addition, 36 percent indicated they are considering retirement in the next 10 years.
Add to those statistics the number of employees in each practice and the dozens of ancillary groups used by doctors”™ offices and the county could face an infrastructure in need of emergency care.
Doctors cited decreasing health care reimbursement, increasing malpractice insurance rates, higher state taxes, rising office costs and higher rents as among the major reasons they are considering for moving, according to The Westchester County Medical Futures Survey.
The survey was taken prior to the passage of the MTA bailout package, which includes a payroll tax of 34 cents per $100, an additional burden, said Amy Newburger, president of the medical society.
In addition, more bureaucratic obstacles, such as the “red flag rules,” were also highlighted by the doctors surveyed. The rules that take effect in August were created by the Federal Trade Commission. Since a doctor”™s office bills patients, it is considered a creditor. As such, it must create and implement written policies to help prevent identity theft of a patient.
Newburger, a doctor with Dermatology Consultants of Westchester in Scarsdale, was surprised “by the magnitude of dissatisfaction” among the 253 doctors who responded to the e-mail survey.
Newburger had heard anecdotal references over the years to doctors leaving the county, but there was no hard evidence to prove it. She contacted Barbara Porco, an assistant professor with the Graduate School of Business at Fordham University and worked out a survey that would be quick and easy to use.
“We wanted to capture information on the economic footprint of the private practice physician community since we are seldom regarded as business entities, but rather as solely the people who provide health care,” Newburger said. “In fact, we physicians contribute substantially to the financial well-being of the community in addition to the physical health of the population.”
Porco and her senior honors students struck upon the Likert Scale, which depends on the level of agreement to a statement, as in strongly agree, agree, neither, disagree and strongly disagree. There were 61 questions in the survey.
The data, which Newburger called the first distillation of information since it is being further analyzed, offers a snapshot of the morale and attitudes of physicians in the county.
The survey found that 77 percent of the doctors felt that morale is low. In addition, 86 percent are not satisfied with the current state of health care.
Today”™s litigious society also keeps doctors in fear of malpractice; 73 percent said so in the survey. The specter of litigation, 49 percent claimed, is keeping them from performing certain medical procedures. This fear has resulted in the employing of what has become known as defensive medicine.
One doctor wrote: “I see defensive medicine being practiced all of the time. There are multiple tests done, most of which are necessary. Ordering four to five CAT scans is a lot of radiation. Overall, it is bad for the patients and the doctor is supposed to think of the patient, not the lawyers, who were referred to as predators.”
Another wrote: “Due to high patient expectations and fear of malpractice lawsuits, doctors will perform tests for the less obvious illness, rather than for the common one. In other words, doctors hear hoofbeats and look for zebras.”
This is a reference to a medical school adage, “When you hear hoofbeats behind you, don”™t expect to see a zebra.” It suggests that the most common cause of a symptom is the usual culprit; not something exotic.
The survey found that if malpractice insurance premiums rose anywhere from zero to 29 percent, 63 percent of the doctors said it would be enough for them to leave the county.
The average gross revenue for each medical practice surveyed is $1.3 million.
In the survey, each practice employed an average of 20 individuals full time and five part time. The average payroll taxes per practice were $90,000.
“This translates into a lot of money for maintenance of the community infrastructure, for our roads, schools and libraries, and other public services,” Newburger said. “Also, these employed individuals usually live in the county and patronize local businesses in their private lives. Additionally, the overwhelming majority of practices refer patients to local pharmacies, physical therapists, hospitals and other ancillary groups, which further contributes to the economic health of the community. And this doesn”™t even include other local businesses and individuals who do contracted work for the practices such as accountants, lawyers and IT groups.”
In an article in the medical society”™s newsletter, Westchester Physician, Newburger wrote that “the well-known shortage and even complete lack of high-risk practitioners in many counties is a harbinger of disaster on the horizon, but increased wait times for primary care visits is just as troubling.”
She said there are nine counties in the state without neurosurgeons.
James Bean, president of the American Association of Neurological Surgeons, testifying before a congressional subcommittee on health in March said, “Lawsuit abuse has gotten so out-of-control that about one-third of orthopedists, obstetricians, trauma surgeons, emergency room doctors and plastic surgeons can expect to be sued in any given year. Practicing neurosurgeons can expect to be sued even more often ”“ every two years, on average and nearly three out of five ob-gyns have been sued at least twice in their careers.”
The majority of cases, 71 percent, are dropped or dismissed, according to Physicians Insurance Association of America Data Sharing Project. However, the cost of defending against the charges averages $25,000.
The Westchester County Medical Futures Survey found that 81 percent of those responding practice and live in Westchester. More than 35 percent have been practicing in the county from 10 to 20 years.
The aging population of doctors was another highlight of the survey. It found that 66 percent of the doctors are between the ages of 40 and 59 with a median age of 52. The average age of doctors in the nation is 46. Newburger said the median age in the county is probably higher because “all these young doctors at the medical school throw off the average.”
As for improving working conditions for doctors, the survey found: 77 percent favored increasing the reimbursement for providers; 47 percent favored reducing health care premiums and 12 percent said tort reform was needed to limit malpractice premiums.
One doctor wrote in the survey: “Our greatest challenge is to deliver quality medical care in an environment where the priorities of medical insurance companies are to minimize the cost of that care.”
