WASHINGTON – At the end of January, Dr. Joe Cutchin told 188 pregnant women that he could not deliver their babies, some of whom were due the next week.
“Some accused me of abandoning them because they didn’t understand what was happening,” said Cutchin, who had provided obstetric care in Salisbury for 34 years.
Cutchin, whose malpractice insurance premium went from $50,000 to $150,000, could not afford to continue practicing obstetrics.
Skyrocketing premiums have led to obstetrician shortages in more than 20 states, including Pennsylvania and West Virginia. Some fear they threaten to do the same in Maryland.
And as insurance rates go up, reimbursement rates from insurers are going down, leaving doctors caught in the middle. Insurance companies cut physician payments 5.4 percent this year and plan another 5.7 percent cut in 2003.
“Now, managed care has brought down the reimbursement for deliveries and the price for malpractice is going up,” said Dr. David Nagey, an ob/gyn at Johns Hopkins Hospital. “Nobody wants to say, `I’m only going to deliver patients who pay out of pocket.’ So instead, they’re getting out of obstetrics.”
Increasing costs are not only forcing obstetricians out early, but keeping them out in the first place, said Dr. Al Strunk, vice president of the American College of Obstetricians and Gynecologists. This year, 7 percent of ob/gyn slots were left unfilled after the first round in which medical school graduates were matched to their preferred residencies, the first time that has happened, Strunk said.
“This is a national crisis,” Cutchin said. “They see the problem.”
Strunk said rising costs could force about 20 percent of current ob/gyns to stop taking high-risk pregnancies, or stop practicing obstetrics, or stop practicing medicine altogether.
Insurance companies nationwide have raised rates significantly because of costly claims. While the number of malpractice lawsuits has not increased recently, the amounts of the settlements did. It is not uncommon for obstetricians to pay out more than $1 million in a lawsuit.
The executive director of MedChi, the state’s medical society, said Maryland has been buffered somewhat because one insurer dominates the market. Medical Mutual Liability Insurance, a doctor-owned mutual company, took no premium increase in 2002, said T. Michael Preston of MedChi.
“In general, we don’t have the instability that we’ve seen in other states,” Preston said. “I’m sure there are some examples of obstetricians limiting their practice to gynecology because of cost and the risk, but it’s not the same widespread problem we are seeing in other states.”
But many say there is a problem in Maryland, and it is getting worse.
“I’m sure as the amount of the awards continues to escalate, then you’re going to see the same things happening in Maryland,” said Dr. Donald Chambers, a Baltimore ob/gyn. “In order to remain liable, companies such as Medical Mutual will have to increase their rates.”
Other companies already have.
Premiums for Drs. Esposito, Mayer, Hogan and Associates rose 45 percent this year, from $310,000 to $450,000, said Stevan Flury, the executive director of the Columbia practice. The increase came even though no claims were made against the doctors.
Nationally, malpractice insurance rates increased 20 to 50 percent and as much as 300 percent in some states, Strunk said.
“In Maryland the situation is still stable,” he said. “But what we mean by that is that insurance is still available there.”
Maryland premiums were stable over the past five years, but increased 18 percent this year, and Strunk predicts a higher increase next year.
In 2001, malpractice premiums for a Maryland ob/gyn ranged from $42,000 to $87,000. This year, they ranged from $49,500 to $102,600, Strunk said. Medical Mutual premiums ranged from $55,000 to $85,000 this year. Premiums for gynecologists ranged from $6,700 to $23,000.
Meanwhile, the reimbursement for obstetric services has decreased, said Dr. Raymond Cox, vice chair for the Maryland chapter of the American College of Obstetricians and Gynecologists.
“You have to make a profit, no matter how small, in order to justify having a business,” Cox said. “If I am paying out of pocket to provide services to my patients, it is not worthwhile.”
Chambers said a doctor in Maryland gets about $1,200 for a regular vaginal delivery, about $600 of which goes to pay malpractice insurance for that delivery. After office overhead, the doctor is “actually getting $300.”
“It makes it economically unfeasible for them to continue obstetric services,” Chambers said.
The departures are not entirely economic. Flury said there is a natural tendency for ob/gyns to scale back their obstetric practice as they, and their patients, get older.
But Cutchin was not planning to stop delivering babies any time soon. The 67-year-old, who delivered 467 of the 2,000 babies born in Salisbury last year, planned to keep going as long as he had his health.
Now, his gynecology practice will have to keep him busy.
“If I was 45 years old, I would be terrified. I would have to retrain and do something different,” he said. “But everything has its season and maybe it was time to get out of it.”