We live in a highly litigious society and the country is over served by lawyers who need work. The merging of those two factors has resulted in millions of law suits per year. There is little rhyme or reason as to how malpractice fees are set but the following examples prove how utterly capricious and discretionary they actually are.

In 2000 a large malpractice insurer charged Cleveland Ohio physicians annual premium rates of $12,500 for the specialty of internal medicine, $49,000 for general surgery, and $69,000 for OB/GYN. In Cincinnati Ohio, during that same year, internists paid approximately $8,000, general surgeons $29,000 and OB/GYN physicians $44,000. During 2009, in Ohio’s Mahoning County, malpractice insurance premiums had risen to $26,000 for internal medicine, $62,000 for general surgery and $98,000 for OB-Gyn. In addition to the wide range in premium rates charged, the extent to which premiums increase over time also varies by specialty and geographic area. There needs to be more uniformity in malpractice fees, and tort reform is the only way to address those inequities.

Because doctor’s fees are set by the Federal Government through Medicare and Medicaid bureaucrats and by insurance companies through HMOs, they cannot make up for the gradual increase in their malpractice insurance premiums by raising their charges. Their only recourse is to practice what has become known as “defensive medicine.” They do that to prevent law suits, knowing that if they are sued their malpractice premium will sky rocket in the following year. In the past we physicians relied upon our clinical acumen, which was based in part upon keeping current with the perpetual advances in medicine through reading medical journals and attending continuing education courses; but most of all we depended upon on our ever growing clinical experience. Today doctors fear law suits so much that they will order radiological studies and laboratory work, not just as a means of discovering what they don’t know about a patient, but as a means of double checking on what they have already learned and believe to be true through an adequate history and physical examination. The bill for those tests adds to the cost of medical care but it does not add to the physician’s income, especially where internists are concerned, for we do little or nothing in the way of procedures. The only answer to this third cause for the precipitous and incessant increase in the cost of healthcare is tort reform; an issue totally ignored in the Affordability Care Act of 2010.