MSNJ Opines on Hostile Physician Environment
While New Jersey has been trending upward lately with its attitude towards businesses, it still ranks towards the bottom when it comes to regulations, taxes and a host of other red tape issues. Being a physician in New Jersey also means being a small business owner and subject to the many difficulties that other small business owners face. One of the glowing differences to being a physician/small business owner is the internal and external pressures of caring for the lives of others. Many of the external pressures are driving current and future doctors away from our state.
The February 6 article entitled “N.J. faces growing shortage of doctors due to med school costs, insurance concerns” brings to the forefront a problem that physicians have known about for years. Newly trained physicians are fleeing because of the overall practice environment. We live and work in a state with the lowest reimbursement for treating a Medicaid patient, yet the highest cost of living and a growing population under healthcare reform. The litigious environment coupled with the costs of defensive medicine are other detractors in retaining the best and brightest future physicians that we train here in the Garden State.
Suggestions for state tax forgiveness, loan repayment, and possible income guarantees for the first 3-5 years of practice are okay, but are not the optimum way to get resident physicians to stay here. And since we as physicians understand that a legislative overhaul of the entire tort system is unrealistic, we do believe that there are several key components that, if updated, can help make New Jersey more appealing for young doctors to open a practice.
In New Jersey, the statute of limitations (or time frame in which one can bring a claim against a physician) for medical malpractice is a moving target. The timeframe for bringing a suit does not begin until the time a patient can reasonably discover that a medical injury has occurred. Good lawyers can use this standard to extend the timeframe for bringing claims for many years. This uncertainty leads to higher premiums as insurance underwriters must prepare financially for long term exposure to liability claims.
Another safeguard for physicians is the requirement of an Affidavit of Merit. Until recently, physicians believed the law required a physician in the same specialty (a doctor doing the same type of work and familiar with the standards of care exercised by similarly trained physicians) to certify that the physician being sued may have committed malpractice. This law is needed to weed out suits that are frivolous or where a poor outcome may have occurred through no fault of the physician. The same specialty requirement is necessary as medicine becomes increasingly more complex. An exception in the law allows plaintiff’s lawyers to work around this requirement and use physicians without the same training as the defendant physician. This exception greatly diminishes the protection of this case screening mechanism and allows non-meritorious cases to proceed.
Finally reform is needed to enforce standards experts can use when testifying in a medical malpractice case. Medical cases rely heavily on paid experts for both plaintiffs and defense lawyers. While there are standards in place for the content of an expert’s testimony, physicians rarely face discipline for unsupported testimony. Creating strong disincentives and penalties for individual expert witnesses that offer testimony that does not meet legal standards would prevent abuse and resolve matters more expeditiously for all involved.
Most physicians enter the profession because they have an intrinsic desire to help people. They spend hundreds of thousands of dollars and years of their lives dedicated to studying the art and science of medicine and have a real fear that it can be all taken away in an instant. New Jersey has a chance to regain its popularity amongst physicians by taking proactive steps to enhance the business climate in order to retain our future doctors.
Donald J. Cinotti, MD
Medical Society of New Jersey