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Obstetrics Malpractice Premiums

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13 years 5 months ago #57616 by Lynnecfmd
OK, Sethina sent me an email to notice that I haven't posted anything for a long time, so I'm being a good girl and doing my homework, it's a lifetime habit....Are there any other ob/gyns out there who have figured out a sane way to pay malpractice premiums and stay in private practice? I am one of a group of four women, soon to be six of us again, thank the goddess!. We have been in practice for 16 to 18 years, all of us are over 45 (3 over 50), and we have a very busy obstetric practice in Northern California, and have an arrangement where we only do call on our call days and don't do office hours and vice versa. However, with only 4 of us (one new, 3 old, 3 left to go to Kaiser and less hours), that means you divide the month up and we're all working at least 80 hours a week. Granted, those are not always full pace hours, but more often than not, we are going a lot. We do 120 deliveries a month (sometimes more), and provide emergency hospitalist backup for our OB unit (which the hospitals here have realized is a medicolegal bargain, and the pay for that used to cover my malpractice premium, but no longer)
I have had one large settlement and 3 nuisance suits (two settled and one dismissed) because I didn't think I could take the time off work to fight in court, even though I knew I did nothing wrong, and had experts willing to testify on my behalf. I went through hell and left my first practice when my expartner did not support me in my struggles (he made his extra money testifying as an expert witness for plaintiffs). I had to go through the Medical Board to fight for my privilege to practice (which was a legal nightmare, but was successful with some good support and therapy and a caring lawyer (oxymoron?)), and so, after all that, when I was nearly suicidal with worry that I couldn't practice and support my family (my husband has stayed home with our kids, but that's a different chapter)...I found my current practice and it's mostly fitting with my philosophy of low-intervention, treat women from all walks of life, I like and trust my partners, the hospital is Ok, and I'm the Vice Chair of the Department...and my insurance went up (in this state with tort reform) when my old insurance cancelled me because I had partners with different insurance, which all means I had to get insurance in the "secondary market" in order to practice at all.
I now work at least 5 months of the year just to pay my malpractice premiums...and I'm not sure it's worth it but I couldn't make as much money doing anything else and I love my work (births and surgeries and women's health in general). I have to work enough to generate the premium and have enough left over for the IRS, the mortgage, and kids (one in college, one in HS, one in JHS), and haven't put anything in retirement since I left my old group. We can't raise our rates and make more money, because most patients are in HMO's which dictate the "going rate" for our services.
I'm trying to come up with some solution, but I keep getting bogged down with reality.
Anybody found a way to do private practice or is everybody going to the employed physician model?

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13 years 5 months ago #57617 by Kristina
As a future OB, I am very eager to hear responses to this one!

Kristina<br />Pre-Med for OB/GYN - Fall 2006<br />Mother, Wife, Doula, Childbirth Educator<br /> <a href=" www.dynamicdoula.com " target="_blank"> www.dynamicdoula.com </a>

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13 years 4 months ago #57618 by Susan Walker
For some reason, I hear this from OBs all the time. I'm in admin and insurance.

I'm sure how to say this, but your profession is simply worth less than it was in past generations.

This happens to the best of us. My dad was an autoworker and those top dollar jobs are gone forever.

The average primary care is about 150K. I think OB is starting to come in line with those figures. This is still pretty good.

To those starting out -- patient safety should be number one. Don't let your nurses or midwives cover things you should. Don't send your patient into the hospital to be evaluated and wait at home to find out -- go in and meet them. If you can work on the hospitalist/laborist model that is best in the long run.

Why? As we all know, reimbursement is about the same no matter where you go. The expense of malpractice is the biggest variable in costs. Of course the difference is your salary. Don't try to see too many patients or especially cover too many locations to increase revenues. It will be counterproductive in the long run. One big settlement will raise your costs for life.

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13 years 4 months ago #57619 by AnnaM
So in other words, the answer is to work harder and make less money. Gee, seems fair to me when you compare what insurance company executives make to what they think OB's should make. I don't mean to be flip, but has anyone noticed how much easier it has gotten to get into OB-gyn residency in the last few years? Nobody wants to go, and I don't blame them. In my state, there are a couple hundred high school teachers making over 100g's a year. The people in this country will get what they pay for in deciding how much OB's are worth, and it's sad.

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13 years 4 months ago #57620 by XildUpNawth

Originally posted by Susan Walker:
For some reason, I hear this from OBs all the time. I'm in admin and insurance.

I'm sure how to say this, but your profession is simply worth less than it was in past generations.

This happens to the best of us. My dad was an autoworker and those top dollar jobs are gone forever.

The average primary care is about 150K. I think OB is starting to come in line with those figures. This is still pretty good.

To those starting out -- patient safety should be number one. Don't let your nurses or midwives cover things you should. Don't send your patient into the hospital to be evaluated and wait at home to find out -- go in and meet them. If you can work on the hospitalist/laborist model that is best in the long run.

Why? As we all know, reimbursement is about the same no matter where you go. The expense of malpractice is the biggest variable in costs. Of course the difference is your salary. Don't try to see too many patients or especially cover too many locations to increase revenues. It will be counterproductive in the long run. One big settlement will raise your costs for life.

It's "simply" simplistic to compare the loss of autoworker jobs with the OB malpractice situation. You can't outsource obstetrical care to Japan (yet). You don't spend 12 years of post-secondary education becoming qualified to work the assembly line. If you screw up building a Chevy, generally nobody dies. Also, at the end of your shift building cars, you go home, and are highly unlikely to be paged in the wee hours to do an emergency auto assembly. I highly doubt any pregnant woman would agree with your statement that the OB profession is worth less than it was in past generations.

It's all about who's paying the bill, and insurance companies generally are, not patients, and they have way too much say in how much the OB profession is "worth." Last time I checked, we spend a higher proportion of our healthcare dollars on administrative costs in this country than in any other industrialized nation, and anyone who has tried to settle a dispute with their insurance company can tell you that the quality of healthcare admin we get in return does not equal the cost. Perhaps your profession isn't the wisest soapbox from which to lecture on this subject.

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13 years 4 months ago #57621 by XildUpNawth
Check out this article. Just one more reason physician pay is reduced by admin costs and inefficient insurance companies. You may have to log in or sign up, which is free.

The Check Is Not in the Mail

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