Despite assertions that high malpractice rates are driving them out of the state, Massachusetts doctors are paying less than they were in 1990, after adjusting for inflation, according to a Suffolk University Law School study.
Massachusetts ranks fourth in the nation for money paid to settle malpractice cases and is one of 21 states described by the American Medical Association as being in a crisis because of high medical malpractice payments and lack of strict laws capping settlements.
Such high payments would seem to predict high premiums, but the Suffolk study, appearing in the current issue of Health Affairs, found that most Massachusetts physicians paid an average of $17,810 in premiums in 2005, a little lower than the $17,907 that the same coverage would have cost in 1990, after adjusting for inflation.
"If you don't find a crisis here, you're probably not going to find one nationally," lead author and health policy scholar Marc Rodwin said in an interview. "Clearly there are some increases in premiums and high premiums for a small percentage of doctors in three specialty groups, but that's entirely different for the rest of doctors."
Rodwin's team looked at data from 1975 to 2005 provided by ProMutual Group, the insurer for about half of the state's doctors.
Premiums cycled up and down, with the steepest peaks and valleys in three specialties - obstetrics/gynecology, neurological surgery, and orthopedics involving spinal surgery - that account for 4 percent of doctors practicing in the state.
In those specialties, rates rose from an average of $66,220 in 1990 to $95,045 in 2005, when adjusted for inflation.
Within obstetrics, discounts and surcharges meant some doctors classified as high-risk paid three times as much as their lower-risk peers. Nearly a third of obstetricians/gynecologists paid less than they would have in 1990, while a quarter paid at least $28,150 more.
National figures from the American Medical Association show that premiums made up 7 percent of total practice costs for all physicians and 12.7 percent for obstetrician/gynecologists.
Even if rates are not out of control, it is still difficult to be a doctor in Massachusetts, said Dr. Bruce Auerbach, president of the Massachusetts Medical Society. Premiums are just one of the pressures on physicians in a state where housing and the cost of doing business are relatively high.
"The issue of the malpractice crisis is not purely a premium-based issue, although we certainly have documented the high cost of liability insurance is a major factor in [physicians'] perspective on the practice environment," he said. "I think to some degree looking at malpractice premiums . . . may provide an unfair picture of what is really going on."
The medical society has testified on Beacon Hill in favor of a number of bills related to malpractice, from protecting doctors when they help out in large-scale emergencies, to allowing physicians to say they are sorry without fear that their apology would be used against them.