Dr. Deborah Wilson, a respected obstetriciangynecologist in Scottsdale, used to deliver nearly 50 babies a month — until she became petrified every time a woman was in labor.
For the last two years, Wilson has been caught in a medical malpractice lawsuit — her first one in a 17-year career delivering about 5,000 babies. The experience was so horrific, Wilson said, her rate of Cesarean sections skyrocketed, she lost sleep and she lost faith in herself.
Last June, Wilson, 51, quit delivering babies.
"It was a really tough decision. I just knew I couldn’t do it anymore once I realized the risks," she said. "You’ve just got a target on your back."
Medical authorities say there are an alarming number of OB-GYNs who are either leaving the medical profession or changing the scope of their prac - tice, in large part because of emotional pressures from medical malpractice lawsuits and the financial burden of professional liability insurance.
According to the American College of Obstetricians and Gynecologists, about 15 percent of 2,185 members surveyed nationwide last year stopped practicing obstetrics because of medical malpractice litigation risks. Eleven percent gave up delivering babies because they couldn’t afford professional liability insurance.
More than 76 percent had a medical liability claim filed against them. One in two was sued in the last four years.
Like Wilson, many OBGYNs are switching to the less risky and less hectic lifestyle of practicing only gynecology.
The trend means fewer physicians to treat a population booming with pregnant women. Last year, 90,658 babies were born in Arizona, nearly 59,000 of whom were born in Maricopa County, according to the Arizona Department of Health Services.
While a major drop in obstetricians hasn’t hit Arizona yet, physicians say it’s only a matter of time.
"If something doesn’t change, the number of doctors to take care of women’s health is in jeopardy," said Dr. Daniel O’Keeffe, director of Phoenix Perinatal Associates.
The loss of OB-GYNs hurts patients like Patty Jasinski. Two months before her second set of twins was born last August, the Scottsdale mother had to switch doctors because Wilson stopped practicing obstetrics. Wilson was Jasinski’s OB-GYN for nearly two decades, helping her through five miscarriages, an ectopic pregnancy and the birth of her first set of twins, who are now 2 years old.
"It was really hard" going to a new doctor, Jasinski said. "It’s just too bad because she’s so good at what she does."
Nationwide, fewer students are choosing high-risk specialties, including OBGYN, said Dr. Thomas Purdon, professor of clinical OBGYN at the University of Arizona College of Medicine in Tucson. Although Arizona has not yet had difficulty filling OB-GYN residency slots, nationwide, the number of residencies filled by U.S. medical students has dropped from more than 90 percent several years ago to 65 percent this year.
"We are a high-risk specialty, and medical students aren’t oblivious to this," said Purdon, a past president of the American College of Obstetricians and Gynecologists.
Quality of life is another factor pushing medical students and veteran OB-GYNs away from the profession, said Dr. John Mattox, director of the residency program at Banner Good Samaritan Medical Center in Phoenix. Many physicians would rather have predictable hours and time with their families than a hectic career of delivering babies.
Dr. Stephen Linn gave up his obstetrics practice last year to practice gynecology exclusively in Scottsdale. Linn said he will stay busy in gynecology because many women seeking routine appointments were crowded out by patients scheduled for prenatal care. But he misses delivering babies.
"The biggest factor for me was personal quality of life," he said. "I personally didn’t mind going in at 3 a.m. to deliver a baby, but my family did."
For those who want to continue practicing obstetrics, the liability and financial burdens are becoming too heavy, Purdon said.
"It doesn’t take a rocket scientist to see we’re going to have a shortage," he said "Doctors are frustrated because they’re having to give up a profession they love, and this means patients are going to have less access to care."
SIGNS OF TROUBLE
O’Keeffe said Arizona has been able to attract and keep OB-GYNs because of its climate and, until this year, relatively stable rates from the state’s largest professional liability insurer for physicians. At Scottsdale Healthcare Shea hospital, for example, the number of OB-GYNs has increased from about 65 last year to 75 this year.
But there are signs of discontent. Northwest Medical Center in Tucson recently lost two of its 15 OB-GYNs and could lose three more this year, said Dr. Edward Miller, the hospital’s chief of staff. Financial pressures are the driving factor, he said.
Health care authorities said the loss of OB-GYNs is part of a larger exodus of doctors from all disciplines who are fed up with flat reimbursement from health insurers, rising overhead to run doctor’s offices and escalating liability insurance costs.
MICA, a company that insures the bulk of physicians in Arizona, raised its professional liability rates 16 percent this month, the largest increase since the late 1980s, said James Carland, chairman and CEO. The company’s annual charge for an OB-GYN climbed from $50,361 in 2002 to about $67,000 this year.
"It costs a lot to defend (lawsuits), it costs a lot to settle, and that’s what drives rates," Carland said.
Last year, MICA’s costs to defend 271 dismissed cases totalled $5.6 million. There were 197 settlements and one jury award, which combined cost $67 million.
Gov. Janet Napolitano signed legislation March 17 aimed at reducing the number of frivolous medical malpractice lawsuits filed, Carland said. The law requires an affidavit of merit from an expert before a case can be filed.
Meanwhile, payouts continue to grow, Carland said.
Reasons include heightened awareness of medical mistakes, new technology, more procedures, the nursing shortage and the perception that $1 million doesn’t mean as much as it used to, he said.
Massive awards for pain and suffering have prompted many in Arizona’s medical community to call for a cap on noneconomic damages. OB-GYNs also are especially vulnerable because family members have longer to file lawsuits involving their babies, Carland said.
Cases with babies can generate enormous sympathy and enormous jury awards, he said. If a judgment exceeds the insurance policy’s limitations, the doctor becomes liable, a risk that prompts many physicians to settle.
Capping awards for pain and suffering, however, is not the answer, said Jon Hinz, director of Fairness and Accountability in Insurance Reform, an organization funded by plaintiffs’ attorneys.
"How much is a child worth? How much is your life worth?" he said. "There are just a lot of other factors that don’t get factored in with compensatory damages."
For many physicians, the pressures and risks of going up against their patients in court are unbearable.
"Most of us went into the field to help people and dedicate our lives to taking care of women and babies," said Dr. Susan Warhus, an OBGYN who left medicine two years ago. "People say don’t take it personally, but it’s hard not to."
By the numbers
A 2003 survey of 2,185 members of the American College of Obstetricians and Gynecologists found that:
• 76 percent had a medical liability claim filed against them
• 57 percent had two or more medical liability claims filed against them
• 50 percent had been involved in a liability claim in the last four years
• 22 percent decreased their number of high-risk obstetrics cases because of liability risks
• 15 percent stopped practicing obstetrics because of liability risks