LOCAL OB/GYNS WEIGH IN ABOUT THE RISING COST OF HAVING A BABY AND WHY IT’S DETERRING NEW DOCTORS FROM COMING TO CLARK COUNTY

A pregnant woman might be worried about the cost of having a baby, thinking about diapers, clothes or a new stroller. What she probably doesn’t know is that her doctor likely has also thought about the costs associated with that newborn.

An obstetrician-gynecologist isn’t concerned with the price of diapers, but does have to pay attention to the price of a lawsuit.

“The cost of a damaged baby is astronomical,” said Dr. Bruce Andison, an OB/GYN physician with The Women’s Clinic of Vancouver.

That cost, in the form of million-dollar lawsuits against doctors who experience complications in delivering babies, is passed on to all doctors by way of insurance premiums. The high price of insurance affects how many doctors are delivering babies in Clark County, as well as how those babies are delivered.

The Women’s Clinic of Vancouver has 14 OB/GYNs on staff. Each is insured at a cost of $73,000 per year, per doctor, which is more than $1 million total annually. That premium pays for $1 million in coverage per doctor.

“Most of us feel that’s not enough,” Andison said, adding that it might cost another $20,000 per doctor a year to increase coverage to $2 million.

Recruiting baby doctors

Dr. Peter Chandler, medical director for Healthy Steps Women’s & Children’s Center at Southwest Washington Medical Center, said insurance premiums make it difficult to recruit new OB/GYNs to the area.

Wages aren’t high locally in the profession, he said, at least in part because of how much goes into insurance. “Every time malpractice insurance goes up, doctors make less money,” Chandler said. “It’s that simple.”

Chandler said if he’s recruiting a doctor from Southern California and tells them how much they’ll make in Vancouver, he doesn’t expect to hear from them again.

Vancouver OB/GYN had to close in 2005 because it attempted to recruit new physicians, but couldn’t get anyone on board. The remaining three doctors joined the staff of The Women’s Clinic of Vancouver.

Doctors and population

The Graduate Medical Education N ational Advisory Committee developed ratios in the 1990s for how many baby doctors are needed in a population. That simple ratio is 9.9 obstetricians per 100,000 people.

With the population of Clark County just over 400,000, there are enough doctors delivering babies here to meet the need, based on the formula.
Legacy Salmon Creek has 41 obstetricians on staff, while Southwest has 75 physicians who deliver babies at its birth center. Ten of those are on staff at the hospital and the others are from Kaiser Permanente or private practices. There are at least three private clinics with obstetricians in Vancouver.

A physician assessment conducted in fall 2006 at Southwest recommended the med­ical center develop some succession planning for up to five OB/GYNs to meet community need. It showed population was expected to be up to 433,491 residents by 2011.

Wage rates

In Washington, OB/GYNs are earning an hourly average of $87.14, according to state Employment Security Department statistics from March. There is no such data available specifically about Clark County.

Nationally, beginning OB/GYNs averaged $220,635 a year, according to a 2006 phy­sician compensation survey by Cejka Search, a company that specializes in recruitment and retention in the medical field.

Andison said new doctors at The Women’s Clinic of Vancouver, however, can expect to start at a level closer to $100,000 a year.

Cost of medical school can run in excess of $300,000, meaning considerable wages are needed to pay off that considerable debt. “It’s a very expensive business,” Chandler said.

Lawsuits and premiums

Chandler, as a hospital employee, is insured through Southwest Washington Medical Center. He said training and education is highly important in a field where lives are on the line and millions of dollars could be at stake. He compared it to the airline industry.

“Taking someone through a labor course is like teaching someone to fly a plane,” he said. “You have to make sure the plane never crashes.”

An accident in delivery and a subsequent lawsuit can affect the entire profession in a community. If a private practice is sued for more than $1 million, for example, and it loses, it likely won’t be able to turn a profit and will have to close. “Then, what we’ve got is an OB crisis,” Chandler said.

Million-dollar lawsuits, while still not the norm, are now expected in Washington, according to Gary Morse, vice president, general manager and secretary of Physicians Insurance. His Seattle-based company is the largest provider of medical malpractice insurance in the state. Morse said he remembers musing with colleagues in the early 1990s about the first case that would require a million-dollar payment.

“Every month we’re looking at the likelihood of paying a million dollars on something,” he said of today’s lawsuit climate.

The size and frequency of claims are the main factors affecting premium prices. Almost all medical malpractice insurance is written on a claims-made basis. That means it covers all claims made during the policy year that occurred on or after the coverage was in place. Each year, the premium is changed to reflect an additional year of coverage. So, as a doctor gains experience, they actually pay more for insurance because the policy has to cover more years, up to five years.

For example, a doctor with three years experience in 2007 will need to be covered for claims that could arise from treatment performed in 2005, 2006 and 2007.

Up until 1986, policies were written to cover a doctor forever. The change to claims-made policies isn’t popular with Dr. Jonathan Erich,
an OB/GYN hospitalist at Legacy Salmon Creek Hospital’s Family Birth Center.

He called the claims-made system a “plot formed in hell” because of the cost put on doctors. Erich is now insured through the hospital, but was unable to start a private practice three years ago because he said there was no one writing any policies at the time.

It ended up working out well for him, as well as for Legacy Salmon Creek. Erich is one of four OB/GYN hospitalists who work in rotating 24-hour shifts at the hospital.

Limiting liability

The hospitalist job is a fairly new concept in health care. OB/GYN hospitalists are on site and available to advise, assist and even perform a child birth if a patient’s regular doctor is unavailable.

Erich said hospitalists backup midwives and family practice doctors and are a resource for other OB/GYNs. They will assist in surgery if a doctor wants an extra set of eyes and hands in the operating room and will handle “unassigned patients” who might be traveling, new to the area or without a regular doctor.

Erich said having hospitalists on staff has saved babies’ lives at Legacy Salmon Creek. A hospitalist is always available to perform an emergency Cesarean section and prevent disasters.

Patient safety is the main reason hospitalists are on staff, but with that additional safety comes less potential liability, reducing the chance for lawsuits against a hospital. Other hospitals have taken notice. “I’ve personally gotten phone calls from across the country,” Erich said about his job, with at least two hospitals sending delegations to learn more about hospitalists.

Limiting options

Private practices, as well as hospitals, will limit liability by not offering certain procedures. Andison said The Women’s Clinic of Vancouver does not offer vaginal birth for a woman who has had a Cesarean section. Doing it can lead to uterine rupture, uterine lining infection and even death of the baby.

Andison said he believes it’s a procedure that can be done safely and patients do ask for it to save themselves from having another C-section. He said, however, it’s “no-win situation” for a clinic.“We strongly discourage it,” Andison said.

Andison has been targeted in a lawsuit. It was his patient, but he didn’t actually perform the birth. The baby’s shoulder got stuck coming out and resulted in a permanent partial loss in the use of the child’s arm. The family sued everyone associated with the pregnancy. Andison said the case result was “favorable” for the doctors, but it still cost him nearly a month out of the office to deal with the situation.

He said the costs of lawsuits, both directly and indirectly, have to be passed on to patients or the clinics providing the services won’t stay in business. “I think we ought to look at it to improve safety,” he said. “I don’t think litigation is the way to do it.”