The latest crisis that medical professionals are facing doesn't focus on their medical knowledge, their skills, or the types of treatments they deliver to the patient. Instead, physicians across our country are facing what the American College of Physicians has called "a growing liability insurance crisis that has physicians across the country struggling with rising premiums and non-renewals" [1].

Instead of simply being able to focus on delivering healthcare at its best, virtually all doctors today are concerned with their finances and the future of their practices. The problem is extended even further by the fact that it isn't just the doctors who should be worried. Instead, as a result of the premium increases, eventually marked changes in the quality of healthcare will be noticed very easily. One problem, outlined by the Joint Council on Allergy, Asthma, and Immunology, states that if costs keep rising and less payments are made, then physicians may be apt to retire earlier than they normally would have [2].

The premium increases are steeper for certain physicians specializing in various areas of medicine, however all doctors in numerous states are affected by these continuous changes. For Illinois doctors, this is all too familiar. For example, the Joint Council on Allergy, Asthma and Immunology also adds that Illinois doctors, specifically those in Cook County, already pay "some of the highest malpractice premiums in the country and for some the annul cost exceeds $110,000" [2]. For some of these physicians, it is beginning to seem as if their costs are coming close to, or in some cases, surpassing their earnings. It is at this time that doctors are feeling like they can't make it in their businesses any longer. In an article written by Phyllis Maguire for the American College of Physicians, the following scenario is illustrated:

In West Virginia, general internist John D. Holloway, FACP, has already seen surgical subspecialists disappear. (Both trauma centers in Wheeling, where Dr. Holloway practices, have closed because specialists couldn't afford premiums.) Now, cardiologists and gastroenterologists are becoming so scarce and overbooked that Dr. Holloway routinely sends patients to Pittsburgh or Cleveland [1]. After hearing this as an example of what many doctors across the country are experiencing, it should be understood that the problems with insurance aren't the result of supposed "greedy doctors." The reality of the situation is that this problem is affecting all types of people living in the U.S.

The American Medical Association, in an account of the result of physician insurance hikes, reports that the average increase in the year 2001 for liability insurance is fifteen percent. They add that this value may easily increase to fifty percent in the next year [3]. The President of the AMA, Dr. Richard Corlin, sums in up best when he says, "Patients can't get care when doctors can't afford insurance. There are too many patients whose physicians have been forced to discontinue high-risk procedures, leave their state and retire early because of out-of-control legal climates and skyrocketing liability premiums. Something must be done" [3].

It is devastating facts such as these that have led to a number of strikes and walkouts organized by physicians themselves. The idea to carry out strikes in protest to the constant premium rises has caught on, with numerous states in the U.S. encouraging doctors to postpone work in order to attend. In West Virginia, a state that has reported the highest annual premium increaes, many surgeon specialists are taking "30-day leaves of absence" as a way to protest the costs that keep rising. One other idea the physicians have is to demand that the state pass legislation that might make it harder for patients to file a malpractice suit. This may be a tactic for lowering the insurance premiums [1]. Currently, it is not difficult for a patient to file any claim against their physician, even though there may be no reason or evidence for one to be made. Dr. Richard E. Anderson, chairman of The Doctors Company, suggests that patients in our country expect nothing short of perfect healthcare no matter what services or equipment may be available to them for use. He says, "The national standard of care is basically perfection, and any result short of that is subject to challenge. While an 80% chance may be good odds if you're betting, many patients in that 20% range think they have the basis for litigation" [1].

The most influential strike was one that was recently publicized across the country as 800 Florida doctors agreed to skip work in order to show disapproval for the inflating premium increases. In our own state of Illinois, many physicians met in Springfield on February 26 in order to address these pressing issues. Some doctors who were interviewed explained that they were planning to postpone and reschedule their normal cases and appointments so that they would be able to show support for the cause. While some may wonder if patients were harmed by so many doctors neglecting work for a day, effort was taken to ensure that staff surgeons and other types of physicians were present and on call to deal with emergencies and to carry out necessary procedures [4]. The strike was organized by Dr. Tom Pliura, who hopes it will increase the awareness of this issue. He also wants to demand that an ivestigation on our current insurance systems occurs. He says that "this is a problem that hits every individual in the state, whether they see it or not." He adds, " In recent years, insurance rates have risen significantly, leaving some new physicians to pay as much as $800 a day, excluding employee salaries and other bills" [4]. This indeed highlights the seriousness of the case against rising insurance costs.

Many politicians have responded to the demands of the doctors by encouraging passage of a bill that would try to limit the number of "exhorbitant lawsuits" and also place a limit of $250,000 of legal awards made to patients for pain and suffering. This legislation was proposed by President George Bush [5]. After voting in support of this bill, Rep. Nancy Johnson, R-Conn. said, "Our nation is galloping toward a health care crisis of dimensions we have never faced before." Rep. Christopher Cox, R-Calif. added that "What we're trying to do is save the patients from a system that is falling down all around them" [6]. The bill was passed, but the problems continue to exist because it is suggested that the U.S. Senate will most likely turn the bill down [6].

In the meantime, physicians are continuing to band together and fight this issue in order to avoid a larger crisis. However, the insurance laws and premium increases are creating an uncertain future for students who may have entertained a career in medicine. In an article in American Medical News , author Myrle Croasdale reports that in 2002, there was a decrease of practically four percent in medical school applicants. The same article states that the number of 2002 applicants was the smallest it has been in the last six years [7].

While many who are uneducated on this issue continue to make fun of the supposed "rich doctors" who are complaining, the health care delivery system in America is slowly coming apart. Even more concerning is the fact that many physicians are leaving medicine or retiring early. Ultimately, resident training programs may not be able to fill their positions with doctors becoming less interested in certain specialties. However, instead of being discouraged from the highly rewarding field of medicine, it is the hope of current physicians that both pre-med and medical students will strive to be aware of the current standing of physicians in America and join the efforts to achieve the health care system that can now only be envisioned by our country.

Kamala is a second-year student majoring in Biology. She aspires to enter the field of medicine.