Hawaii Faces Doctor Shortage Due to Rising Med-Mal Premiums

Hawaii faces doctor shortages in at least two fields, obstetrics and orthopedics, because fears of lawsuits and the rising cost of medical malpractice insurance premiums are forcing some to quit.

Premiums for physicians who specialize in obstetrics-gynecology are high because insurers are required to pay for the care of injured infants for the remainder of their lives, while orthopedic emergency room work is deemed high risk because doctors are usually unfamiliar with trauma victims’ medical histories.

Over the past five years, malpractice insurance for OB-GYNs has risen by 53 percent to $62,500, said Paula Arcena, executive director of the Hawaii Medical Association.

Expensive premiums speed the already high rate of attrition in obstetrics and orthopedics among Hawaii’s doctors.

A survey by the American College of Obstetricians and Gynecologists says the number of obstetricians has dropped by 9 percent in Hawaii in the past two years.

The study says 42 percent of Hawaii’s OB-GYN’s plan to leave obstetrics in the next five years. Twenty-nine percent say they will likely stop delivering babies in the same period. The projected loss on the outer islands is even more dire, with 67 percent intending to quit by 2009.

Most obstetricians said the risk of getting sued spurred their decision to leave the field. The average practitioner is sued 2.6 times in the span of a career, according to a national survey by the American College of Obstetricians and Gynecologists.

In the past five years, average take-home pay for obstetricians has decreased 17 percent, said Dr. Nathan Fujita, the group’s Hawaii section chairman. The dip in pay comes mostly from health insurance companies cutting reimbursements to doctors for certain procedures.

Meanwhile, the number of orthopedic surgeons has fallen by 29 percent in the last decade, according to the Hawaii Orthopedic Association, which says there are now only 48 orthopedic surgeons in the state.

Some hospitals face a critical shortage of emergency room orthopedic surgeons, who treat trauma patients such as car crash victims.

Kapiolani Medical Center for Women and Children doesn’t have any orthopedic surgeons taking emergency room calls regularly. Castle Medical Center in Kailua staffs for just half the week.

The Queen’s Medical Center, which takes cases too complex for average emergency rooms, only puts two orthopedic surgeons on call daily for major cases.

The Neighbor Islands face an even greater shortage of orthopedic surgeons. One surgeon is on call for eight days a month at Hilo Medical Center. That leaves three weeks without surgical care coverage for victims with bone injuries, said hospital director Ron Schurra. Patients are forced to wait, or catch an air ambulance flight to Oahu for treatment.

In the past two years, Hilo Medical has attempted to recruit more orthopedic surgeons and other specialists, but the annual salary of $250,000 to $350,000 is 10 percent to 20 percent lower than pay offered at hospitals on the mainland, Schurra said.

“It is a time bomb that’s waiting to explode,” said Maui Mayor Alan Arakawa. “It’s the most critical issue in the state right now.”