Wednesday, October 20, 2004

The number of licensed physicians in Maryland has risen steadily since 2000, even as doctors warn of an exodus because of the state’s high medical-malpractice premiums.

State records show a gain of more than 1,000 physicians across the state as a Maryland doctors group lobbies for tort reform under a campaign called “Maryland’s Vanishing Physicians.”

Records obtained from the Maryland Board of Physicians show the number of licensed physicians in Maryland rose from 21,779 physicians three years ago to 23,101 in 2003.

Since 1996, the number of licensed physicians has increased by more than 2,000, the figures show.

But doctors say the statistics are incomplete.

For one thing, they point out that state officials say cannot seem to agree on how to calculate another important statistic: how many of Maryland’s physicians actually treat patients.

Physicians say that number is dropping fast. Trial lawyers, who oppose tort reform, disagree. And state health officials say they’re not sure.

“Nobody has that number, and that’s what we’re working on right now,” said Barbara McLean, spokeswoman for the Maryland Health Care Commission.

The health care commission thinks that about 12,000 physicians practice in the state, said Ms. McLean. But the Board of Physicians reports 15,321 physicians are practicing.

Doctors also point out another limitation in the state statistics, which do not show population changes for specific medical specialities. That’s a glaring omission in the medical-malpractice debate, doctors say, because surgeons, cardiologists and obstetricians are among the hardest hit by rising insurance premiums.

“If it hasn’t already, the number is going to decrease enormously,” said Dr. Laurie Poss, who practices in Annapolis and was recently appointed to chair a federal task force to study malpractice and tort reform.

“Every doctor I know is trying to get out of medicine in their 50s, when they used to practice well into their 70s,” Dr. Poss said. “I’ve looked at this pretty closely, and more physicians are leaving Maryland than coming in. It’s one of the most regulated and highly restricted states in the country.”

However, the absence of so many hard numbers could pose a problem as state lawmakers consider a sweeping package of tort-reform legislation. Gov. Robert L. Ehrlich Jr., a Republican, last week met with Democrats Senate President Thomas V. Mike Miller Jr. and House Speaker Michael E. Busch to discuss plans to call a special session on the tort-reform issue next month.

Michael Preston, executive director of the Maryland State Medical Society, stood by the doctors’ contention that many are fleeing the state, even though state statistics show more licensed physicians in Maryland since 2000.

Mr. Preston said many doctors leave the state but keep their Maryland license just in case they want to return someday.

In addition, he said, thousands of other physicians live and work in Maryland, but they do not treat patients. Instead, he said they’re employed as researchers at large government agencies such as the U.S. Food and Drug Administration and the National Institutes of Health.

C. Irving Pinder Jr., executive director of the Board of Physicians, said his agency began to change how it figures out how many practicing doctors work in the state in 2001. The previous system relied on formulas based, in part, on the percentage of time that doctors spend seeing patients, Mr. Pinder said.

“The situation was getting so political that I said that I have to get some good numbers,” said Mr. Pinder.

But change from one formula to another has led to massive fluctuations in statistics from year to year. In 2000, for example, the Board of Physicians reported 10,127 practicing physicians across the state.

Two years later, that figure skyrocketed by more than 60 percent to 16,577 physicians before dropping slightly to 15,321 last year, records show.

Doctors dispute the state numbers.

“If the board is showing a significant increase, it’s not because more doctors are coming here, it’s because the board has adopted some different measure of accounting,” Mr. Preston said.

Mr. Pinder agrees: “I didn’t really feel comfortable quoting those numbers,” he said of previous years’ statistics.

Despite uncertainty about the number of practicing physicians over the years, state officials say they are confident in statistics showing the number of licensed physicians in the state.

“Those are firm numbers,” Mr. Pinder said.

Those figures show that the state has gained more than 1,300 licensed physicians compared with three years ago.

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