Doctors’ issues pose numbers game for state lawmakers

Stacy J. Willis

Friday, July 19, 2002 | 3:48 a.m.

WEEKEND EDITION: July 21, 2002

CNN's Paula Zahn interviewed him live. U.S. News & World Report and USA Today featured him. The Wall Street Journal quoted him and one of his patients.

But by the time Las Vegas obstetrician Dr. Shelby Wilbourn, 44, got his 15 minutes of medical-malpractice-crisis fame in early July, it was too late.

His story had changed. He had announced that his practice -- which saw 40 women per week and brought 20 babies per month into the world -- was closing. He had accepted a job in Maine. He had put his house on the market.

His story was no longer about leading Nevada physicians' fight against escalating malpractice insurance rates. It was no longer about championing a doctor-friendly legal environment. He was simply leaving Las Vegas.

And although that story appears to be more common -- and appears to be affecting recruitment of doctors to the area -- Nevada policymakers still don't have a reliable way to keep track of how many doctors actually are coming and going.

In fact, as lawmakers plan to enter a special legislative session July 29 to address the dilemma -- the central threat of which is that health services will be undermined because a significant number of doctors are leaving -- no government agency is keeping track of how many doctors are practicing in the state.

"When we have a crisis like we do, it would be nice if we kept track," Assembly Majority Leader Barbara Buckley, D-Las Vegas, said. Buckley, an attorney, is chairwoman of the legislative committee charged with investigating the medical malpractice issue and making recommendations for solutions. The committee's research staff is trying to compile numbers before the session, but doesn't have reliable resources.

"In the long term, it is probably the Medical Board's job to track this and identify any alarming trends," Buckley said. "That is the job of the regulating body."

The Board of Medical Examiners -- the state's medical licensing arm -- maintains a database of licensed doctors, but it does not differentiate between doctors who actively practice in the state and doctors who hold licenses here but practice elsewhere. Many doctors -- like Wilbourn -- keep their licenses active in the state when they leave. Others fail to report address changes, and some have licenses and reside in the state, but do not practice.

So while dozens of Clark County physicians say they are leaving, the board reports net growth in doctor licenses. According to the board, 142 new medical licenses have been issued this year, and the state has had an average net gain of 108 new physicians each year since 1980.

The American Medical Association ranked Nevada 47th in doctors-per-100,000 people in 2001, with 196 licensed physician per 100,000 residents. California, which has the tort legislation that Nevada doctors tout as the answer to the medical malpractice problem, ranks 13th with 216.

Although Nevada doesn't keep track of who is practicing, other groups try to. The Nevada State Medical Association updates its "physician survey" monthly.

On the association's July list, 88 doctors report they are "considering" leaving. Another 28 reported they have closed their practices. Eighteen say they are "in the process" of closing.

But the association's list is limited -- not all of the state's physicians belong to the association nor respond to the survey, and Larry Matheis, executive director, says he doesn't keep track of new doctors' arrivals.

"Probably no one will be able to get accurate, complete numbers until the end of the year," Matheis said. "But at some point we've got to go back and tease out of the very unsystematic information the answer to the question, 'What really happened?' "

Not having accurate numbers, however, doesn't change the Nevada's image for the nation, where media reports such as Wilbourn's reinforce the image of doctors leaving Las Vegas. And that makes recruiting even more difficult.

"We have enough trouble just convincing doctors that Las Vegas is a wholesome place to raise a family. Now they've all heard about the malpractice problem, and it's virtually impossible," said Karen Odell-Barber, who manages her husband's obstetrics-gynecology practice. Dr. James Barber inherited patients from two practices that closed as a result of doctors' malpractice rates and the Barbers are searching for a new doctor.

Odell-Barber said they spoke with doctors in Pennsylvania and New York who would not consider moving to Las Vegas.

"And most of the California folks were like, 'Forget it,' " she said. However, the Barbers hired a doctor fresh from residency at UCLA who had family in Las Vegas.

Dr. John Nowins, Clark County OB/GYN Society president, said he doesn't get many phone calls from doctors who are interested in moving to Las Vegas anymore.

"I used to get a bunch of calls from people who were considering coming to work here," Nowins said. "But they see the press...

"So I had my first call today in a while from an out-of-state doctor. It was a doctor in Michigan. He said he had seen the press about Nevada. He asked me, 'If I was your brother, would you recommend that I practice medicine in Clark County?' and I said, 'No.' "

However, some group practices that offer to cover the medical malpractice insurance premiums and pay their doctors a salary are having better luck.

Kristin Grimes, professional medical staff recruiter for Southwest Medical Associates, says she is having no problem finding doctors willing move to Las Vegas.

"We advertise nationwide.I would say we're certainly having more extensive conversations about medical liability insurance, but that's not a headache for us," Grimes said, because Southwest negotiates group liability rates and covers its doctors.

Southwest is a multispecialist health services provider that employs about 150 physicians at 11 sites in the area.

"I'm not having a problem nationally," she said. Additionally, Grimes said, she is in negotiations with two local obstetricians who are ready to leave their private practices because of medical malpractice rates.

Dr. Paul Canale, an orthopedic surgeon, is leaving Las Vegas because he doesn't see any political commitment to making long-term changes in the state's medical liability climate.

"(Policymakers) are going to try to deal with the political crisis first, But there are long-range structurual problems that need to be studied, and I don't see it happening," Canale said.

"I am closing my practice and I am leaving Southern Nevada because it is too hostile an environment to practice in," Canale said. "That's all over the nation. Southern Nevada is a hostile environment for physicians."