Medical Liability Reform’s Promises Kept

 Sept. 9, 2013  

 10-Year Anniversary TMA Survey Documents Increased Access to Care

When an early-2003 survey showed that the lawsuit epidemic had significantly reduced sick and injured Texans’ ability to get the health care they need, the framers of the state’s medical liability reform plan promised things would be different — very different — after passage of House Bill 4 and Proposition 12. 

A follow-up Texas Medical Association survey released today — 10 years after HB 4 took effect and the voters approved Proposition 12 — documents that medical liability reform has kept its promises. The landmark law and accompanying constitutional amendment have: 

1. Assured good Texas physicians they can take on the most complicated illnesses and serious injuries without fear of facing a groundless lawsuit in return, and 
2. Attracted record numbers of new physicians to the state. 

“My mom taught me that you’re only as good as your word,” said Stephen L. Brotherton, MD, of Fort Worth, the TMA president. “We’ve kept our word. Mom would be proud. And the patients of Texas are so much better off because of it.” 

Overall, 80 percent of the Texas physicians surveyed rate the current liability climate in Texas for physicians as good (51 percent) or excellent (29 percent).

“We were able to continue to deliver babies in rural East Texas.”
– Family medicine physician, 63, Henderson County

The 2003 survey demonstrated the extent of the lawsuit crisis. Because of professional liability pressures, TMA’s survey team reported at the time, half of Texas physicians had stopped providing certain services to their patients in the previous two years, and 62 percent had begun denying or referring high-risk cases. 

The follow-up survey found that 89 percent of physicians who were practicing in Texas both then and now say the professional liability climate for physicians in Texas today is “better” or “much better” than before September 2003.  

As a result of the 2003 medical liability reforms, the survey released today found:

• 13 percent of physicians who were practicing in Texas both then and now are providing new or renewed services to their patients, and
• 36 percent are accepting more high-risk patients.

“I would not be in Texas if there was no reform.”
– Colon and rectal surgeon, 54, Harris County   

The 2003 survey revealed shocking figures about Texas physicians’ practices. As many as 1 in 6 said that, because of professional liability pressures, they had retired; closed, sold or relocated their practice; or stopped providing patient care. Recruiting new physicians to Texas was a bleak prospect. 

One-fourth of the physicians who answered the new TMA survey were practicing medicine in another state or were in an education/residency program in September 2003. They began clinical practice in Texas, on average, between 2006 and 2008.  

• These physicians list the liability climate as one of the top three reasons they decided to practice in Texas (39 percent).
• 63 percent report the professional liability climate was “important” or “very important” in their decision to practice in Texas.

Compared with 2003, almost three-quarters (72 percent) of today’s physicians who have attempted to recruit new physicians to their practice, hospital, or community have found it easier to do so. They have been overwhelmingly successful (up to 80 percent) in their attempts to recruit “high-risk” specialists such as obstetricians, neurosurgeons, pediatric subspecialists, and trauma surgeons.

“I honestly do not believe I would still be in medicine today if not for Proposition 12.”
– Family medicine physician, 37, Nueces County   

If the 2003 Texas medical liability reforms were repealed by the Texas Legislature or nullified by federal law, the new survey found, physicians most likely would reduce or eliminate high-risk procedures (42 percent) in response. Younger physicians more likely would reduce or eliminate high-risk procedures. Older physicians more likely would retire early. 

About the Survey

Invitations to participate in the online survey were emailed to 52,480 physicians in Texas and out of state. Analysis includes answers from 1,615 respondents, a 3-percent response rate, who completed the survey Aug. 6-20, 2013. The margin of error for questions answered by the entire sample is plus or minus 2.5 percent. 

Respondents were physician members (77 percent) and nonmembers (23 percent) of TMA. They live and practice in Texas (93 percent) and out of state (7 percent). Their ages were 40 years and younger (17 percent), 41 to 50 (20 percent), 51 to 60 (28 percent), and 60 and over (35 percent). They were male (73 percent), female (27 percent). 

Physicians’ specialties included radiology, pathology, and other indirect access care (13 percent); primary care (24 percent); pediatrics (9 percent); surgical specialties (11 percent); emergency medicine (4 percent); obstetrics and gynecology (7 percent); orthopedic surgery (4 percent); and nonsurgical specialties (30 percent).  

TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 112 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans. 

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