NAD: It could be devastating, unfortunately, and this is something none of us want. But we are small business operators and, when you can’t make your payments, you can’t stay in business. Our orthopedic group covers probably 80 percent of the orthopedic care in our county. We cover eight hospitals, including a major trauma center. If we are not available to do any surgery or take any emergency call, it could be devastating. I believe that there will be patients who can’t get their emergency needs met and may need to be transferred to other hospitals or maybe even out of state. In terms of elective work, we won’t be doing any surgery. We will be working in the office.

NAD: Our immediate goal is to survive. By dropping surgery, we immediately drop our overhead dramatically. My malpractice insurance premium will go from almost $100,000 probably to below $20,000. We will be working harder in the office. I may see 10 or 20 patients for every surgery that I do, so I will still have office patients. As an orthopedic surgeon who’s been in private practice almost 20 years, I have never been sued. I have never had a lawsuit against me and I’m paying almost $100,000 currently—I think that is outrageous. More long term, our goal is really to say that our backs are against the wall and we’re not going to take this anymore. We are not going to keep paying the bills for a broken system. The bills keep rising and, as long as doctors pay the bill, the problem will escalate. As orthopedic surgeons in southeastern Pennsylvania, we have the highest malpractice in the country and the lowest reimbursement in the country. Unfortunately, this is not being felt statewide. Orthopedic surgeons in the western part of the state have lower surcharges. They often have higher reimbursement. So, they’re not sensing the severity of this problem. But this is a statewide problem. We have a broken system statewide. We have lawmakers that have been unwilling to listen and unwilling to act on these matters. They can solve this problem almost overnight if they wanted to. But they have been resistant to move on this. We believe that an additional aspect of what we’re doing will be to emphasize the current crisis.

NAD: When it starts affecting patients and employees, then I believe that the lawmakers will pay attention more. We make up a large percentage of what goes on in our hospital, both on the emergency side and on the elective side. If we’re not operating, I can guarantee you that our hospital will lay people off. They will not be able to keep the operating rooms open. They will not be able to keep people around on payroll. Our hospital employees are very worried. At our hospital we’ve lost eight surgeons this year because of the malpractice situation and that has made us vulnerable. We don’t have a neurosurgeon. We just lost the best trained vascular surgeon that we have, the best in the region, I think. When those people leave, for certain situations at certain times, patients are going to get in trouble and they are not going to get the quality care that they need. If you have an aneurysm and you go to that hospital and the clock is ticking, you want the best trained vascular surgeon. If you have a head injury, you want a neurosurgeon. That’s an access problem. I was recently informed that five of our general surgeons, two colorectal surgeons and three urologists, will not get their malpractice insurance renewed in January. Their Florida insurance company said they’re going to drop these doctors. We have made a conscious decision to stop operating and stop paying this type of extortion. These other doctors—they may have had that decision made for them. They may not be able to get coverage. We have to do what we can do. The power that we have is to stop doing the thing that only we can do—and that’s providing the care. If we’re not providing the care, patients will be affected, jobs will be lost, hospitals may close because of the support we render in terms of orthopedic care. Then I think you’ll start to see action.

NAD: The more physicians who make this decision, the more powerful the message will be. I think that if you saw any of the big, high profile Philadelphia groups step up and say, "We can’t take this anymore," that message would hit Harrisburg overnight. Short of that, you would need pockets of smaller groups making this decision. I just saw an open letter in the newspaper this week about a very large plastic surgery group that handles most of the plastic reconstructive and burn work in Delaware County. They said that, as of January 1st, it does not look like they are going to be able to continue surgery. Just from some of the panic and frustration I’ve heard over the last year or two from doctors in Pottstown, northeast Philadelphia and scattered suburban areas, I have a feeling there’s going to be other people doing this. The question is whether they have clout. The reason we’ve made such a splash with this is that we’re a large group that basically can paralyze a county. But I think there will be a cumulative effect if enough people start sending letters in and saying that, "We’ve had it. We can’t afford to be surgeons anymore." Antitrust law prevents physicians from getting together as a group and doing this, and I don’t think we should be doing that. But I know, just speaking to my colleagues, no-one talks about patient care anymore. Nobody talks about interesting cases. Everyone in this region is frightened by this, especially surgeons. The surgeons in this corner of the state are getting unfairly hammered by this situation. It’s a statewide problem but other physicians around the state and even non-surgeons in this area don’t quite feel it at the level that we’re feeling it. They see the payments mounting but the surgeons in this corner of the state are at break-point. So I think, come January 1st, when either they cannot get insurance or they see their rates go up tremendously, you’re going to see a lot of other doctors doing the same type of thing. A lot of doctors have elected to just get up and leave. But we as a group said this is our home court, this is our home town. We’ve been here, many of us, between 10 and 20 years. We’re committed to this community and we’re going to fight. We’re not going to leave.

NAD: No. We have not really sat down and thought that out. My own personal feeling is that, if times goes by and nothing’s happening, I think physicians will probably go back to work—temporarily. They will then make other plans with their life. They will start looking at other opportunities. They will look to leave the region and they will never be replaced. We believe that, by us not being able to afford insurance and other physicians being in the same situation, when January 1st comes around and we’re not available to cover emergency rooms, there’s going to be a crisis. I think you’re going to see some serious things happen where patients can’t get care and I believe that will turn the heat up and put the appropriate amount of light on this problem. Then we’ll look at what the response is and we will make a decision, whether it’s a month or two months into it. I tell can you, in two months if nothing has happened, then you’re going to see a real fallout. Doctors are going to leave. We have three or four orthopedic surgeons in our group that have one foot out the door and this is their last hope of seeing something happen.

NAD: Yes, I think you can. It probably would not be sustainable for 20 of us. But I think people will leave and those who stay will have a higher office volume. You’d have to change your lifestyle. You might have to reorganize your office. If in your group you have four or five offices, you may have to consolidate them. I think we’re pretty efficient as it is, but we’ll have to do even better at that.

NAD: I think that’s a small step in the right direction. You’re paying off a loan differently and hopefully the surcharges will be less. I think there’s a portion of it that is our responsibility but, if it’s a broken system and not a bad doctor problem, I disagree with the whole idea that physicians need to pay this bill. I think other people should kick in on this bill, but I know that that would not be popular in Harrisburg, patients wouldn’t like that, insurance companies wouldn’t like that and lawyers wouldn’t like it.

NAD: Short term, we need some breathing room, some relief. I believe that the surcharge could be spread out differently. Personally speaking, I think the formula that came out of the 1996 agreement with the Pennsylvania Medical Society unfairly pounded specialists in this corner of the state. If lawmakers are willing to collect the same amount of money from the doctors but spread the hurt differently, doctors can stay in business. Now, no other doctor in the state wants to pay any more, but many of them have paid very little for this broken statewide problem and they need to feel this a little more. As small business operators who are struggling to stay in business, zero-interest loans to help finance our malpractice payments could help. When I get my malpractice bill, last year I think I got it January 2nd or 3rd and it was due on January 1st. Rarely can anyone pay it off up front, so you have to finance it. That’s another 10 percent the finance company charged me, so you add another ten grand to this bill.

The real solution to this problem is going to be meaningful tort reform. That’s a step-wise process and we all understand that. If we saw people moving in that direction, some bills coming forward, we wouldn’t stay out of work for the one or two years that it takes to pass. If we saw movement in that direction, we would be more than happy to work and take care of patients, which is what we’ve spent our whole life training to do. We need to be moving this, rather than having bills that are sitting in committees buried, where big newspapers are being fed information from the trial bar saying that there’s no problem. We need people to accept that there’s a major problem going on and that there’s a genuine willingness and a sincerity to solve this problem. I think that would get everybody working.