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Comment and Controversy

Complacency begets complacency

June 2006 · Vol. 18, No. 6
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Dr. Barbieri’s editorial eloquently describes the problems we all face in today’s malpractice crisis. Over the past 5 years, my malpractice premiums have doubled, while reimbursements have steadily declined.

Although I appreciate the editorial, I am in awe of Dr. Barbieri’s complacency regarding this issue. We are in desperate need of strong leaders to guide us through this dilemma. ACOG and the AMA want my dues, but they aren’t doing anything, either.

Joseph Livoti, MD
West Islip, NY

Dr. Barbieri responds:

Innovative solutions are clearly needed I appreciate the time Drs. Ptasinski, Smith, Pinzon, and Livoti took from their busy professional and personal lives to write about actions ObGyns can take to improve the relationship between reimbursement and professional liability premium expenses.

As Drs. Ptasinski and Smith note, we could improve our situation by stopping our practice of accepting insurance and starting to “pass through” increases in professional liability insurance premiums directly to patients. Some surveys suggest that about 10% of physicians are now refusing to accept insurance contracts that prevent them from balance-billing patients. Many obstetricians are reluctant to take this step because of the financial burden it might place on some of their patients.

I agree with Dr. Pinzon that in our current liability environment a liberal use of cesarean section and cautious adoption of new surgical procedures is wise. Rather than persist in past clinical practices, we should focus on achieving no bad newborn outcomes, the chief cause of obstetrical liability risk.

Dr. Livoti concisely describes the complexity of trying to change a tort system that is broken, and the difficulty physicians face in leading political change.

Robert L. Barbieri, MD

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