Sep. 4--Like doctors in the rest of the nation, West Virginia's physicians are often dissatisfied with managed care organizations. But unlike their counterparts in other states, they are not being nudged into early retirement by HMOs.
The main reason is the low penetration of HMOs in the state.
'When you look at the number of people covered by HMOs in West Virginia and compare it to national rates, it's very low,' said Evan Jenkins, executive director of the West Virginia State Medical Association.
Patients enrolled in the four HMOs operating in West Virginia account for only 10 percent of the population, with heaviest enrollments in densely populated areas, according to the West Virginia Hospital Association.
Jenkins said managed care may be a factor in a doctor's decision to retire or change careers, but the reasons are more complex and varied.
'I'm sure there are some physicians who are retiring or who have changed careers because of intrusions into their practice by HMOs and other third parties, but there are a plethora of issues that make practicing medicine in West Virginia harder than it would be in some other states,' he said.
'The practice of medicine is not what is used to be. There are seasoned professionals who are saying they've had it -- be it managed care or other frustrations.'
Dr. Phil Polack is a plastic surgeon in Wheeling, an area where many patients are enrolled in the Health Plan of the Upper Ohio Valley, an HMO.
'I will soon be 55 and virtually every member of my class is either in administrative medicine or retired,' Polack said. 'I wish I could say there was one particular reason they have, but we have a relatively patient-friendly HMO here, and the truth is there are many reasons.'
Jenkins said doctors in the state are more likely to retire, move or change careers because of medical malpractice suits. 'What we are seeing is that the liability climate in the state is having a more significant impact on doctors than HMOs,' he said.
Polack said malpractice insurance costs for doctors have increased 20 percent to 25 percent this year from the previous year. 'It varies according to specialty, but I know one neurosurgeon whose premium went from $97,000 last year to $172,000 this year,' he said. 'Compared to other states we pay a lot. A general surgeon I know will be moving to Decatur, Ill., where his malpractice premium will be $18,000 a year -- here it was $63,000.'
Jenkins said in addition to liability costs and HMOs, reduced reimbursements from Medicare and the Public Employees Insurance Agency, government regulations and the state provider tax of 2 percent of physicians' income, all contribute to early retirement.
'The frustration level among physicians is very high,' he said. 'Doctors are leaving the state and it's hard to recruit in West Virginia.'
But U.S. Census Bureau numbers indicate that the state's doctor/population ratio remained steady between 1990 and 1999, and some doctors approaching retirement age say they will stay to weather whatever problems arise.
'I know there is a lot of dissatisfaction out there,' said Dr. William Harris, a family practitioner and geriatrics specialist in Charleston. 'But the question for doctors is the same for everyone who lives in West Virginia -- why do you stay when there are better opportunities in other places?
'The answer is for the love of the land, the mountains and the people -- that's what's keeping all of us here.'
Harris said West Virginia has high numbers of elderly and sick who desperately need doctors. 'We need every doctor we can get. Regardless of how much pressure and heat is put on us, my colleagues and I plan to stick it out and stay in practice,' he said. 'We'll be the ones to turn the lights out -- we're not leaving.'
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(c) 2000, The Charleston Gazette, W.Va. Distributed by Knight Ridder/Tribune Business News.
