mleonard@wvgazette.com
Like doctors in the rest of the nation, West Virginia'sphysicians are often dissatisfied with managed care organizations.But unlike their counterparts in other states, they are not beingnudged into early retirement by HMOs. The main reason is the lowpenetration of HMOs in the state.
'When you look at the number of people covered by HMOs in WestVirginia and compare it to national rates, it's very low,' said EvanJenkins, executive director of the West Virginia State MedicalAssociation.
Patients enrolled in the four HMOs operating in West Virginiaaccount for only 10 percent of the population, with heaviestenrollments in densely populated areas, according to the WestVirginia Hospital Association.
Jenkins said managed care may be a factor in a doctor's decisionto retire or change careers, but the reasons are more complex andvaried.
'I'm sure there are some physicians who are retiring or who havechanged careers because of intrusions into their practice by HMOsand other third parties, but there are a plethora of issues thatmake practicing medicine in West Virginia harder than it would be insome other states,' he said.
'The practice of medicine is not what is used to be. There areseasoned professionals who are saying they've had it - be it managedcare or other frustrations.'
Dr. Phil Polack is a plastic surgeon in Wheeling, an area wheremany patients are enrolled in the Health Plan of the Upper OhioValley, an HMO.
'I will soon be 55 and virtually every member of my class iseither in administrative medicine or retired,' Polack said. 'I wishI could say there was one particular reason they have, but we have arelatively patient-friendly HMO here, and the truth is there aremany reasons.'
Jenkins said doctors in the state are more likely to retire, moveor change careers because of medical malpractice suits. 'What we areseeing is that the liability climate in the state is having a moresignificant impact on doctors than HMOs,' he said.
Polack said malpractice insurance costs for doctors haveincreased 20 percent to 25 percent this year from the previous year.'It varies according to specialty, but I know one neurosurgeon whosepremium 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 knowwill be moving to Decatur, Ill., where his malpractice premium willbe $18,000 a year - here it was $63,000.'
Jenkins said in addition to liability costs and HMOs, reducedreimbursements from Medicare and the Public Employees InsuranceAgency, government regulations and the state provider tax of 2percent 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 WestVirginia.'
But U.S. Census Bureau numbers indicate that the state's doctor/population ratio remained steady between 1990 and 1999, and somedoctors approaching retirement age say they will stay to weatherwhatever problems arise.
'I know there is a lot of dissatisfaction out there,' said Dr.William Harris, a family practitioner and geriatrics specialist inCharleston. 'But the question for doctors is the same for everyonewho lives in West Virginia - why do you stay when there are betteropportunities in other places?
'The answer is for the love of the land, the mountains and thepeople - that's what's keeping all of us here.'
Harris said West Virginia has high numbers of elderly and sickwho desperately need doctors. 'We need every doctor we can get.Regardless of how much pressure and heat is put on us, my colleaguesand I plan to stick it out and stay in practice,' he said. 'We'll bethe ones to turn the lights out - we're not leaving.'
To contact staff writer Martha Leonard, use e-mail or call 348-1254.
