Part I

Capitalism/the free market is a lousy way of getting things done in the healthcare arena.

Now before folks demand that I turn in my membership card to the VRWC, I should add this: having spent a brief time in Eastern Europe, I believe that socialism/the centralized economy is a catastrophic way of getting things done in the healthcare arena, or in anything else for that matter.

We're stuck with the free market for now. We might as well do the best we can within the system.

What are physicians' options in coping with the malpractice crisis? Our medicolegal system has been so corrupted that it is impossible to dream up a complaint that has not actually led to a lawsuit in our country. Even more telling, it is becoming increasing more difficult to dream up a lawsuit in which some jury somewhere in our fair land hasn't actually awarded damages to the plaintiff. Pay a visit to Overlawyered.com or sickoflawsuits if you need to be convinced of this point.

The free market understands supply and demand very well. Reduce the supply of a service and combine it with increased demand for said service and you will exert irresistible pressure on the way in which the service is delivered. Physicians (in contradistinction to lawyers?) are constrained by ethical and professional considerations in the way we supply healthcare. As attractive as some sort of collective bargaining action might seem, going on strike (for example) is illegal, unethical and ultimately counterproductive. We can strive to put more and more limits and boundaries on what services we provide; consider the number of OB-GYN's who no longer will deliver babies, or the number of specialists who refuse to have their names put on ER call rosters. We can try what I'm attempting, which is to limit severely the amount of services and numbers of patients I will accommodate and rejoice in being able to meet my overhead and pay for my health insurance coverage if nothing else.

None of the above protects us from the $23 million judgment and the financial ruin it would bring. The only way we can do this is to quit.

Yes, I'm aware of all sorts of methods to shield our assets from lawyers. This is like trying to construct a squirrel-proof birdfeeder: it can't be done. They're too clever. There will be a way in our system for the lawyers to get to the money. Charging "elder abuse" instead of malpractice in claims of negligence on the elderly is just one way that lawyers are now circumventing measures like malpractice award caps. Other maneuvers will come.

This is a problem for anyone who has put twenty or thirty years of training and practice into their field. It seems like a tremendous waste of human capital to toss it all. What I do ain't rocket science or brain surgery, but it takes a high-school graduate thirteen years of training to prepare for my field. Maybe they could condense it down to two or three years of training at a technical school. I wouldn't want to get a colonoscopy from one of them, but who knows? That might be the only option we have in the future.

To be continued.