Stephen Burger, M.D.
Editor's note: Belleville neurologist Stephen Burger, M.D. and president of the St. Clair County Medical Society discussed medical malpractice reform-related issues with the Record recently. Here's what he had to say:
Q)How has the availability/affordability of medical malpractice insurance affected your practice?
A)A very complex question…I am and have always been ISMIE-insured since coming to southern Illinois in 1995. Directly, our premiums have risen quite a bit between about 1998 and 2003, but in the last couple of years premiums for my group have plateaued.
It is important to remember though that rates are determined not by just one’s personal claims history, but also by risk assessments based on specialty throughout the entire state as well as geographical risk assessments based on where one practices.
Are my rates higher than neurologists in other parts of the state or in other parts of the midwest? Absolutely!
In response, I have limited many services I formerly offered in an attempt to lower potential risk exposure. It doesn’t ease the medical availability problems when you cut back on services, but sometimes it is required to keep your practice open for those patients you can help. In the first seven or eight years of my practice, I rarely needed to refer patients out of the Metro-East for needed medical services.
Now it has become a matter of routine, and sometimes there are considerable distances required and time delays involved for patients to get the care that several years ago they would have acquired right here.
Q)In general, how has medicine changed in the course of your career?
A)In the past the practice of medicine was the practice of medical science. Certainly many times there have been situations where not as much scientific knowledge into a patient’s problems was as abundant as one would like, and at those times physicians relied on the collective experience of our peers and ourselves to deal with those situations (the so-called “art” of medicine).
What I have found in the last 10 years is that due to liability concerns, physicians are less inclined to offer up the “art” of medicine in those situations where the science is lacking, for to do so exposes one to potential liability. If it is not printed in gospel it is not offered to the patient, and in many areas of medicine where scientific understanding remains lacking, to remove the “art” of medical practice really limits potential treatment options to many patients.
Q)You are among the few neurologists left to practice medicine in the Metro-East. How demanding is that on your practice?
A)It’s all about supply and demand. You have an ever-increasing patient population with increasing age and medical needs in the face of ever-restrictive access to medical providers. Waiting times are longer, follow-up times are longer. As I frequently tell my patients when they sometimes are seen a couple hours late for their scheduled appointment: ”There is only one of me and many of you. Everybody gets the time they need, and I’m doing the very best I can do under very trying circumstances. You are called a ‘patient’ for a very good reason…this situation requires a great deal of patience from both of us.”
Q)Personally speaking, has the exodus of colleagues had a demoralizing effect on you and other doctors in St. Clair County?
A)It is difficult to see many personal friends and colleagues leave an area after spending many hours working together with them for a common cause: better health care in the community.
Unfortunately, I can see both sides when it comes time for a physician to decide whether they should stay or leave, and believe me, these are very difficult decisions for doctors to make both personally and professionally.
Physicians are an integrated component in the community and their commitment to both their patients and community run very deep. So to pick up and leave requires a great deal of reflection. Most of the time when a doctor leaves it comes down to the fact that ultimately they really don’t have a choice.
Circumstances are thrust upon them. Our colleagues that have left have all resumed successful practices in new communities with new patients and patients have been fortunate to acquire a great new medical provider. On a sad note though, our community has also lost a great asset, and one which ever more commonly can’t be replaced.
Q)Please explain your position on the medical malpractice insurance reform legislation passed by the state legislature.
A) I think that recent initiatives supported by both the Illinois House and Senate reflect a mutual understanding and acknowledgement of the medical liability crisis in Illinois and a recognition that diverse measures must be pursued to ensure that Illinois citizens have ready access to affordable comprehensive health care.
As to the extent and impact of the proposed legislation on lowering medical liability insurance rates and expanding the medical liability insurance marketplace (which were two of our primary aims) to “Keep Doctors in Illinois,” I simply think it is too early yet to predict. There remain too many “what-ifs” in the legislation at this time to allow insurers to responsibly begin to lower rates and predict whether outside insurers will wish to return their offerings to Illinois physicians.
Q)What effect does the legislation's passage have among the medical community?
A)I think there is unanimity among Illinois physicians that initiatives in the legislature are a start. Some areas in Illinois are suffering from decline in medical access and services much more acutely than others, and in those areas, hope for more immediate relief has caused some to express disappointment, as the measures proposed so far may not realize benefit to Illinois physicians and patients for quite some time.
By no means do any of us who have been working on these reforms for a minute believe that the proposals are the final end-all solution to a very complex problem…but they are a start, and a very important start, but much more work will need to be accomplished before this problem is truly permanently fixed.
Q)As president of the St. Clair County Medical Society, how will you lead on this issue?
A)I think that as a leader my role is to remain as knowledgeable and insightful about all sides of the issues as I can be. Many different factions with many different objectives are at the table of discussion, and I believe one of my very important roles is to be an informed resource for my membership and a valuable resource for those who are positions of legislative leadership.
This crisis did not develop over a short period of time, nor is it unique to Illinois. It is the result of years and years of denial, neglect, and self-serving interests, which have culminated in a health care access crisis for our patients. It is time to fix a very complex problem once and for all, and this requires knowledge, insight, and understanding of all sides of the issue, so we don’t continue to perpetuate this crisis any further. Our efforts are for the common good of Illinois patients, not special interests from physicians, insurance companies, or lawyers. It is important to realize that the common good of Illinois patients is first and foremost our mission.
Q)Pertaining to insurance rates and carriers, what are your predictions (if and) after the bill is signed into law?
A)As above, I think right now there are too many “what-if’s” to be able to accurately predict the impact of this proposed legislation. What I do know is that until we have court-endorsed support for the proposals, nothing for the better will occur.
In the last couple of weeks there have been a flurry of lawsuits filed in Illinois, and as in the past, these suits will place additional burdens on insurance reserves which ultimately will require insurance premium increases to cover those needed reserves.
I would not be surprised to see in the next year or two insurance rates again rise to cover those needed reserves pending court confirmation on the new legislation. Whether rates will ultimately come down again I think depends on what happens with mandated insurance reserves. If medical liability severity assessments and lawsuit frequency decline, liability insurance rates will decline.
If these measures don’t occur, rates wouldn’t be expected to decline. On the other hand, if outside insurers see a stable and predictable liability marketplace, they will likely return. But until insurers’ concerns about stability are confirmed, I would not expect any quick rush back into Illinois. We will simply have to wait and see…and for many areas in Illinois with medical access plight, we simply don’t have a lot of time left.