Physician exodus questioned

By Christopher Guadagnino, Ph.D.

Doctors have been deliberately misleading. That’s the charge being leveled against the medical community by PaTLA and its interest groups, key state legislators and even some press accounts regarding whether Pa. is losing physicians as a result of the state’s medical malpractice crisis, as stated in public ads and lobbying efforts by the Pennsylvania Medical Society (PMS).

In an attempt to damage the credibility of medical community and its contention that the state’s malpractice crisis is eroding access to health care, opponents of tort reform are showcasing recently released MCARE Fund figures that do not show an exodus of physicians from Pa., and are questioning the legitimacy of a list of “Pennsylvania’s Disappearing Doctors” used to lobby legislators for further tort reforms. Physician supply numbers from other sources have since been thrown into the mix, only to prompt critics to question whether the medical community can be trusted to “get its numbers straight.”

Some legislators have assumed a stance of outrage and are demanding that the medical community be held accountable for its alleged misinformation campaign, and that state-sponsored abatement of physicians’ MCARE Fund premiums be curtailed.

Whether the attack is warranted, and what impact it may have on the medical society’s credibility are important questions. Beyond those questions lie others that continue to be ignored, at least publicly, and which remain essential if public policymakers are to make rational determinations of whether, or when, additional malpractice crisis interventions should be enacted:

· What data should legislators rely on to draw conclusions about Pa.’s supply of practicing physicians?

· Is physician supply data – whether statistical or anecdotal – sufficient to determine the extent to which access to health care services is being threatened by Pa.’s malpractice environment?

· If physician supply data alone is insufficient, what kind of access data should be considered, and is it available or obtainable in a reliable form?

· If sufficient and reliable data were obtainable, would it make a difference in the political arena, where differences of interpretation of the same data inevitably lead to different conclusions?

This last question may very well explain the physician supply controversy, as the same MCARE numbers are viewed very differently by advocates and opponents of tort reform. All data require interpretation, and in the political arena, all interpretation is filtered by political agendas.

House Democrats want to suspend further appropriations for physicians’ MCARE abatement until they get more reliable data on these issues. House Minority Leader William DeWeese (D-Waynesburg) and House Democratic Whip Michael Veon (D-Beaver) have introduced a House resolution, HR 750, to create a task force to study physician recruitment, training and retention of Pa. physicians to determine if an access emergency exists, and to study whether Pa. can change its policies to improve these areas.

The task force would have nine members – including the Pa. Insurance Commissioner, the majority and minority chairmen of the House Insurance and House Health and Human Services committees, and two appointees each from the House Speaker and Minority Leader – who would have the authority to subpoena testimony for its data collection. The task force would also conduct, tabulate and analyze the results of a survey of “the public or affected persons and groups relating to physician recruitment, training and retention” and would develop recommendations “to address any current and future physician shortages and distribution issues.”

The resolution calls for the the House to make no appropriation for MCARE abatement or any similar program until at least 30 days after the task force files its report, which would be due by Nov. 1, 2004.

According to DeWeese’s Press Secretary Tom Andrews, passage of HR 750 would require a simple majority House vote, which would authorize the creation of the House task force, while allowing House Democrats to bring the resolution’s MCARE abatement suspension provision to the state budget negotiating table, as they plan to do with a separate proposal to shunt half of the state’s $220 million earmarked for MCARE abatement to Pa.’s adultBasic health insurance program. Veon said that the money would “still indirectly go to doctors, since people covered by adultBasic will go to doctor’s offices for regular checkups and get preventive care.” The other half of the MCARE funding, under DeWeese and Veon’s proposal, would be specifically directed toward doctors in high-risk specialties.

Fuzzy Data Sparks Heated Controversy

Apparently triggering the physician supply flap were press reports that compared 2002 and 2003 MCARE Fund enrollment figures and concluded that Pa. has not lost physicians, as claimed by medical community lobbying. Because 2003 MCARE enrollment figures are not yet available, reporters used the number of physicians who applied for abatement of their 2003 MCARE premiums as a proxy for that year’s actual enrollment number and calculated that the number of Pa. physicians remained above 35,000 in both 2002 and 2003, did not decrease, and may even have increased.

The Allentown Morning Call broached the issue – and apparently took sides on it – in an April 18 article with the headline, “Diagnosis of the numbers shows doctors not leaving the state in droves,” in which the journalist wrote, “Whatever the tabulation, it’s clear doctors – even specialists – aren’t staging a mass exodus. All parties agree the new statistics are the most accurate barometer of physician presence in Pennsylvania.” The article indicted the PMS for tapping fears and emotions for its statewide lobbying campaign: “From the start, the effort’s rhetoric exceeded tangible proof of any exodus. Anecdotal evidence, meanwhile, piled up and was put into play by the doctors’ lobby. Lawyers were fingered as scapegoats and blamed for bringing frivolous lawsuits 85 Besieged lawmakers and others close to the issue of departing doctors – sensing much more rhetoric than reality – have tired of the game.”

Appearing with the article was a sidebar, “’Disappearing docs’ list is inaccurate, a few phone calls show,” in which the journalist attempted to verify whether physicians appearing on the “Pennsylvania Disappearing Doctors” list – maintained by former PMS Alliance President Donna Rovito – have in fact left the state, found that some did not, and implied that the list is deceptive.

Other newspapers ran articles portraying similar skepticism in light of the MCARE numbers, including Wilkes-Barre’s Citizen’s Voice, the Pittsburgh Tribune-Review, and the Pittsburgh Business Times.

The Morning Call also stated that Pa. had gained 800 physicians since 2002, initially characterizing it as “the state medical society’s own statistics – never before disclosed publicly.” A Scranton Times Tribune editorial said the number disproved “the assertion that doctors had fled the state en masse due to high liability insurance rates” and, when combined with MCARE numbers, “paints a clear picture that the liability controversy has not driven large numbers of doctors from Pennsylvania.” In a later article, the Morning Call (correctly) attributed the “800 physicians” figure to American Medical Association data and noted that, according to the PMS, the figure represented a temporary gain in medical residents.

Press accounts of data casting doubt on physician flight were accompanied by heated remarks by legislators. The Morning Call quoted Veon: “The data they [the PMS] repeatedly cite, and which served as the basis for legislative action in the last two years, appears to be seriously inaccurate and part of a deceptive campaign. We want the real numbers and there should be no further action until the deficiencies of the data are corrected and we know the truth.” The Pittsburgh Business Times quoted DeWeese: “We were led to believe there was a mass exodus of physicians from the Keystone State. The mass exodus is an exaggeration of the first order.”

Deliberately Misleading?

“The numbers are the numbers are the numbers. That’s not spin or philosophy. Legislators don’t like to be lied to,” says Mark Phenicie, legislative council to the Pennsylvania Trial Lawyers Association (PaTLA), referring to the discrepancy between the message that the number of physicians in Pa. is declining – which he says has been the focal point of the physician’s tort reform campaign – and the MCARE enrollment and “800-physician” figures. Although he allows that the PMS did not specifically maintain that physician MCARE enrollment would be down, Phenicie says it framed the issue on the supply end – that access to medical services is down because doctors are leaving the state, and that legislators feel misled in the face of data to the contrary.

The “doctors are leaving” message has been the medical society’s “trump card to scare people into believing that their access to health care is in danger, and to relinquish their rights” according to Paul Lyon, executive director of the Committee for Justice for All, which he describes as a victim’s rights advocacy group. “I think the wheels are off the wagon, at this point. Their ability to make people believe that physicians are leaving is the key for them to get caps on pain and suffering in malpractice lawsuits,” he adds.

Ads and slogans disseminated by the PMS have indeed emphasized that the malpractice crisis is causing the supply of Pa. physicians to dwindle. A widely cited newspaper ad run by the PMS reads, “Will the last doctor leaving Pennsylvania please turn off the X-ray machine?”

Such an emphasis may have led the public to expect that the raw number of Pa. physicians is declining. When advocates, politicians and journalists cite credible numbers to the contrary – regardless of whether or not those numbers fail to give a true count of practicing physicians, or fail to capture regional scarcity of high-risk medical services, or fail to provide a meaningful index of the malpractice crisis – physician credibility is jeopardized.

The PMS says it stands behind its claims and dismisses the allegation that they are misleading as an unsurprising attempt by adversaries to try to derail movement on tort reform, particularly a Pa. House vote on SB9, according to PMS Executive Vice President Roger Mecum. The bill, which would permit Pa. residents to vote on whether to amend the state Constitution to allow for caps on non-economic damages in medical malpractice cases, passed the Senate earlier in the year but has languished in the House Judiciary Committee for months, making a vote on it by early July imperative for the cap proposal to proceed to the next phase of public referendum – something tort reform opponents fiercely oppose.

As this story went to press in late June, SB9 appeared likely to die in the House Judiciary Committee unless members passed an unprecedented resolution to override Committee Chairman Dennis M. O’Brien’s (R-Philadelphia) refusal to bring the bill to a vote by early July.

Viewed in the context of the impending urgency of SB9’s fate, says Mecum, the question of whether Pa. is losing physicians is not so much a “controversy” as it is a high-stakes pressure tactic by the trial lawyer lobby, its interest groups, and legislators who oppose caps to divert attention away from mounting problems of access to physician services.

MCARE enrollment numbers are not reliable indicators of physician supply trends, according to Mecum. “You cannot look at the MCARE number and try to equate it with the number of full-time physicians who are providing direct patient care. It is a number that applies to physicians who are doing some medical practice,” Mecum adds, noting that MCARE enrollment is required by physicians who conduct more than 20 percent of their practice in Pa., and that the number would include double-counts of residents who moonlight at more than one institution, as well as part-time practitioners. The 2003 MCARE abatement number also includes 209 nurse midwives, according to the Pa. Insurance Department.

MCARE figures are unreliable indicators of physician supply for other reasons as well, according to Stephen Foreman, Ph.D., J.D., M.P.A., assistant vice president for research at the PMS:

· MCARE data significantly overcounts the supply of Pa. physicians in active practice who are actually offering patient care because it includes physicians who are academic, residents in training, researchers, administrative, out-of-state and others employed by companies, as well as physicians who have already left the state but not cancelled their licenses.

· Pa. has seen a temporary increase of nearly 1,000 doctors in training during the past two years – included in the MCARE count, but few of whom are staying in the state after they complete their residency.

That last figure, according to Foreman, accounts for the press reports that quote the PMS as “admitting” that Pa. had gained 800 physicians since 2002, while the reports do not mention that they are residents in training whose practice is limited by supervisory requirements and whose temporary stay in Pa. masks a more reliable count of full-time, actively practicing Pa. physicians. Only 17 percent of residents, for example, remained in Pa. in 2003, while the decline in Pa.’s ability to retain them is accelerating, according to Foreman.

Public release of the MCARE abatement application numbers, and the ensuing press reports and legislator pronouncements charging the PMS with dishonesty about Pa.’s physician loss, has prompted the PMS to purchase AMA Masterfile statistics for Pa. back to 1978, which Foreman regards as the most reliable data source for ascertaining physician manpower trends at the state level. These new data, he says, permit counts to pinpoint only actively practicing physicians and to account for both physician departures from, and arrivals to Pa.

The new data show a trend of increased physician departures and reduced recruitment of new physicians, both of which have led to a net decline in the number of practicing Pa. physicians, according to Foreman. At the end of 2001, the data show that there were 29,744 physicians (excluding residents in training) who listed Pa. as their work state and who were involved in providing direct patient care. At the end of 2002, there were 29,530, and the number dropped to 29,240 by the end of 2003.

Foreman says the numbers substantiate the claim that Pa. is losing doctors in the aggregate: the state lost a net 214 active practicing physicians in 2002 and another net 290 in 2003. The state experienced its first ever net loss of 145 active practicing physicians in 1999, reversing 20 years of substantial physician growth in Pa., averaging more than 700 physicians per year. Foreman notes that Pa.’s only physician net loss years in 25 years – 1999, 2002 and 2003 – have occurred during the current medical liability crisis.

Aggregate numbers aside, the very emphasis of physician supply deflects attention from more serious problems, says Foreman:

· Statewide numbers distort local problems and problems in particular specialties. Growth in family practice and internal medicine, for example, may be masking serious declines in some specialties. Rural regions are seeing serious reductions in an already scarce supply of specialists.

· Numerical counts mask a serious consequence of the medical liability crisis, namely, that high-risk specialists who have not left the state are nevertheless being driven to give up the delivery of babies or high-risk procedures, to reduce their scope of practice, and to defer upgrading equipment due to costs.

These data are notoriously difficult to secure, and are included in the anecdotal reports appearing on Donna Rovito’s “Disappearing Doctors” list. As of June 2004, the list contained references to 1,014 physicians who have relocated to other states; 408 who have been forced to significantly alter their practice of medicine or curtail services; 194 who have retired earlier than they had planned; and 254 who were either laid off, forced to close their practice, gave up the practice of medicine, or passed away with no hope of replacement – all as a result of the burgeoning medical liability crisis in Pa. The list’s cover sheet notes that the most recent physician losses will not be reflected in medical licensure or insurance figures for several years, and that curtailment in services or other alterations in practice will never be reflected by any quantitative measure.

Mecum says the PMS has never regarded the list as anything other than a barometer of physician practice changes in response to the malpractice crisis – including leaving the state, retiring early and restricting risky procedures. “It’s not a scientifically valid indicator of the number of physicians who have left Pa. We’ve never said that,” Mecum adds.

Donna Rovito affirms that the PMS has always been careful about the way it cited her list, never sending out a copy of the list on its own – instead, referring interested parties directly to Rovito to obtain the list – and never promoting it as statistical – instead, describing it as a collection of anecdotes by a member of the PMS Alliance (she is currently past legislation chair of the Alliance). For at least a year now, says Rovito, the cover sheet of the list itself includes a methodology qualifier, which currently reads: “This list does not represent itself to be a statistical analysis of the number of physicians practicing – or not practicing – in Pennsylvania. It is, rather, a series of loosely connected ‘snapshots’ of the growing problem of access to care in Pennsylvania.”

Rovito says she emails quarterly updates of the list to all Pa. legislators, along with the list’s methodology qualifiers – both on the cover sheet of the Word document containing the list and in the text portion of the email memo to which it is attached. “All legislators see the qualifiers,” she says, adding that, “There’s really no good reason to misinterpret it, unless you’re just either not paying attention, or you want to.”

In her information request to build the list, Rovito says she uses some 7,000 email addresses to solicit health care professionals around the state to send information about themselves or any colleagues who have left the state or altered their practice since Jan. 2001 in response to the malpractice environment. Rovito says she gets 20 to 30 email responses per week to the information request, and concedes that, “as a single volunteer sitting at a computer in Allentown,” she does not independently verify each response, which may render the list subject to factual error. “I rely on the honesty and accuracy of the people who are providing the information,” says Rovito. As her list of contacts has grown over the two years she has developed the list, Rovito says she is getting more multiple reports corroborating a physician’s reported behavior, and the proportion of first-hand reports has grown to about 25 percent.

“I will continue to do the list until the day the medical society says it is no longer valuable, and they’re not saying that,” Rovito declares, noting that the list is now organized by county to further pinpoint regional impacts.

HAP also dismisses the physician supply flap as a diversion by the trial bar to manipulate data, confuse people and create controversy to erode support for SB9, according to Jim Redmond, HAP’s senior vice president of legislative services. “Would it have been more helpful to have clearer information or a credible data source from the beginning? Yes. Would it have mattered? Probably not,” says Redmond.

HAP has an easier time than the PMS in arguing that the malpractice crisis is causing problems in access to care, which is much more visible when hospitals eliminate obstetrics units and close trauma centers, Redmond says, noting that HAP has used these incidents in its lobbying information about hospitals’ inability to recruit physicians, particularly in high-risk specialties.

Credibility Impact

While the PMS is now using a new data source – the AMA Masterfile data – in its lobbying efforts, tort reform opponents maintain that the MCARE numbers flap has produced lasting damage to the medical society. In the short term, according to Rep. DeWeese, “The inexorability of caps, as politically perceived six months ago, has certainly been extinguished. There may some day be a level of support to sustain caps. But the issue has lost its image of invincibility.”

“They’re impressing legislators that they’re not to be believed, and that the alleged malpractice crisis is not what it’s cracked up to be,” says Phenicie. Referring to the impending vote on SB9, Phenicie adds, “Categorically, whether they win or lose this time, it will take years to rebuild doctors’ credibility as a political force.”

Has the PMS set itself up for skepticism by failing to provide credible physician shortage numbers while running ads that emphasize shortage? “Perhaps. But we stand behind our data,” says Mecum, noting that he is not surprised that the MCARE numbers were puzzling to some, in light of several years of first-hand experience with access-to-care problems felt by legislators and the public.

“Part of the problem has been that one ad that we ran. Another thing is Donna Rovito’s list, which we never tried to portray as a well-researched, accurate number,” he adds.

The ad was designed to draw the public’s attention to the issue that Pa. has a lawsuit problem that is resulting in physicians leaving, while the provocative headline, “Will the last doctor leaving Pennsylvania please turn off the X-ray machine?” was in line with typical advertising strategies, Mecum explains.

That approach, by dramatically drawing attention to the notion of aggregate physician shortage, may have the unintended consequence of deflecting attention away from the specialty- and region-specific physician access problems that are more important, albeit more difficult to render in the form of numerical data or dramatic slogans.

Mecum says the PMS has been emphasizing those access issues to legislators all along, refuting the charge that the PMS has somehow been “deceptive” in its lobbying campaign.

Legislators ultimately may interpret the physician supply controversy more as a partisan political battle rather than a PMS credibility gap.

“A lot of the reaction is colored by predisposition. If you’re adamantly in favor of SB9, this [supply controversy] is unlikely to sway you. If you are adamantly opposed to it, you may use it as further evidence of your position. I don’t think it’s swaying people on either end,” believes Rep. Daylin Leach (D-Montgomery).

The physician supply controversy may have some impact on legislators in the middle, from the standpoint of assessing the severity of the malpractice situation, but not from the standpoint of questioning the honesty of the medical society, says Leach. “The total number of doctors in the state does not tell the whole story. Any study can be inaccurate, and statistics can be misinterpreted” he says. Leach says he meets regularly with a bipartisan group of legislators who are “middle of the road” on tort reform issues and who are almost unanimous in the belief that there is a real malpractice problem in Pa., while there is a diversity of opinions about solutions.

While he supports SB9, Leach says he is disappointed that lobbying efforts have focused on caps, rather than other reforms he endorses, such as special medical claims courts, neutral expert witnesses, frivolous lawsuit curtailment and remittitur reform. “But we never hear about any of these from physicians,” says Leach.

“I don’t know too many people, legislators included, who don’t have first-hand knowledge of physicians leaving the state as a result of the malpractice crisis,” according to Rep. Ellen Bard (R-Montgomery), who says the concern is widespread in the House Republican Caucus that physicians are leaving the state and health care is suffering as a result. “I don’t feel that there has been a significant impact on the Republican side from this issue [the physician supply controversy],” says Bard.

“Those who are talking about this issue in the press have a reason of their own to be doing this,” Bard adds, noting that Veon and DeWeese have both opposed most tort reforms in the past, and were the ones who have brought the lawsuit challenging joint and several liability reform.

“These statistics [the MCARE numbers] don’t have a whole lot of meaning. You have to pay attention to specialties leaving. All you have to do is listen to your constituents when they call up and tell you that their third OB has left the Commonwealth or gone out of business, ask residents at any of our fine medical schools where they’re going to practice medicine. When virtually all of them tell you they’re not going to practice in Pennsylvania, you know that Pennsylvania is losing out,” says Sen. Jeffrey Piccola (R-Dauphin). “I don’t think it is only a supply issue. That’s part of the equation. It’s also an access and quality issue. The information is everywhere. It’s not difficult to find,” Piccola notes. Even if statewide physician numbers remained flat, Piccola adds, access will still be diminished because Pa. has a high utilization rate for medical care, and an aging population that will further boost demand for services.

Even legislators identified by the Pa. Bar Association as “swing voters” on the effort to force SB9 to a vote recognize the physician supply controversy to be a creature of politics. “When you have two adversaries who are at each others’ throats, so to speak, it’s very difficult to get a full picture,” says House Insurance Committee Chair Nicholas Micozzie (R-Delaware). Micozzie says he believes the real number of physicians in Pa. is somewhere in between the statistics advanced by PaTLA and PMS.

Micozzie says he would probably support SB9 if it came to a vote, although he has reservations about the fairness and efficacy of caps, but he believes the “discharge resolution” – which would force a vote on SB9 by overriding the committee chairman – would set a bad precedent in Pa. He shrugs off the physician supply controversy as having any impact on his views.

Micozzie believes that other political influences will have a far greater impact than the physician supply issue on how swing voters will vote on the fate of SB9. A swing vote on the discharge resolution will likely be guided by whether or not a legislator is concerned about circumventing the committee process, while a swing vote on SB9 – with its scope narrowed to malpractice lawsuits, rather than broadened to general tort – is based on whether a legislator thinks the business community should be included in a caps bill, says Micozzie.

Other political factors further crowd out the relevance of the physician supply question: swing voters in the House who are supporters of PaTLA know that SB9 would probably pass only if unamended, says Micozzie. They could vote in favor of SB9, then add amendments to it in order to kill it, knowing that the Senate would probably not vote on those amendments, he adds.

Would Better Information Matter?

Although the present controversy was made possible by an information vacuum regarding physician supply, combined with provocative slogans and nonscientific collections of anecdotes that Pa. is losing physicians, it is not clear whether the difficult task of securing and deploying credible data would be worth the effort, given the partisan predispositions of legislators.

The PMS continues to focus on noneconomic damage caps and MCARE abatement extension in its lobbying, says Mecum, while its use of AMA Masterfile data is intended to show that the concern about Pa.’s loss of physicians is, in Foreman’s words, “Real, demonstrable and significant,” and “A far cry from fear mongering.” The PMS may shift the focus of its advocacy away from the “losing physicians in the aggregate” message, and instead focus on specific regions and specialties that are hardest hit by the malpractice crisis, Mecum says. Rather than arguing about whether Pa. had a slight loss or gain in physicians in recent years, according to Foreman, policymakers should focus on the dramatic drop in medical resident retention, which he says is the most compelling trend coming out of the new data.

Reliance on a raw count of practicing physicians remains a superficial way to account for physician “supply,” which is meaningful only inasmuch as it affects access to care, which in turn necessitates a complex calculus of demand and productivity factors specific to given specialties and geographic regions, including scope of practice reduction, number of hours delivering care, age of practicing physician workforce, proportion of employed physicians (which some studies suggest is inversely related to productivity), recruitment trends, and probably several other variables.

There is no consensus among researchers on how to measure whether a given supply of practicing physicians is adequate to meet the demand for medical care, which Foreman says is expected to grow significantly in Pa., giving its high concentration of aging citizens relative to other states.

Studies emanating from the Project on Medical Liability in Pennsylvania, funded by the Pew Charitable Trusts and devoted exclusively to examining important aspects of the crisis, are not addressing the question of whether the state’s malpractice environment is creating a shortfall of physicians. The sole Pew study that focuses on physician supply – by Harvard researcher Michelle Mello, J.D., Ph.D., and due to be released soon – will consist of survey results about what changes Pa. physicians in five high-risk specialties plan to make in their practices in response to the state’s malpractice environment, as well as survey results from residency programs in six specialties that will compare medical resident retention rates over the past five years. The study will not draw conclusions about whether physician departures are causing a shortage in Pa., or whether a shortage exists in Pa., according to Mello.

A recent federal study on how malpractice costs affect physician behavior offered some provocative findings, as well as serious limitations in methodology. The General Accounting Office’s (GAO) Aug. 2003 study, Medical Malpractice: Implications of Rising Premiums on Access to Health Care analyzed assertions of physician departures from five states with reported malpractice-related problems – including Pa. – using survey results, information compiled by provider groups, and anecdotal reports. The study noted that most of its surveys had low response rates, typically 20 percent or less, making survey findings unlikely to be representative of the actions taken by all physicians.

Among the study’s conclusions was that rising malpractice premiums have contributed to physician access problems – including emergency surgery and newborn deliveries – on a localized rather than widespread basis, often in rural locations where maintaining an adequate number of physicians may have been a long-standing problem, and typically involving patients having to travel further to receive care.

Those findings were based partially on provider self-reports of practice closures or reductions, an audited sample of which proved to be unsubstantiated, raising questions about the soundness of data from that source. The study also noted that, despite the reported departures of 30 orthopedic surgeons from Pa. from 2001 to 2003 – the largest single reported loss of specialists from the state – the rate of orthopedic surgeries among Medicare enrollees in Pa. increased steadily between 1997 and mid-2002, as it has nationally.

According to the Committee for Justice for All, the GAO study does not offer compelling impetus to lift a constitutional ban on capping malpractice awards. Says Lyons, “There has to be evidence of a widespread crisis, and there’s not. Until we know whether there is an access problem, legislators cannot possibly consider taking away people’s rights with such sweeping public policy revision.”

Therein may lie the ultimate obstacle to further reform: the only compelling evidence to some legislators is an actual, serious access crisis. Any fresh data on Pa. physician supply or access, in the absence of a present emergency, may very well end up taking a back seat to political predispositions of legislators.

DeWeese, referring to PMS’s recent data showing a net loss of over 500 Pa. physicians in 2002 and 2003, says that, “If there are about 34,000 doctors in Pennsylvania and only 500 have migrated hither, thither and yon, that’s 500 too many, but that does not reach the level of calamity that has been reported by the medical community.”

In the face of data that the PMS regards as publicly verifiable and the best that is available for physician trending purposes, as well as data on medical resident turnover and other localized access problems, DeWeese continues call for further study of the issue. “We have to all agree that solid numbers are paramount. It doesn’t seem controversial at all to me to want to provide a bona fide count,” says DeWeese.

To that end, the task force that he and Veon want to create to determine if an access emergency exists faces an ambitious charge, given the short time it would have to confront conceptual and methodological challenges even nationally recognized researchers have not overcome in an attempt to study physician access issues.