As published as an OpEd in The Hartford Courant, May 1, 2005.

Crisis Poisoning Obstetrics

By James F.X. Egan

Trial lawyers suggest that their lawsuits are removing bad doctors from practice. I believe the opposite is true, especially in the critical field of obstetrics, where some of our best and brightest doctors no longer deliver babies because of the malpractice crisis.

At the University of Connecticut School of Medicine and medical schools across the country, there has been a sharp decline in the number of graduates choosing to pursue obstetrics. The National Resident Matching Program reports that since 1997, the number of U.S. medical school graduates choosing OB-GYN has declined 21.8 percent. The UConn School of Medicine has witnessed a more rapid decline. The number of graduates choosing OB-GYN fell from an average of seven or eight in a class of 86 students over the past two decades to only three students this spring.

Medical students repeatedly tell me and my colleagues that, although they are intrigued by the fascinating medical problems posed by our specialty, challenged by the surgery and exhilarated by the joy of participating in the birth of a baby, they choose other specialties because obstetrics and gynecology are in the crosshairs of the malpractice crisis.

Furthermore, many established and successful physicians who practice obstetrics and gynecology are no longer delivering babies. This was illustrated by the April 2004 issue of Connecticut magazine, which published a list of top doctors in Connecticut. Four women from the Hartford area were selected in the field of obstetrics and gynecology. They are wonderful clinicians who have earned the respect of their colleagues through their dedication, skills, compassion and knowledge. However, of the four chosen OB-GYNs, only one delivers babies. This sad fact is a direct result of skyrocketing malpractice premiums - currently $167,000 per year in our area and closing in on $200,000.

In fact, this year, many of the applicants to the obstetrics and gynecology residency program at the UConn Health Center, Hartford Hospital and New Britain General Hospital wrote candidly of the lack of support for their decision to choose those fields. One said that the "response from my parents and friends when I finally announced that I had found my field, obstetrics and gynecology," was: "You want to be an obstetrician. Do you know how much you are going to pay for malpractice? You're going to get sued and the hours are long." Another was told of "the sleepless nights, the physical exhaustion, the mental fatigue and the high malpractice insurance costs that are part of this profession." A third noted that "classmates have asked me what I see in OB-GYN. They want a lifestyle with 9-5 hours, no call and minimal liability."

This is the discouraging advice our medical students are hearing. This is why applications in our specialty have fallen so sharply.

I am in no way defending malpractice. There are legitimate errors in medicine, and patients should have recourse under the law. However, the law must be fair and evenly applied. Unfortunately, there are capricious lawsuits that seek damages for bad outcomes that are not preventable. A good lawyer can persuade a jury to award damages often enough that insurance companies don't want to risk a trial and will settle out of court. Years of practice have taught me that there are limits to what medicine can achieve: Despite 35 years of fetal monitoring and dramatic increases in the Caesarean section rate, there has been no change in the rate of cerebral palsy.

Our family is no stranger to the effects of cerebral palsy. One of our three grandchildren, Jack, is a beautiful 3-year-old with a sweet disposition who has never spoken, rolled over, crawled or reached for my glasses. He has a feeding tube and suffers from severe spastic quadriplegia. Our son, his wife and their 5-year-old daughter are doing a wonderful job of caring for him. They clearly understand and have lovingly embraced the duties and responsibilities attendant to raising a severely disabled child. This experience has made me more sensitive to the challenges faced by families who have a child with cerebral palsy or other major disabilities.

The legal climate is depriving our specialty of the best and the brightest. Trial lawyers are not removing bad doctors from practice; they are preventing the best ones from continuing to practice and frightening our brightest students away from a truly wonderful career. This unfortunate trend will continue until the malpractice crisis is resolved.

James F.X. Egan, M.D., is a professor and chairman of the Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington.