University Times

HARRISBURG — High student debt and Pennsylvania’s sharply rising premiums for malpractice insurance are driving Pitt School of Medicine graduates out of the state to practice, the school’s dean told the state House appropriations committee Feb. 25.

In a 1998 School of Medicine survey, more than 70 percent of the University’s graduating medical students and senior medical residents expressed interest in practicing medicine in Pennsylvania, said Arthur S. Levine, Pitt medical school dean and senior vice chancellor for Health Sciences.

Among students set to graduate this year, the percentage was 30-40 percent, Levine said.

Last June, 85 percent of Pitt’s graduating medical students were in debt; their mean debt was $139,000, compared with the national mean debt among medical students of $109,000, according to Levine.

“Interest compounds on that debt while our graduates complete their residencies, so many of our graduates are ultimately going to face a debt of between $200,000 and $250,000,” he said.

Saddled with such debts and the prospect of paying the state’s high malpractice premiums, Pitt medical graduates “are all going to become interventional radiologists and move to Beverly Hills, not to rural Pennsylvania,” Levine warned.

This month, the state Senate is set to consider a legislative bill that senators may amend to limit non-economic (i.e., “pain and suffering”) damages against doctors sued for malpractice. Even with such a cap, there would be no limit on compensatory damages for lost wages or medical bills resulting from a doctor’s mistake.

The cap on non-economic damages, if approved by legislators this year and next, would require a referendum in 2005 to amend the state constitution. Then the state legislature would determine the actual cap figure.

Doctors say malpractice caps are essential. Trial lawyers oppose them.

Last month, more than 1,200 students from the medical schools of Pitt and five other Pennsylvania institutions (including Penn State and Temple) sent a letter to Gov. Ed Rendell declaring that “the soaring and uncontrolled cost of malpractice insurance in this state is a staggering obstacle to establishing a career here.”

Levine argued that student indebtedness, more than any other factor, is discouraging Pitt medical students from practicing in Pennsylvania: With less debt, young doctors could afford higher malpractice rates.

“The most important thing the commonwealth can do is to come up to the national average in state appropriations for medical education,” Levine declared.

Pennsylvania subsidizes medical education by about $11,000 per student a year, Levine noted, while the national average is $46,000 a year. Among the nation’s 76 public medical schools, Pitt’s ranks 72nd in the amount of state assistance it receives. (Penn State’s College of Medicine ranks dead last. PSU president Graham Spanier told lawmakers that changes in Medicare reimbursements and managed care have made it impossible for the medical college to continue surviving on clinical revenue generated by the PSU-affiliated Milton S. Hershey Medical Center. Penn State is seeking $30 million from the state over the next three years for its medical college.)

Raising Pennsylvania’s subsidy of the Pitt medical school to the national average would require increasing the school’s state funding from $6.5 million to $24 million a year.
“It would greatly reduce student debt and I think it would have a dramatic impact on the retention of young physicians in Pennsylvania,” Levine said.
Would it solve Pennsylvania’s doctor-drain problem? he was asked.

“It wouldn’t solve it completely,” Levine replied, “but it would be one hell of a good start.”

Pitt supports loan-forgiveness programs, he and Chancellor Mark A. Nordenberg told lawmakers. “A year of practice in the state in exchange for a year of loan forgiveness would be a very attractive notion,” Levine said. While Pennsylvania ranks near the bottom among states in supporting medical education, a new report by the Association of American Medical Colleges (AAMC) found that Pennsylvania ranked second, behind New York, in benefiting economically from its teaching hospitals and medical schools.

The AAMC study found that Pennsylvania’s academic health centers boosted the state economy by more than $26 billion in 2002, Levine said. But Pennsylvania will lose its advantage “if we don’t do something quickly about the debt of our students and malpractice costs,” said Levine.

Ironically, he noted, Pitt’s medical school is attracting more applicants, and higher-quality ones, than ever. “It’s an extremely competitive medical school,” Levine said. “I doubt that I would have gotten in. But the fact is, once they’re in they recognize the issues of tuition debt and malpractice, and it becomes a real problem to keep these [Pitt-trained] physicians and researchers in the state.”

Pitt dental graduates, too, are graduating with large debts and leaving the state, Levine told lawmakers — although it’s not as serious a problem, he said.

“There are many fewer dental students and more of them are from Pennsylvania, so there is more of a motivation for them to stay here,” Levine told the University Times following the House hearing. “Also, Pennsylvania’s dental malpractice premiums are about the same as the other states.’”

—Bruce Steele