AMA Medical Indemnity Fax-Poll
An AMA fax-poll of doctors conducted in late August and early September 2002 shows that one in five doctors (19.2 per cent) are considering winding back the provision of some types of medical services because of the medical indemnity crisis.
Of the 3142 doctors polled - across all specialties, all States, cities and regions, AMA members and non-members - 1156 responses were received, a response rate of 36.7 per cent.
AMA President, Dr Kerryn Phelps, said today that the poll reflects the anecdotal evidence that has been flowing into the AMA since United Medical Protection (UMP) went into provisional liquidation in April.
"As the Government continues to fail to provide certainty over their future, more and more doctors are being forced to make important career decisions," Dr Phelps said.
"The AMA poll shows that areas of health need - outer suburban and regional areas - will be hardest hit by doctors leaving practice or reducing services because of the crippling effect of medical indemnity premiums.
"Of greatest concern is the large number of obstetricians and GP proceduralists who are deciding not to deliver babies any more. This is a monumental social problem for the whole community and a huge political headache if the Government does not resolve the crisis."
Of GP respondents, 17.6 per cent will cease the provision of some types of services and 2.7 per cent say they will stop practice altogether. The situation is similar with procedural GPs, with 23.3 per cent ceasing the provision of certain services (including delivering babies).
Of Obstetrician and Gynaecology specialists, 28.4 per cent will give up providing some types of services - indicating a move away from obstetrics to concentrate solely on gynaecology - while 4 per cent will give it away altogether. Almost 30 per cent of Neurosurgeons, Plastic and Reconstructive Surgeons and Orthopaedic Surgeons indicated they would cease providing some types of services (27.3 per cent), while 8.2 per cent of general surgeons indicated they would cease practising entirely.
Dr Phelps said the poll shows similar concerns among anaesthetists and physicians with many indicating they will move from private practice to public.
"The Government's medical indemnity guarantee is leaking like a sieve," Dr Phelps said.
"This poll is compelling evidence that doctors and their patients need to see a comprehensive long-term solution to the medical indemnity crisis to give doctors the security to continue working."
CONTACT: John Flannery (0419) 494 761
Sarah Crichton (0419) 440 076
Australian Medical Association Limited
ABN 37 008 426 793
42 Macquarie Street, Barton ACT 2600: PO Box E115, Kingston ACT 2604
Telephone: (02) 6270 5400 Facsimile (02) 6270 5499
Website : /
President: Dr Kerryn Phelps
Secretary General: Dr Robert Bain
15 September 2002
AMA Medical Indemnity Fax-Poll
Background
A fax-poll questionnaire (see p4) was sent to 3,142 practitioners in private practice on 12 August 2002. The survey covered all craft groups and geographic regions. It was sent to AMA members and non-members. GPs and Obstetrics were over-represented in the sample - however as the fax-poll has been analysed on a craft group by craft group basis, the over representation does not affect the findings on premium increases by craft group (other than perhaps increasing the reliability of the data for those groups).
As at 26 August 2002, 1156 questionnaires had been returned representing an overall response rate of 36.7% - much higher than normal. The response rate by peer group is set out in Table 1 below.
| Response Rate |
| Pathology | 5.6% |
| Diagnostic Imaging | 6.8% |
| General Practice - Non Procedural | 31.6% |
| Anaesthetics | 56.1% |
| Physician | 33.0% |
| Surgery | 36.6% |
| Gynaecology | 43.8% |
| Obstetrics | 50.7% |
| Neurosurgery | 57.4% |
| General Practice - Procedural | 33.7% |
| Total | 36.7% |
There were too few responses from pathology and radiology for the sample to be valid. The following discussion presents results for the other peer groups.
The two main areas of interest in the poll were the extent of increases in Medical Indemnity premiums from 2001 to 2002 by peer group; and the impact of the medical indemnity crisis on the future practice intentions of those surveyed. These areas will now be addressed in turn.
Premium Increases
The extent of premium increases by peer group found in the fax poll is set out in Table 2 over the page.
Of note is that, at the time of the survey, only around half of the respondents had received notification of their premiums for this year.
It was also clearly evident that a significant proportion of the respondents had already changed their practice mix or quantum as a result of increasing premiums. It is hard to distinguish whether the change in the cost of insurance faced by individual practitioners was entirely due to the change in price charged by the insurer or was a reflection of the practitioner ceasing the provision of high risk services or scaling back the overall number of (privately provided) services.
| Peer Group | Premium 2001-02 | Premium 2002-03 | % increase | ||
| (3) Non-procedural GP | 3,239 | 4,198 | 29.6% | ||
| (4) Anaesthesia | 14,445 | 20,166 | 39.6% | ||
| (5) Physician, Psychiatry & Dermatology | 7,947 | 10,329 | 30.0% | ||
| (6) Surgery n.e.i. | 22,272 | 28,610 | 28.5% | ||
| (7) General, Vascular & Gynae. Surgery | 23,849 | 28,561 | 19.8% | ||
| (8) Obstetrics | 39,219 | 58,155 | 48.3% | ||
| (9) Neuro, Ortho, Plastic & Recon. Surgery | 31,450 | 45,063 | 43.3% |
It is intended that the survey be repeated in February 2003. This would enable a more complete picture of increases to be gained and provide a more up to date indication of changes to practice profiles being undertaken by practitioners in response to the increases in premiums.
Impact on Practice Intentions
The results of the answer to the question on future practice intentions are set out in Table 3 below.
Table 3: Compendium of Practice Intentions
Peer Group | Ceasing practice altogether | Reducing services but not ceasing practice altogether | Moving a significant portion of your practice into the public sector | Ceasing the provision of certain types of service. | Total intending to change in some way |
Anaesthetist | 6.3% | 6.5% | 4.2% | 22.9% | 39.8% |
GP - Non Procedural | 2.7% | 9.0% | 3.0% | 17.6% | 32.3% |
GP - Procedural | 1.3% | 9.3% | 9.2% | 23.3% | 43.1% |
Surgery -Neuro, Orthopaedic, Plastic etc | 3.0% | 10.6% | 6.1% | 27.3% | 47.0% |
Surgery - other | 8.2% | 10.1% | 4.6% | 19.4% | 42.4% |
Gynaecology only | 0.0% | 15.3% | 0.8% | 18.6% | 34.7% |
Ob & Gyn | 4.0% | 11.9% | 7.9% | 28.4% | 52.1% |
Physician | 4.2% | 10.1% | 9.4% | 11.0% | 34.7% |
Unsurprisingly, the peer groups showing the highest inclination to change their profiles in some way were Obstetricians & Gynaecologists (O&G - 52.1%), Neurosurgeons, Orthopaedic and Plastic and Reconstructive Surgeons (47%) and GP Proceduralists (43.1%).
Of the O&G respondents, 28.4% indicated that they intended to cease the provision of some types of services and a further 7.9% indicated an intention to move a significant proportion of their services into the public sector. A high proportion of GP Proceduralists (23.3 %) also indicated their intention to cease the provision of certain types of services or to move services into the public sector (9.2%). Over 8% of respondents from the general surgery peer group (8.2%) indicated an intention to cease practice altogether as a result of the indemnity crisis followed by 6.3% of Anaesthetists.
Key points are:
The above responses have potentially very serious implications for many areas of medical practice and provide additional weight to comments from the profession as to the seriousness of this issue and the implications for the continued availability of services such as obstetrics in the private sector; as well as many procedural services provided by GPs particularly in rural and remote locations.
These results should also come as a wake up call to the private health insurance industry, which has to date been invisible on the indemnity issue. If the range of services available in the private sector contracts, the attractiveness of private health insurance membership will decline.
Medical Indemnity - Fax-poll
Dear Colleague,
You will be aware of the medical indemnity crisis. The AMA is fighting this issue on several fronts and details are on the AMA website at
One key aspect of the medical indemnity crisis is the impact on medical fees. We are currently updating the AMA List of Medical Services and Fees for 1 November 2002.
The fax-poll results will be used to update fees and inform the AMA in its lobbying of Government and other groups. Results will be published in Australian Medicine and on the AMA website.
To assist us we would appreciate you completing the questions listed below in relation to your medical indemnity insurance premium and return by fax to 02 6273 5706.
Thank you for your assistance.
Kerryn Phelps
President
1. Specialty: 2. State:
- Premium: Call: Total:
5. Premium: Call: Total:
6. Insurer (optional):
If YES, will this involve? (tick one):
Ceasing practice altogether
Moving a significant portion of your practice into the public sector
- Ceasing the provision of certain types of service. Details: _____________________________________________________________________
Other - details: _____________________________________________________________________