What’s Up Doc Revisited: A Reply To Ted Frank (American Enterprise Institute)
Ted Frank finds it “curious” that I focused on the number of physicians practicing in Texas rather than the number of physicians per capita. Really? The Texas Medical Association (TMA) and the Texas Alliance for Patient Access (TAPA) used the number of physicians in their assertions. I used the same measure when saying they are wrong. Why is meeting their claims head on even remotely curious? To me, it would have been odd, and possibly unfair, to use a different measure than they did. When accusing others of spouting falsehoods, one should relate their claims faithfully and respond directly. Notice that Frank did not accuse me of misrepresenting their positions. Nor did he accuse me of being mistaken.
Frank did ask about physicians per capita, however, and this might be a better measure of access to health care than TMA or TAPA employed. I therefore quickly calculated the number of practicing physicians per 1000 Texas residents over time. The chart below displays the trend from 1990 to 2005. Again the growth rate is steady, and the increase from 2003-2005 is not especially impressive.
I also prepared a chart showing the 1-Year and 2-Year percentage change in the number of doctors per 1000 Texans. Again, the largest increases occurred in the period from 1997 to 2000—the years that earned Texas its place on the AMA’s list of states enduring a malpractice crisis that supposedly endangered patients’ access to care. The increases for 2004 and 2005 are below the 1- and 2-year averages for 1990-2002. Using physicians per capita rather than total physician population leaves the conclusion intact: access to care did not grow especially fast in the immediate post-reform years.
Looking at the licensing data, Frank contends that the number of physicians will jump sharply in 2007. Maybe it will. But that won’t change the assertions of TMA and TAPA from false to true. They claim the physician population surged in 2004 and 2005. That claim is false, and always will be. Moreover, no one can say how large the growth in 2007 will be. I spent an hour on the phone with a friend at the Texas Medical Board (TMB). He did not predict a massive up-tick in 2007. He said the TMB cannot process more applications without more FTEs, which he hopes the legislature will fund. My aim in pointing the bottleneck at the TMB was partly to build a fire under the tort reformers who sold Texans the 2003 reforms. Those who promised Texans more doctors should appropriate the money needed to clear the backlog.
Finally, as is his wont, Frank takes a swipe at attorneys and asserts that “[t]he median Texan came out ahead” on the 2003 tort reforms. As for attorneys, I agree (if this is Frank’s point) that the loading costs on malpractice payments are shamefully high. Doctors, hospitals and their liability carriers could reduce them considerably by paying valid claims without forcing patients to litigate. Maybe in the future, they will. A movement led by COPIC and gaining steam elsewhere gets money to injured patients quickly and avoids litigation. As for the median Texan’s wellbeing, Frank offers no evidence for his assertion and I know of none that would prove it.