LISLE - The Illinois Academy of Family Physicians, representing over 4,800 family physicians, family practice residents and medical students, strongly urges Governor Blagojevich to take a closer look at communities that may lose access to care as a result of the crisis created by skyrocketing medical liability insurance premiums. Many family physicians will confront enormous rate increases that take effect on July 1.

IAFP's membership survey conducted in May revealed that the exponential rise in medical malpractice premiums is the number one concern reported by 37% of respondents. Declining reimbursements finished a distant second at 24 percent. Further contact with members revealed that the crisis is affecting access to care for many communities.

Illinois family physicians are struggling to make ends meet. Currently the federal government continues a system where Medicare cuts are always a potential threat. Decreasing revenue sources, combined with increasing costs to provide care, leave physicians struggling to balance their budgets. Yet medical malpractice insurance reform is clearly the biggest concern. Many family physicians have already taken difficult steps; some no longer deliver babies, others have stopped taking new Medicare or Medicaid patients. Some physicians seriously wonder how long they can keep their practices afloat.

Illinois family physicians care for 70 percent of the state's population. If they can no longer provide primary care services, where will patients go for their healthcare? Family physicians are the only doctors who are distributed throughout the state, and are trained to treat 85-95 percent of the healthcare problems presented by patients. Who will care for Illinois if family physicians can't?

If family physicians give up procedures, retire early, close their doors or leave their state, patients in already underserved areas will have to travel greater distances for care. A broad-based solution is needed to ensure immediate relief for physicians and long-term reform for the system. A federal bill that could provide a long range solution remains stalled in the U.S. Senate. The state of Illinois has not addressed the runaway malpractice system at all. Who will care for the patients of our state if primary care providers like family physicians and obstetricians close their doors or no longer deliver babies?

Patients are facing a crisis in confidence when they can not be sure that their trusted physician will be there to care for them a year from now. The physician-patient relationship is the foundation of comprehensive, quality healthcare. That relationship will be destroyed if physicians retire early or leave the state. The Governor has pledged to make healthcare a priority for our state. His priorities will never materialize unless we have the primary care physicians to make those priorities reality.

After 16 years in practice, a family physician will close his practice on July 18^th. His two-physician family practice group also provides obstetric care, a dire need for this town of 6,000. However, when the malpractice insurance premium jumps from $28,000 to $87,000, this Greenville physician made the difficult decision to relocate to Kansas where premiums are lower.

The largest family practice group in Monroe County has five family physicians serving 20,000 patients. Two of those physicians gave up obstetric services as the malpractice premiums skyrocketed upwards. Currently, this practice now pays $165,000 plus $33,000 for tail coverage. Beginning July 1, that rate increases to $226,000 plus $33,000 tail coverage. The physicians fear they may not be able to continue operations much longer. Now they practice "defensive medicine," ordering more tests than they feel necessary and referring patients for outside counsel more often. Both of these tactics are necessary to protect themselves from litigation, but are also driving up the cost of healthcare overall.

A family practice center opened in 1996 affiliated with St. Mary of Nazareth Hospital and the founding family physician went solo in 1998. In 2000 he was forced to stop delivering babies when his malpractice insurance nearly tripled, from $5,897 to $15,955. By 2002 the rate is over $19,000 with no surgery or obstetric services. He is considering relocating to another state where he can find lower premiums. According to his sister, who manages the practice, "The number of patients coming into our office is decreasing because companies are downsizing or their employers are not offering insurance any longer. I do not think this practice can survive this crisis." Another Berwyn family physician is giving up obstetric and surgical assist privileges, even though she'll still pay $32,000 when her new rates take effect on August 6, up from $11,000. These physicians cannot raise their fees to offset the increased costs because of managed care contracts.

A solo family physician in Carbondale has practiced full time since 1979. He's switching insurance companies to avoid an increase of 50 percent, from $16,000 to $24,000. However, the doctor will still have to purchase "tail" coverage for $38,600. "For the first time in many years, I have taken out a business loan to pay for the tail coverage," he says. He's unable to compensate with increased fees since his managed care contracts, Medicare and Medicaid are fixed reimbursements. "I have concerns about the long range viability of the practice. If this trend continues I would have to consider relocating since I'm too young to retire."

A physician in a family practice group office revealed his malpractice insurance premium will jump by nearly $10,000 from $14,100 to $24,003. As a result, the doctor will do everything he can to limit his risk, by limiting what patients he's willing to see. Patients can also expect to see increased fees as the practice tries to balance out the dent in their finances from the increased premiums. Perhaps the most significant effect is on future for this physician, as he now plans to retire as early as possible. He only graduated residency training 17 years ago.

A family physician owns a solo practice in Marseilles. After 20 years, she no longer delivers babies so she can afford her insurance premium and she's no longer accepting new patients. When her premiums jumped to $16536 in 2002, she made the difficult decision to drop obstetrics and general surgery. Without those privileges her premium starting July 1 will be $15, 395. "Some women will need to go to other doctors to deliver their babies, even though I delivered for their first babies."

A solo family physician may be forced to close her practice at the end of the day on June 30. Her current insurance provider is leaving the market that day and she has yet to secure a new provider. In 12 years of medicine, she's never appeared in court or settled a malpractice claim. She is looking for new coverage, and so far has been offered only one option, with a premium of $60,000, plus $20,000 tail coverage for her group of three family physicians. "If I don't pay the increase, I'm out of business, because I won't go ‘bare,' I wouldn't' even be able to take a phone call from a patient for fear of litigation," she says.

A veteran physician has a solo family practice in Elmhurst. His malpractice insurance will rise from $19,300 to $28,000 this year. To keep costs from going $5,000 higher, this physician has stopped assisting in surgery and may have to increase his office fees to keep pace. "It's unfortunate because my patients still want me to assist in their surgeries, and I can't do it anymore," he says. After 17 years in practice, his patients will miss having him in the operating room with them.

Anette Mnabhi, D.O. is a new family physician who just opened Synergy Health Care in May. Although she's never been named in a malpractice claim, her insurance rates for full time practice will more than double, from $6,000 to $15,000. To reduce that insurance burden, Dr. Mnabhi has decided to reduce her patient contact to part time, seeing patients only 21 hours per week. "I would have been forced to take out a loan to meet the premium increase this year. By petitioning for part time status, I will be okay for now." But getting an appointment in a 21-hour week might be hard for her patients.

A young family physician just opened his solo practice in February 2002. On July 1, his malpractice insurance premiums will nearly double, from $15,000 to $28,000. According to the doctor, that amount is more than half of his 2002 gross income. "If I don't increase my gross revenue at least 100 percent by the end of the year, I may be forced to close my solo practice."

One member of a family practice group revealed that his practice is concerned about the future of their support staff. His malpractice insurance premium will jump by $6,140 to $23,203. "I don't know how long we'll be able to sustain our present services. Sooner or later we will have to cut back on the services we can offer," he says.

A solo family physician will pay malpractice insurance at the rate of $48,000, which includes $18,000 in tail coverage. The new premiums will equal a 30 percent cut in the doctor's salary. But without the tail coverage, he'd be forced to declare bankruptcy if he were ever sued. As a result, he plans to limit new patients and will have to refer more of his patients for procedures that he is forced to give up to attain lower insurance rates. Given the current conditions, he is considering closing his practice and re-enlisting in the Air Force.

Although he's been practicing medicine for 17 years, a family physician is not able to treat patients like he used to. Now that his medical malpractice insurance premiums have jumped over 51 percent this year from $15,124 to $22,949 he's had to limit his services. This doctor no longer delivers babies, can't assist in surgery, can't do flexible sigmoidoscopies to screen for colon cancer, and no longer can accept new patients.

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The Illinois Academy of Family Physicians is a professional membership society of over 4,800 members, including nearly 2,200 active family physicians from across the state..