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Medscape article: WV is third worst state for physicians to practice; state medical association responds

MORGANTOWN – The Medscape medical news site recently posted a piece ranking West Virginia the third-worst state to practice medicine in the U.S.

In the wake of that, The Dominion Post reached out to local and state medical leaders to get some perspective on how accurate the piece is, what it means, if it describes real problems that need solutions, and other questions.

Our story has two parts. This one gives an overview of the piece – a slide show and infographic – and the response of the West Virginia State Medical Association. A companion piece provides comments gathered at a roundtable with Mon Health System physicians.

The piece is called Best and Worst Places to Practice 2022. It bases its rankings on a number of criteria, including number of adverse actions against doctors, compensation, livability, burnout, (medical) resident retention, cost of living, malpractice payout amounts, physician density and tax burden (whether that’s income tax or business tax is not explained).

It says of third-worst West Virginia, “Picturesque as it may be, West Virginia presents numerous challenges for doctors, The state ranks in the bottom two quintiles for most measures, including compensation, tax burden, malpractice payouts, adverse actions against doctors, competition and resident retention [physicians who complete their medical residency and stay in state to practice].”

It continues, “West Virginia ranks last in public health and had the second highest level of medical liability premium increases in 2021, according to the American Medical Association.”

The one positive note: “Morgantown, a college town on the banks of the Monongahela River, is frequently recognized as a great place to live.”

Small consolation is that neighbor Maryland ranks second worst. The piece recognizes Maryland’s high ranking in access and health care quality, but calls the state economically challenging, with high taxes and malpractice payouts and tight competition.

Idaho, Georgia and South Dakota take the three best spots. Neighbor Virginia ranked 20th. Virginia has a high cost of living but rates high for livability, pay and health care.

The states between the top 25 and the bottom five aren’t listed in order or described.

Regarding insurance premiums, the AMA said of its review of 2021 rates, “After nearly a decade of fairly stable rates, the proportions of medical liability insurance premiums that have increased year-to-year over the past three years have reached highs unseen since the turn of the century.

AMA President Gerald E. Harmon commented, “The medical liability insurance cycle is in a period of increasing premiums, compounding the economic woes for medical practices that struggled during the past two years of the pandemic. The increase in premiums can force physicians to close their practices or drop vital services. This is detrimental to patients as higher medical costs can lead to reduced access to care.”

The AMA reported that 12 states saw premium hikes of more than 10% during 2020 and 2021. Illinois was worst, at 58.9%, followed by West Virginia at 41.7%. Third-place Missouri saw rates jump 29.6%. Neighbor Kentucky jumped 7.4%.

The Dominion Post contacted WVU (specifically the medical school), WVU Medicine and Mon Health.

WVU and WVU Medicine referred questions to the West Virginia State Medical Association, citing its mission: “The WVSMA advances health and promotes quality and safety in the practice of medicine in West Virginia by representing the interests of patients, public health and physicians.”

Dr. Lisa Costello, a WVUM pediatrician and president-elect of the medical association, spoke for the assocation.

“We’re pleased to practice in West Virginia,” she said. “I love working here and serving my home state.”

The association, she said, advocates about the importance of having a robust workforce. “It’s well documented that people tend to stay close to where they do their residency. A lot of med school graduates do their residencies here and many of those choose to stay here.”

Some of them don’t, for numerous reasons, she said, including lack of job openings in certain specialties here and incentives offered elsewhere.

“If you’re practicing in West Virginia, you want to serve rural America and you want to serve rural communities.” But some prefer other amenities available elsewhere. “People have to balance the decision for themselves. We certainly always want to make it a place people want to work and live.”

West Virginia does have some limited resources, she said. For instance, there’s just one pediatric cardiothoracic surgeon in the state. We’re seeing growth, “but we certainly have room to improve as well.”

The state saw some physicians leave during the pandemic, but that wasn’t limited to physicians.

“People are just choosing to leave health care in general, for multiple reasons,” she said. That’s being explored by the association and legislators. “It’s more than just one thing.” Multiple factors contribute to them leaving the area or the field altogether.

We discussed compensation, and the idea that many people, especially in relatively low-income West Virginia, consider physicians relatively wealthy.

Costello said people tend to look at the bottom number, which doesn’t give the full picture.

“I’m not in medicine for the money and if you talk to a lot of doctors, they’re not.” But she has a family and has to pay the bills.

The average medical school debt is close to $300,000, about the same as a house mortgage, she said. And then comes residency, ranging from three to nine years, more for certain specialties. The loan payments cost thousands. “That’s a pretty considerable kind of hole to start in.” People want to be fairly compensated for the work, including what it takes to get to that point.

On the topic of a physician’s tax burden, Costello said that residents earn about $50,000 a year working 80 hours per week. They enter practice and suddenly jump up the tax brackets while dealing with all their other expenses. A bipartisan 2021 bill – SB 100 – aimed to address that by establishing a tax credit for physicians who are new graduates and locate in West Virginia to practice medicine for at least six years.

The bill died without seeing a committee agenda.

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