Doctors are caught between lawsuit fears and health insurance denials

Gov. Brian Kemp is right to push for tort reform to reduce the practice of defensive medicine and prevent frivolous malpractice claims in Georgia. But if the state is truly committed to protecting its physicians and ensuring access to quality health care, more must be done.

Georgia faces a severe physician shortage, and the problem is growing. According to the 2022 Georgia Healthcare Workforce Commission, the state will need to add 66,000 new health care positions by 2032 to meet rising demand.

Obstetric care is particularly strained. As of 2020, 82 of Georgia’s 159 counties lacked a single obstetrics/gynecology specialist. Another 15 counties had only one provider. This means more than half of Georgia’s counties do not have adequate obstetric care, forcing many women, particularly in rural areas, to travel long distances or forgo care altogether. No wonder Georgia ranks near the bottom of the 50 states for maternal morbidity and mortality.

Malpractice lawsuits are a major factor behind these disturbing numbers. According to the American Medical Association, obstetrician-gynecologists face among the highest rates of malpractice claims, with 62.4% experiencing a lawsuit at some point in their careers.

Tort reform is critical for protecting access to maternal health care in the state, according to Dr. Genevieve Fairbrother, CEO of Atlanta Women’s Healthcare Group — which delivers approximately 15,000 babies a year in Georgia. Massive lawsuit damage awards are deterring doctors from practicing in the field, she warns.

“Georgia is facing a critical challenge in retaining obstetrician-gynecologists,” she says. “Our state’s medical professionals grapple with … declining reimbursements and soaring malpractice costs, which significantly hamper our ability to recruit doctors and maintain high-quality practices.”

But tort reform alone won’t cure what ails doctors and our state’s health care system.

Health Insurers have tightened their grip on medical treatments, routinely denying services as “medically unnecessary.” They are particularly aggressive in their denials through Medicare Advantage – the federal program that funnels taxpayer dollars earmarked for the care of seniors and disabled Americans through private insurance companies.

Unlike with traditional Medicare, Medicare Advantage plans give insurance providers the power to approve a range of medical procedures. But insurance corporations regularly abuse this “prior authorization” authority. A 2024 survey from the American Medical Association found 93% of physicians said that prior authorization delays access to care, with 29% reporting that it has led to “a serious adverse event” for a patient in their care.

The goal of these denials is not medical prudence but insurance profit — reducing utilization of services to maximize insurance corporate earnings.

Physicians are not just frustrated. They are trapped in an ethical crisis. They are forced to fight insurance companies for treatments they know their patients need, diverting their time and energy away from care and into endless bureaucratic battles.

When doctors and nurses are systematically prevented from fulfilling their professional oaths because of insurance-driven policies, they are left feeling powerless, ethically compromised and unable to uphold the very principles that define their profession. Researchers have coined a term for this painful, untenable situation: “moral injury.”

Moral injury is part of what’s making it harder to retain physicians and other clinicians in Georgia. As it stands, 3.7% of the state’s health care workforce leaves the field each year.

Doctors suffer from “more than just burnout and frustration,” says Carol Paris, past president of research and advocacy group Physicians for a National Health Program. “Doctors don’t need yoga and meditation, we need freedom from the shackles of a corporate health insurance industry that constrains us from giving patients the treatment we took an oath to provide.”

Physicians did not take an oath to serve insurance companies. They didn’t sign up for a profession that is attacked with frivolous lawsuits. They took an oath to serve their patients to the best of their ability.

Tort reform to prevent defensive medicine is important. So is health insurance reform. Without both, we risk driving more doctors out of the profession, deepening the health care crisis and leaving countless Georgians without the care they deserve.

The choice is clear: Georgia must stand with its physicians and remedy the two ailments that plague them. A healthy future depends on it.

Credit: KAYLINN GILSTRAP

Credit: KAYLINN GILSTRAP

Mark Craig is CEO of Write-Off Warrior, a research and advocacy firm dedicated to saving rural hospitals and improving health care access.