State of Medicine Explained

Lehigh County Medical Society hosted a "State of Medicine" conference in an effort to regain physician autonomy in medicine and reestablish doctors as true advocates for their patients. Dr. Chaminie Wheeler serves as president and Dr. Greg Wheeler serves as a Board Trustee of Lehigh County Medical Society. This conference showcased 3 specific areas in the healthcare landscape in Pennsylvania where profits come before patients:

1. Restrictive Covenants Restrictive covenants in medicine, commonly known as non-compete agreements, are contractual clauses that prevent physicians from practicing within a certain geographic area or for a set period after leaving an employer. While these agreements are framed as protecting business interests, they ultimately serve to consolidate power in corporate medicine at the expense of both patients and physicians. By restricting where doctors can work, these clauses disrupt continuity of care, forcing patients to either travel long distances to continue seeing their physician or transition to a new provider, which can lead to delays in treatment and worsened health outcomes. For physicians, restrictive covenants undermine professional autonomy, limiting their ability to serve their communities and practice medicine in alignment with their values. Rather than fostering competition and patient choice, these agreements primarily benefit large healthcare corporations by reducing independent practice options, further entrenching the corporate control of medicine.
   

2. Scope of Practice Scope of practice defines the medical responsibilities a healthcare professional can perform based on their education, training, and licensing. While Nurse Practitioners (NPs) and Physician Assistants (PAs) play essential roles in healthcare, their training differs significantly from that of physicians, who complete four years of medical school followed by years of residency and specialized training. Expanding NP and PA scope of practice beyond their level of training, particularly independent practice without physician oversight, raises concerns about patient safety, fragmented care, and increased healthcare costs. Patients deserve transparency about who is providing their care, as the depth of training directly impacts diagnostic accuracy and treatment decisions. The growing trend of labeling all clinicians as "healthcare providers" obscures these distinctions, potentially misleading patients and eroding the physician-led model that ensures the highest standard of medical care. Clear distinctions between medical roles empower patients to make informed choices about their healthcare and preserve the integrity of the physician-patient relationship.
   

3. Venue Shopping Venue shopping in medical malpractice lawsuits allows plaintiffs to file claims in jurisdictions known for awarding higher payouts, regardless of where the alleged malpractice occurred. This practice drives up medical liability insurance costs for physicians, forcing many to practice defensive medicine where unnecessary tests and procedures are done to mitigate legal risks that increases overall healthcare costs risks for patients. Additionally, higher malpractice premiums can lead to reduced access to care, as some physicians may relocate or avoid high- risk specialties like obstetrics and neurosurgery altogether. Pennsylvania provides a clear example of these dangers. Prior to the implementation of venue reform in 2003, venue shopping caused a mass exodus of physicians, particularly OB-GYNs, from the state. With malpractice claims being concentrated in high-payout jurisdictions like Philadelphia, liability insurance premiums skyrocketed, forcing many obstetricians to stop delivering babies or leave Pennsylvania entirely. Between 1999 and 2020, the number of obstetric units in Pennsylvania hospitals declined by 40%, demonstrating the direct impact on maternal healthcare access. The 2003 reform, which required malpractice claims to be filed in the county where the alleged harm occurred, helped stabilize the medical liability environment, encouraging physicians to stay and ensuring greater patient access to care.

   
   

   However, the Pennsylvania Supreme Court’s 2022 decision to eliminate these restrictions has already triggered a surge in malpractice filings in plaintiff-friendly venues, setting the stage for history to repeat itself. In the first 20 days of 2023 alone, 57 medical malpractice cases were filed in Philadelphia, this was a 148% increase compared to the monthly average in 2022. This sharp rise signals a return to the legal environment that previously drove physicians out of the state, jeopardizing access to essential medical services. Notably, Philadelphia has seen some of the largest malpractice verdicts in Pennsylvania, including a record $183 million award in 2023 against the Hospital of the University of Pennsylvania for delays in performing a cesarean section, resulting in severe brain injuries to a newborn. Such substantial payouts exemplify the financial risks that contribute to escalating insurance premiums and the potential reduction of medical services. Ultimately, venue shopping prioritizes legal tactics over fair justice, increasing the financial burden on healthcare while undermining both the quality and accessibility of patient care.