By Tom Walsh

Speaking out on professional liability: Anathea Powell, BU medical student, Top; Christina Sebesteyn, M.D., above left; Marisa Stumpf, M.D., at above right.

Christina Sebestyen, M.D., was well along in her obstetrics/gynecology fellowship at Brigham and Women's Hospital in Boston when she realized that, largely for financial reasons, she was in the wrong place at the wrong time.

Today, she is practicing and living in Rochester, N.H. -- not far in miles from the Massachusetts border but light years from the Bay State when it comes to physician finances.

"OB/GYNs pay more than $80,000 a year in malpractice insurance premiums in Massachusetts," Dr. Sebestyen said. "In New Hampshire, it's $50,000." The soaring cost of professional liability insurance, especially in a "riskier" specialty such as OB/GYN was just one reason why Dr. Sebestyen walked away from a prestigious fellowship in Boston.

"The cost of living in New Hampshire is so much less on top of it," she said. She estimates that she will spend $1 in Rochester to live for every $2 she would need to live in Brookline. With a New Hampshire salary comparable to what she made in Boston, and $30,000 a year less for professional liability insurance, the math is self evident.

Marisa Stumpf, M.D., started out in an OB/GYN residency but is now in her last year of an emergency medicine residency at Beth Israel Deaconess Medical Center in Boston. "I switched partially out of lifestyle concerns," she said. "But another major component of my decision was seeing the malpractice issue facing OB/GYNs here [in Massachusetts]."

Dr. Stumpf said she enjoyed being in the delivery room. "I loved what I was doing," she said. "But the other factors were playing too much of a role." And while physicians practicing emergency medicine must also be aware of malpractice issues, she said, "There are a lot more malpractice factors at play with OB/GYN. It seems that if anything goes wrong with the child, people just want to point the finger at the doctor."

Law School an Option
Dr. Stumpf said that had she known more about the financial and practice cloud under which doctors now practice in Massachusetts and elsewhere, she might have pursued a different career. For now, she plans to seek an ED position at a Boston-area community hospital. But, in the back of her mind, she is also thinking of eventually going to law school. "If I do that," she said, "I'll become a defense attorney for physicians."

Anathea Powell, in her fourth year at Boston University School of Medicine, said she had considered pursuing OB/GYN as a specialty but instead has chosen general surgery. "One of the things that made me uncomfortable about OB/GYN was professional liability," she said.

Drs. Sebestyen and Stumpf and Ms. Powell are not alone among young doctors or medical students with serious concerns about today's physician practice environment. A recent American Medical Association survey found that 96 percent of medical students consider the professional liability issue to be a major problem. The survey also found that 39 percent of respondents said the issue was a factor for them in choosing a state in which to pursue a residency program.

Similarly, the MMS 2003 Massachusetts Physician Workforce Study found that "one of the root causes of the physician shortage in Massachusetts derives from the relatively large ratio of residents and fellows who leave upon completion of their training."

Boston Still Special
Despite the problems, Drs. Sebestyen and Stumpf and Ms. Powell all expressed a strong desire to remain in or near Boston. "There is something about training in a city where everyone is focused on medicine and health policy issues," Ms. Powell said.