To the Editor:

The article “Understanding the Physician Liability Insurance Crisis” [October 2002, page 47] failed to mention one aspect of the growing crisis. I would argue that as increasing numbers of physicians are employed by organizations, especially organizations not wholly owned by physicians, our malpractice risk increases. For example, accountants at my hospital system determine that we need to see more patients per hour, causing documentation patterns to change and the doctor-patient relationship to suffer. In this environment, the employed physician no longer represents the best interests of the patient, but now represents the needs of the organization.

I would argue that over the next decade, part of the insurance crisis could be solved by enabling physicians to once again be entrepreneurs. In the current climate, insurance costs make it next to impossible for someone to open a solo or private practice. However, it has been shown that a low-volume, high-intensity practice can survive financially, improve patient care and increase patient loyalty [“Going Solo: Making the Leap,” February 2002, page 29]. These factors will help drive down the cost of malpractice insurance.