Paging Rick Perry’s Texas Doctors

Photo: eschipul

Texas Gov. Rick Perry claims to have lured many doctors to Texas, some of the many jobs he claims to have created. (The media’s treatment of which we’ve touched on here.) At the same time, a friend on the board of a local community health center says they cannot find doctors to staff it—there is an insufficient supply at the wage they have always been paying. How can this be consistent with Perry’s claim?

One possibility is that the reduction in malpractice insurance costs raised the net wage in the private sector relative to the public sector. Even if Perry’s claim is correct, there may be more doctors than before, but relative supply may have shifted to the private sector, leading to a shortage in the public sector.

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  1. Mike B says:

    Texas has wide disparities between rural and urban areas. Large parts of rural west and east Texas have been battered by the decline in both ranching and oil production and have been loosing populations for years. It is virtually impossible to attract doctors to these communities unless they are on a J-1 Visa or have dubious credentials. Refer to this episode of Freakonomics Podcast arch rival This American Life for the problems this situation can cause.

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  2. Tim says:

    Your biased anecdotes are getting tired. Please provide some hard data to back your preconceived notions.

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  3. Clancy says:

    Since most of the jobs were created in the service sector as a result of steady population growth, I would expect the number of doctors to rise as well. Though maybe doctors are not following patients fast enough.

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  4. Dr. says:

    Low numbers of physicians in rural/public areas is an issue everywhere. It is definitely true that malpractice climate in Texas has attracted physicians. Check out the number of applications for licensure for the state. It has gone up. More and more physicians are leaving places that are toxic for them due to malpractice.

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    • nobody.really says:

      Yup, since malpractice reform was adopted in 2003 applications for physician licensure has gone up. But but the POPULATION has gone up. So if we discover that licensure of hairdressers had gone up since 2003, would you credit that to medical tort reform, too?

      In fact, the rate of growth in physician licenses was greater BEFORE tort reform. Go figure.

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    • Clancy says:

      I understand the ridiculousness of some malpractice suits, and the need for serious tort reform, but using it as a method to attract more physicians to your state (from other states) doesn’t seem like a good idea. It seems to me that the number of doctors is determined primarily by the number of patients. It also seems like sheltering doctors from malpractice suits would have a stronger incentive effect on less competent doctors who face more exposure to suits, so you would expect to see a drop (maybe only a very slight one) in the quality of doctors in the state.

      You might also expect to see a slight drop in health care costs, but there’s not any evidence of that either:

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      • Sam says:

        Of course the primary determinant of the number of doctors is the demand (number of patients) for those doctors, but other factors do play a part.

        If the theory is sound then more doctors of all skill levels would move to the state, at least up until the point that competition brought their take home pay back down to pre-reform levels. But then you’d presumably have cheaper health care (at the possible cost of lower quality care).

        At the very least it’s an interesting experiment to see what will happen.

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  5. jonathan says:

    So let’s assume every state lowers malpractice rates. Then what? I’ve read a number of analyses of Perry’s claim and his numbers are not only off but most of the increase in doctors is due to population increasing. (As an aside, the same is true for much of the very large increase in public sector employees in Texas.)

    But Perry’s argument is more about how states act relative to each other. It has nothing to do with the country as a whole because lowering malpractice rates doesn’t create more doctors. It probably has some shifting effect.

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    • Sam says:

      Why is it a problem if every state lowers malpractice rates? If it does indeed work in Texas then it would work for the entire country – more doctors would practice here than elsewhere in the world and more smart kids would go into medicine instead of law or business.

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  6. nobody.really says:

    If Perrys’ claim is accurate or not, who cares? What relevance would this have for his presidential bid?

    Perry claims that he created a system that attracted physicians to Texas – from where? From the rest of the US. Begger-thy-neighbor is a neat trick if you’re a governor. But how would luring physicians from one state to another help matters when you’re president?

    Moreover, while malpractice reform may advance the interest of physicians, does it advance the interest of society? Harm caused by malpractice is real harm. Tort permits the cost of that harm to be spread to the physician. Insurance permits the cost to be spread throughout society. Absent these mechanisms, the harm is visited entirely on the harmed patient. Why is that a good thing?

    Whether it’s a good thing or a bad thing, it’s a Texas thing. In 1829, for example, the state put a moratorium on the collection of Anglo debts to out-of-state creditors, and has maintained generous bankruptcy laws pretty much ever since. And yes, this begger-thy-neighbor policy did manage to boost immigration, as indebted people fled to that jurisdiction. But does that make it good public policy?

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    • Joshua Northey says:

      Excellent point. I get so frustrated with Presidential policy discussion when much of the policy discussed are things which don’t even work on a national scale. “My state attracted manufacturers from neighboring state with tax credits”.

      That is great Bob, which states are you going to steal from when you are President?

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  7. Johann says:

    A shortage? Really? A shift in supply causes a shortage? Come on!

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