For quite a while there has been speculation that neurosurgeons across the country are heavily influenced in their practice by the legal environment that exists in their state. To determine whether or not the assumption is true, the American Association of Neurological Surgeons (AANS) recently conducted a study among more than 3000 of its members. The study involved an online questionnaire which used targeted questions to determine how neurosurgeons view the legal environment of their state and how it has affected their work.
Not surprisingly, permanent staff neurosurgeons are extremely sensitive to the legal environment. That sensitivity increases for the private practice doctor who has no one to fall back on in case of a lawsuit. As for the neurosurgery locum, he or she needs to be sensitive to the legal environment in a number of states according to the location of accepted assignment. The threat of legal liability plays a big role in how much a neurosurgeon practices defensive medicine.
The Quandary of Caution
The AANS study showed that neurosurgeons in states with volatile legal environments tend to be much more cautious in how they treat their patients. They order more tests, they are less likely to attempt unproven treatments, and they are less likely to be aggressive in their overall treatment plans. Doctors in these states tend to have more distant relationships with their patients based on a perception that a good majority of those patients don't really trust them.
All of this brings into play the quandary of caution. If a neurosurgeon is afraid of a lawsuit, how cautious should he or she be? If a neurosurgery locum picked up some valuable treatment experience on a previous assignment that might be helpful in his current one, is he likely to employ that experience if he's afraid he could get himself into trouble? In medicine there is a fine line between caution and ineffectiveness. It is a line that many in the field of neurology are having trouble defining.
Declining Rates of Neurosurgery Graduates
Perhaps the most alarming part of the AANS study is the realization that defensive medicine and the risk of legal problems may be directly contributing to the declining number of new neurosurgeons entering the field. Medical school students seem to prefer other specialties that are not as high risk over taking their chances with something like neurology. And even among those who do choose a neurosurgery career, they tend to gravitate toward lower risk states.
In many of the high risk states it is the neurosurgery locum stepping in to provide services that are otherwise unavailable from a permanent staff doctor or a private practice neurosurgeon. And as neurosurgery services decline among private practice doctors, it is the neurosurgery locum that will be depended on to pick up the slack. It's certainly a good time to be a neurosurgery locum if you enjoy that field of specialty and don't mind the liability risk.