Claiming high premiums are forcing them out of business, at least 45 doctors in Scranton said they have stopped accepting new patients and won't perform surgeries after Jan. 1. The total includes 10 of the small city's 18 general surgeons, 14 of its 15 orthopedists, and all 8 of its urologists.
"I don't want to be irresponsible. I just want someone to put their feet in my shoes for a while," said Scranton neurosurgeon Shripathi Holla. "We need more people to take care of these patients, and the insurance situation is driving us out of the market."
Doctors have tried mass walkouts elsewhere in the nation.
In Las Vegas, 150 doctors at University Medical Center resigned in July to protest high insurance premiums, prompting the hospital to shut down its trauma center for 10 days.
The action prompted a special session of the Nevada Legislature, which enacted a law capping damages in trauma center malpractice cases at $50,000, except in cases of gross negligence. About half the doctors returned to work after the bill passed.
The American Medical Association, the country's largest physicians group, said that while such mass demonstrations are rare, physician groups have also been forced to shut down in several other states because of high insurance costs.
In Scranton, some are calling the threatened walkout a protest. Others insist it is a simple business decision. Holla said his malpractice insurance costs $450 a day - a rate he says is strangling his practice and preventing his hospital from recruiting doctors.
If the surgeons follow through, it could hobble the city's five hospitals and force some patients to travel long distances for care.
The area's largest, Community Medical Center, said it would be forced to temporarily close its trauma center and divert patients at least 70 miles away if Holla, its only regular neurosurgeon, follows through on his threat to boycott work from Jan. 1 to Jan. 7.
Scranton's 200-bed Mercy Hospital has already cut back on scheduled operations for January in anticipation of having fewer surgeons available, said hospital vice president Jeff Lewis. He said he hoped the doctors would keep working.
"If this were to come to fruition, obviously there would be a terrible void here in the area," he said.
The Scranton surgeons have shied away from calling their planned shutdown a strike.
AMA ethics guidelines enacted in 1998 discourage doctors from refusing to work, saying "Strikes reduce access to care, eliminate or delay necessary care, and interfere with continuity of care. Each of these consequences is contrary to the physician's ethic."
But many of the Scranton surgeons said given their high insurance costs, they have no choice but to close.
"Most of our doctors will either retire, or will move to another state," said Margo Opsasnick, chief executive of the general surgery group, Delta Medix. "Some of them are applying for licenses in other states."
It's unclear whether doctors who leave Pennsylvania would fare better elsewhere.
In two neighboring states, New Jersey and Ohio, doctors have also pushed for bills to hold down insurance costs by capping jury awards in malpractice suits.
Pennsylvania Gov.-elect Ed Rendell has appointed a special commission to consider short-term aid packages that would keep the doctors working while the state tries to develop a permanent solution.
"Mr. Rendell hopes that doctors won't punish patients," his spokesman, Tom Hickey, said. "At the same time, he acknowledges that they have a legitimate issue and he wants to find a way to help."
By David B. Caruso