Q&A with Dr. Gary Woods, President, N.H. Medical Society

A California native, Dr. Gary Woods is an orthopedic surgeon who has been in practice in Concord for 22 years. He is currently president of the New Hampshire Medical Society.

A graduate of the University of California at Berkley, he received a master’s degree in physics from Johns Hopkins University in Baltimore and graduated from the University of Rochester Medical School.

Q. What do you see as the major health-care problem facing New Hampshire?

A. Probably the biggest is access. We don’t have enough doctors to serve the communities that we have. There are a number of reasons. New medical students have on average about a $130,000 bill by the time they finish medical school, and that’s something that really makes you think, “Even though I’d like to be in a rural community, I don’t think I can afford to do that because of reimbursement. So maybe I’ll practice in a small clinic. Or maybe I’ll stay in the big city where they’ve got an office set up, where my malpractice is covered, I get a guaranteed salary and things look good.” So rural areas are hurting more than urban areas.

Q. Why is the nation’s medical system so much under fire?

A. We’re under stress because we’ve decided that we’re going to deliver health care on a market-based system. That’s really the premise we start from — that we want choice, we want to be able to get the health care we want, but we want to deliver it on a market-based system. So you can have the Anthems, the Cignas and the Harvards of the world, where the CEOs get $47 million bonuses and you have to live with that. You also have to live with that big “R” word that we talked about 10 or 12 years ago — “rationing.” Right now, rationing is even more prevalent than it was at that time. Because we ration now, but we do it economically.

Q. The changes in Medicaid proposed by the state Health and Human Services Department have created some controversy, particularly in terms of how they would affect nursing homes. How do you view that controversy?

A. I understand what they’re trying to do. It’s very similar to what we did with the mental hospital many years ago, when we provided halfway houses and things like that. It did provide an element of better care to those who really didn’t need to be institutionalized. And it provided a little bit more workforce, with people who were completely independent, could do the job very nicely and interacted well in society.

Q. But will the elderly population, with all the disabilities and frailties that come with old age, be able to adapt as well?

A. It depends on the degree of disability. There are actually private corporations trying to fill that niche, that will take care of Mom when she needs to go to the dentist or the grocery store. Visiting nurses have a whole variety of home-care services, from the visiting nurse who comes and checks the blood pressure or checks the post-op incision to developing telemedicine so you don’t even have to go to the doctor’s office. Eventually we’ll even have things like a portable x-ray machine. So it’s foreseeing a different perspective on the homebound or potentially homebound.

Q. Senate Bill 110, which became law last year, allows insurers to use the medical history of the employees as a factor in setting a company’s health insurance premiums. Should employers have to pay more because some of their workers have an unfortunate medical history?

A. I have some difficulty with that because as physicians, we’re trained to treat everybody the same. You come in, you got a problem, I’m looking at what’s the best care for you. I don’t care what kind of insurance you’ve got or if you’ve got no insurance. The market, in terms of paying for it, says “Well that’s not the way it’s going to work.”

Q. What kind of increases are you seeing currently in medical malpractice insurance?

A. It depends on the specialty, of course, but I’ll use myself as an example. It went up 25 percent last year. It’s a little more stable this year, but it has in the last five years gone up close to 250 percent.

Q. What’s driving those big increases?

A. If you look at the jury verdicts that have been handed out in medical malpractice, it’s really escalated. Between 1999 and 2001 it went from about $800,000 to a little over a million. Between 2001 and 2003, it went to almost $3.5 million, and we haven’t had that much in this state, although we did have one just about a year ago for $2.5 million.

Q. Will the New Hampshire Medical Society be lobbying for medical malpractice reform again this year?

A. It will be brought forward again. It may look a little bit different, but yes, we do need liability reform for everybody’s concern, primarily for our patients. I look at it in terms of access to care. Because in some areas OB-GYN people are not providing “OB” service any longer, or they’re not doing high risk, or they’re leaving the state.

Access is huge and it may end up that someone’s really going to get hurt. It’s like in West Virginia, where they went through this. They had no neurosurgeons in the entire state for a while and one physician lost his son because he’d had an accident, had a head injury, and there was nobody there to do a straightforward procedure to relieve the pressure on the brain. They had to have him airlifted to Pennsylvania. That’s a six-hour delay. And he ended up dying.

Q. What’s the main feature of tort reform legislation you hope to see passed?

A. It’s called a pre-trial panel, and it parallels the actual preparation for a trial. What it’s meant to do is get people at the table, to get people to look at it seriously and see if you really do need to go into trial or not.