The day after Christmas, days before her malpractice insurance bill came due and Maryland politicians hammered out a bill in the hope of rescuing doctors such as her, Nancy Brown-Holt - feeling she was between a rock and a hard place - simply quit.
"I can't play with my family's livelihood like that, I just can't," Brown-Holt said. She felt she was unable to come up with $30,000 to pay her increased insurance premium and continue as an obstetrician-gynecologist after 11 years. Instead, she chose to "retire completely and permanently" from medicine.
"I absolutely loved what I did," she said. "I could not believe I would be giving up a career at 41 simply because I could not afford it."
Some doctors around the state, especially in certain high-risk fields, have had to decide this week whether to quit, alter their practices or find a way to cover rapidly rising malpractice rates while Maryland's Republican governor and Democratic-led legislature clash over a solution.
Maryland's largest insurer of doctors, the Medical Mutual Liability Insurance Society, raised its rates 28 percent last year and 33 percent this year.
That prompted Gov. Robert L. Ehrlich Jr. to call for a special session of the legislature last week to try to hold the increase to 5 percent.
During its first special session since 1992, the legislature approved a measure to add a 2 percent surcharge for health maintenance organizations. It would raise about $65 million in its first full year and bolster the insurance fund.
The governor criticized the solution as a tax and promised to veto the measure, leading legislators vowing to override it. If his veto stands, Ehrlich said yesterday, he will provide cash in the short term to limit the insurance increase.
While the politicians worked on the details, doctors found themselves owing thousands of dollars in additional insurance premiums Saturday, money they're not sure will come back to them despite legislative efforts.
To cover premium increases, some physicians have begun charging their patients membership-style fees or stopped performing risky procedures. Some, to boost revenue, have started requiring office visits for even mundane questions or opened their practices to dozens of new patients.
Steven Adashek, 47, an obstetrician-gynecologist in Lutherville, has moonlighted performing ritual circumcisions for Jewish baby boys to make up for the premium increases.
"It's a shame that doing it is what is allowing me to deliver babies," he said. "I do love doing both, but it's a shame one has to support the other."
Teresa Hoffman, a Baltimore obstetrician-gynecologist, has steadily added patients over the past several years to keep up with insurance rates and other rising costs. She sees about 50 people a day but gave up her private practice last year and partnered with Mercy Medical Center, which offers an insurance trust fund with lower rates, about $105,000 this year.
"Doctors can no longer afford to be out in their own practice," said Hoffman, who worked with Brown-Holt for three years. She is also considering leaving medicine. She has talked with her husband, an emergency room doctor at North Arundel Hospital in Glen Burnie, about her retiring this summer.
Some physicians have considered moving from state to state to chase less onerous malpractice insurance rates.
Brian Holmes, 44, a Hagerstown neurosurgeon, moved in 2002 to escape the financial burden of Pennsylvania insurance bills. His next move will be a career one if premiums become prohibitive, he said.
"I'll leave medicine," he said. "I don't want to be like a military family moving from place to place."
Adashek, the Lutherville obstetrician-gynecologist, said he would consider dropping the obstetrics portion of his practice and that he would keep a close eye on the General Assembly's reform efforts.
"The doctors that I talk to in my specialty are very concerned about the financial burden of premiums," said Holmes, the neurosurgeon. "But most people say what's really going to drive them out of medicine is the courts."
Holmes has stopped repairing cerebral aneurysms because he is worried that he will be sued, a fear some of his colleagues also express.
"Unfortunately, if you make a mistake, even if you're well-intentioned, families can sue and actually get into your personal holdings," said Daniel J. Levy, a pediatrician in Owings Mills who was sued unsuccessfully three years ago. "Every day, my livelihood and whatever assets I have and my family's life are on the line. I don't think people quite realize that."
Sun staff writers Dennis O'Brien, Michael Stroh and Erika Niedowski contributed to this article.
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