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Does Tort Reform Affect Physician Supply — Evidence From Texas Says No

An extensive academic study was performed recently, and the conclusion was that medical malpractice “tort reform” does not increase the supply of physicians, as usually claimed by proponents.

The study is, as you would expect from professors, dense and somewhat difficult to read. Here are the first few paragraphs, and the entire study can be found online.

Does Tort Reform Affect Physician Supply?

Evidence from Texas

David A. Hyman, Charles Silver, Bernard Black & Myungho Paik


Does state tort reform affect physician supply? Tort reformers certainly believe so. Before Texas adopted tort reform in 2003, proponents claimed that physicians were deserting Texas in droves. After tort reform was enacted, proponents claimed there had been a dramatic increase in physicians moving to Texas due to the improved liability climate. We find no evidence to support either claim. Physician supply was not measurably stunted prior to reform, and it did not measurably improve after reform. This is true whether one looks at all patient care physicians in Texas, at high-malpractice-risk specialties, or at rural physicians.


The United States recently completed its third malpractice crisis of the last forty years. As with previous crises, a precipitous increase in malpractice premiums prompted a push for tort reform, especially in states that had not already enacted caps on noneconomic or total damages (“damage caps”). Both sides deployed the standard mélange of anecdotes, slogans, talking points, and heartfelt appeals to larger principles. As in prior crises, physicians often had the upper hand, with nine states adopting new damage caps between 2002 and 2006, and seven more adopting caps on punitive damages or other reforms intended to limit malpractice suits.

We focus on Texas, which adopted a strict cap on non-economic (“non-econ”) damages and other reforms in 2003. These reforms caused total payouts on med mal claims to decline by more than 70%. Physician supply issues played a prominent role in the tort reform debate in Texas. Proponents argued that physicians were fleeing Texas because of lawsuit risk and high insurance premiums, but would stop leaving if the state adopted tort reform. After the reforms took effect, they claimed that the reforms brought new physicians to the state in droves – a more impressive result than the original prediction, which was only that doctors already in Texas would stay put.

In a previous article, we examined the number of physicians practicing in Texas post-tort reform. Using active, direct patient-care (DPC) physicians per 100,000 Texas residents as a measure, we found no evidence of a pre-2003 decline in access to care and no evidence of a post-reform improvement. To the contrary, the rate of increase in Texas DPC physicians per capita was lower after reform. We did not suggest that tort reform caused the slowdown, which seems implausible. Instead, we hypothesized that physician supply was driven primarily by other factors such as economic growth and the size of Texas’ population of insured patients.

Bob Kraft

I am a Dallas, Texas lawyer who has had the privilege of helping thousands of clients since 1971 in the areas of Personal Injury law and Social Security Disability.

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The title of this blog reflects my attitude toward those government agencies and insurance companies that routinely mistreat injured or disabled people. As a Dallas, Texas lawyer, I've spent more than 45 years trying to help those poor folk, and I have been frustrated daily by the actions of the people on the other side of their claims. (Sorry if I offended you...)

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