Almost four out of five doctors responding to a survey by the Doctors Company, a physician-owned medical liability insurer, say that the growing threat of lawsuits makes them hesitant to recommend a medical career to their children. Although nearly 80 percent of malpractice lawsuits against doctors are ultimately found to be without merit, the emotional and financial cost of these suits is forcing many doctors to reconsider their professional lives and the careers they envision for their children.

In Maryland, almost 40 percent of the doctors surveyed said that they regretted their decision to enter medicine because of liability concerns, compared with 30 percent nationwide. These are the signs of a profession in crisis.

Doctors whose children still want medical careers advise their offspring to choose a specialty that is a less-frequent target of lawsuits. Two out of three respondents said that means no obstetrics or gynecology; nationally, an obstetrician can expect to be sued once every three years. Many states are losing OB-GYNs because their laws encourage unwarranted suits, which lead to the high insurance premiums that force doctors and medical groups to close their doors.

Without decisive action, the outlook for the next generation of doctors -- and patients -- is bleak. There is hope, however.

Maryland's liability insurance relief fund, which provides doctors with a subsidy to reduce the cost of premiums, is a start, but caps on unlimited payouts must be enacted for long-term relief. In Texas, for example, signs of life have returned to the profession in the few months since voters passed a constitutional amendment allowing the implementation of a cap on pain-and-suffering awards. Almost every malpractice insurer in the state has announced a rate decrease, and obstetrics practices that had closed are reopening.

The model for the reforms in Texas and other states is California's Medical Injury Compensation Reform Act of 1975, which was enacted by a Democratic legislature and signed by a Democratic governor. It is before Congress today. California physicians still pay some of the lowest premiums in the nation even though the state had almost 10 percent of the nation's paid medical liability claims.

The California law limits awards for intangibles such as pain and suffering, but it doesn't limit how much can be recovered for economic losses such as medical care and loss of wages. It also requires disclosure of additional sources of compensation, such as life and health insurance, to prevent double-dipping; limits attorneys' fees to a sliding scale; and allows insurers to spread payment of the awards over the period of need to ensure that money will continue to be available to pay for care.

Such reforms will do more than help good Maryland doctors today. They will encourage the development of a new generation of doctors and discourage the exodus of physicians to other states or to early retirement.

-- James Rivers

-- Richard E. Anderson

Dr. Rivers is past president of the Maryland

OB/GYN Society and chief of the OB/GYN service

at Anne Arundel General Hospital and Medical Center in Annapolis. Dr. Anderson is an oncologist and chairman and chief executive of the Doctors Company.