But the ads aren't telling the full story.

While many doctors are deeply frustrated with rising insurance rates, there is no mass exodus of physicians, an Enquirer review of public records shows. To the contrary, there are more doctors in the state today than there were three years ago.

Since early September, the Ohio State Medical Association has been running the ads to help elect judges to the Ohio Supreme Court. The doctors - along with hospitals and business interests - hope a majority of justices will uphold a $350,000 cap on jury awards in medical malpractice cases.

The cap, in effect since April 2003, has never been tested in court. It limits non-economic damages, such as for pain and suffering, that malpractice victims can receive. Direct losses, such as medical bills, are not affected.

Dr. Anureet Bajaj (center) helps prepare for surgery on a patient's hand Friday at Holmes Hospital in Corryville as another surgeon diagrams the procedure. Bajaj, 35, recently came to Cincinnati. The Enquirer/MICHAEL E. KEATING

Until the cap is upheld by the state's highest court, doctors argue that malpractice-insurance fees will continue to rise, eating into their livelihoods and threatening quality care.

"Rising health care costs," the ads state, "are forcing good doctors to close their practices, leave the state or eliminate vital services."

But records of the Ohio State Medical Board say otherwise:

• The number of doctors holding active Ohio medical licenses was 33,917 in 2003, up slightly from 33,855 doctors in 2001.

• The number of doctors maintaining an Ohio address was 24,833 in 2003, up from 24,633 in 2002. The board did not report a similar figure for 2001.

• The number of new licenses issued each year increased to 1,660 in 2003, up from 1,583 in 2001.

"There is a malpractice issue in this state and all over the country that needs some resolution. However, the data just doesn't translate into doctors leaving the state," says Larry Savage, president and chief executive of Humana Health Plan of Ohio.

Doctor supply growing

Contrary to popular notions, the doctor supply in Ohio - as in every other state in the country - has been steadily growing for years.

In 1970, Ohio had 67 doctors for every 100,000 residents. In 2000, there were 120 - an increase of 79 percent, according to a July 2003 report from the U.S. Department of Health and Human Services.

In Kentucky - another state without effective caps on malpractice damage awards - the doctor supply grew even faster. Kentucky's rate climbed 87 percent during those decades, to 99 doctors per 100,000 residents in 2000.

Surgeon Dr. Anureet Bajaj

Retired surgeon Dr. Walter Matern (Photos by Michael E. Keating/The Enquirer)

The closest thing to an official measure of doctors leaving Ohio over malpractice concerns comes from a running list kept by the Ohio Department of Insurance. That list counts 220 doctors who say they've quit or moved away since last year. Those doctors include five from Hamilton County and two from Butler County.

But 60 of Ohio's 88 counties, including Warren and Clermont, have shown no doctor departures at all. Moreover, the total number of doctors lost is less than 1 percent of the state's licensed doctors - a number far outweighed by new doctors receiving licenses every year.

Still, stories of frustrated physicians retiring, moving or no longer delivering babies have made headlines. And the impact of physician frustration over rising malpractice costs can't be measured simply by counting licenses, the doctors say.

For instance, the numbers can't reflect the impact of doctors who avoid tough cases, says Tim Maglione, senior director of government relations for the Ohio State Medical Association.

Nor do the numbers reflect possible shifts among specialties, such as new doctors who might choose to avoid obstetrics or other high-risk fields, Maglione says. He says those kinds of trends are extremely difficult to measure, and he's unaware of any studies in Ohio that have tried.

The doctors cite, instead, a mail survey answered by 874 of 4,000 randomly selected doctors statewide last spring. Nearly 56 percent said they've ordered more tests to reduce their chances of being sued by patients, and nearly 48 percent said they plan to retire earlier than they thought because of rising liability costs.

Nearly one of four doctors also said they plan to limit their practices to low-risk patients within two years because of malpractice costs, but almost half said they have no such plans.

The American Medical Association says there's no national shortage of doctors, although there is an imbalance, which has led to shortages in some rural and inner-city areas. The group makes no conclusion about the cause, however, and notes that one of the most severe shortages is of rural family practice doctors, who traditionally have had low malpractice rates.

Maglione acknowledges that few people in Ohio are going without care because their doctors quit. But he insists that current trends are unsustainable.

"Should we wait another five years for this to become a bigger crisis? Or should we do something now before things get worse?" Maglione says.

Retiring early

So how hard are doctors being hit? Drs. Walter Matern and Henry Nealeare two longtime Cincinnati-area surgeons who say they were finally pushed out of their profession by soaring malpractice rates.

Matern, 65, retired from his surgical practice nearly a year ahead of his plan because he faced paying a $48,000 annual malpractice insurance bill.

That amounted to nearly one-fourth of his gross income of about $200,000 - from which Matern also has to pay taxes and his share of support staff and office expenses. After all his business expenses, his take-home pay was closer to $70,000.

"To pay out nearly $50,000 just to keep practicing, well, I wasn't bringing in that much money," Matern says.

Neale, 64, recently retired to North Carolina after serving for many years as chairman of plastic and reconstructive surgery at the UC College of Medicine.

He was paying $80,000 a year for malpractice coverage and had been quoted another 50 percent increase for next year. The malpractice fees already were about 25 percent of his total revenue, which was declining. After spending 14 years in post-college training and leading a productive 30-year career, his take-home pay was less than $100,000 a year, he says.

"My accountant told me, 'Every day you keep practicing, you're losing money,' " Neale says.

He still does some part-time teaching at a VA Medical Center in Asheville, N.C. When he talks to medical students and residents, he warns them that times have changed.

"The public thinks all doctors are rich, but that's not true," Neale says. "I tell students if you have any idea of going into medicine because you want to have a comfortable life, get out of it. Get out now."

Coming in

Then there are professionals like Drs. Lori Shutter and Anureet Bajaj, two of the more than 100 new doctors recruited to Cincinnati in the past two years.

These doctors chose to work in Cincinnati despite well-publicized complaints about lower-than-average doctor pay and high malpractice rates.

Bajaj, 35, is a plastic and reconstructive surgeon who started working in Cincinnati about seven weeks ago after completing a fellowship at the prestigious MD Anderson Cancer Center in Houston.

"For me it was the job. I'm interested in academic medicine, and the UC Medical Center had a good reputation," Bajaj says. "I have the opportunity to teach, do research and provide clinical care. Also, I really like the people here. That was the fundamental factor."

Like most doctors who work in academic settings, she doesn't pay directly for her malpractice insurance. Her coverage is arranged through a group contract.

However, Bajaj's father is a plastic surgeon in Oklahoma, and her sister is completing an obstetrics residency in Washington, D.C. They complain frequently about high malpractice-insurance rates, which makes Bajaj question claims that doctors are fleeing Ohio.

"Malpractice is a problem everywhere. If (doctors) are leaving Ohio, I don't know where they're going," she says.

Shutter joined the Mayfield Clinic in mid-2003. As a neuro-intensivist, she spends nearly all her time working at University Hospital's neuroscience intensive care unit.

Shutter, 46, got a raise to leave the Loma Linda Medical Center in California, and benefited further from Cincinnati's lower cost-of-living.

Like Bajaj, her group covers her malpractice insurance, so the rising costs played no role in deciding to come here.

She also doubts that patients are suffering widespread problems because of doctors making malpractice-related career moves.

"Are all the good doctors leaving Ohio? I don't think I can say that. I can't speak to everywhere in the state, but there are good doctors coming to this town," Shutter says.

If some doctors are being chased out of the profession because of high malpractice fees, Shutter suggests that there may be an upside to the trend.

Patients may get more compassionate care from doctors who choose their careers knowing they face a less rosy economic outlook than previous generations.

"There was a time when some people got into medicine for the money. Now, it's becoming a vocation again. It's becoming a calling," she says. "You do this because you care."

Enquirer staff writer Jim Siegel contributed. E-mail tbonfield@enquirer.com