Reports of doctors leaving the state of Pennsylvania are not new, but the latest report is nonetheless disturbing. Following a temporary reduction in doctors' malpractice premiums for the state's portion of the mandated $1 million coverage, officials in Harrisburg have been behaving as if the crisis has been resolved. The Pennsylvania Medical Society disagrees, and paints a gloomy picture about the future of health care in Pennsylvania.

The latest evidence of the crisis is found in a 120-page report documenting a decline in the number of full-time physicians practicing in Pennsylvania. And for a state with an aging population, that's a very troubling trend.

In addition to highlighting the failure to attract new doctors and to keep practicing doctors from leaving the state or retiring, the study also notes that about 900,000 state residents are without health insurance.

The lack of insurance is a growing national crisis, but the looming shortage of doctors is unusual, particularly among states with the largest populations in the nation.

The contrast is striking. The medical society's report notes that most larger states have seen the number of practicing physicians increase by 15 percent to 25 percent from 1999 to 2005. But in Pennsylvania during that same period, the number of doctors declined by 10 percent.

Just as troubling, if not more so, is the steep decline in the number of younger doctors choosing to remain in Pennsylvania after completing their residencies. This retention statistic dropped from just over 50 percent in 1994 to 7.8 percent in 2004. The fact that fewer than one in 10 new doctors will remain to care for patients in this state once they complete their residency at a Pennsylvania hospital should grab everybody's attention.

It is disturbing that the pipeline of doctors appears to be inadequate to care for the health needs of Pennsylvanians in the years and decades ahead, particularly once the Baby Boom generation reaches senior-citizen status, when medical needs generally increase.

The reason for the drop in doctors practicing in the state is mostly due to the high costs of medical malpractice insurance, at least according to most people in the medical community.

The profession on the other side of the medical malpractice debate, the lawyers, argues that there is no crisis since fewer medical malpractice lawsuits have been filed in recent years. But insurance industry documents suggest that while fewer medical malpractice claims are being filed, the dollar amount of the claims continues to grow.

The debate between doctors and lawyers over who is to blame for high medical malpractice insurance premiums inPennsylvania has been going on for the past decade. Capping so-called "pain and suffering"or noneconomic damages is one strategy more and more states are employing to hold down medical malpractice financial awards — and, thus, insurance premiums for doctors. So far, Pennsylvania's lawmakers have not chosen that path to reform.

The best solution to the prospect of fewer doctors practicing medicine in Pennsylvania is probably not found in a single solution. The best answer should include tort reform — with a cap on noneconomic damages, a review board to screen out frivolous lawsuits, efforts by doctors and hospitals to reduce medical errors and tougher disciplinary actions against doctors who are found to be deficient — or dangerous.

Elected officials in Harrisburg cannot pretend that the problem of medical malpractice has gone away. It's time for Gov. Ed Rendell and legislative leaders to propose a multi-faceted approach to actually solving the crisis, as opposed to leaving the existing band-aid in place.