The following report by medical editor Marilyn Brooks first aired Aug. 2, 2005, on Channel 4 Action News at 5 p.m.

---

Have you tried to find a medical or surgical specialist lately? If you live outside Allegheny County, you're probably having trouble.

In fact, the farther away you are from Pittsburgh, the fewer specialists there are.

It's not just established physicians who are leaving the state. Medical and surgical residents in training at our hospitals are deciding not to stay when they finish.

Angela Christo, 19, has had two brain surgeries in the last year -- first, to remove a tumor, and now, to drain a cyst.

There is a new hospital near her Franklin home, but there's no neurosurgeon there, so she traveled an hour and a half to Pittsburgh.

Christo, neurosurgery patient: "It irritates you very much."

She represents just the tip of a very serious problem that all Pennsylvania hospitals wrestle with every day -- the flight of surgery specialists.

Dr. Jack Wilberger, chairman of neurosurgery, Allegheny General Hospital: "There are no neurosurgeons between Pittsburgh and Erie, which is a huge space, and no neurosurgeons east of Pittsburgh until you get close to Harrisburg."

And he says it's tough to get anyone to come fill the slots in neurosurgery, general surgery, ob-gyn, orthopedic surgeons and trauma.

Currently, there are 4,000 board-certified neurosurgeons in the country. More than half are over age 50. Only 100 new ones come out every year. Pennsylvania trauma centers are 132 surgeons short.

One reason: the cost of malpractice insurance in Pennsylvania. It's only part of the problem, albeit a major part.

Also, consider that Pennsylvania has the lowest reimbursement rates for surgeons of anywhere in the country.

Wilberger says malpractice rates -- $90,000 for a neurosurgeon -- are rising at triple the inflationary cost each year, while reimbursements are going down. It's a bad combination.

Wilberger: "The less money you make, the less you have to pay for the malpractice insurance. It's been doubly difficult in Pennsylvania because of those two factors."

Wilberger blames low competition among insurers for low physician reimbursement, and Medicare, which is tied to the wage index. Pittsburgh gets 20 percent less than other areas because of a lower number of wage earners.

Wilberger: "It hurts people to not have the availability of the type of physician that can take care of them when they really need immediate care."

They won't have physicians because residents like Dr. Darren Frank are also leaving. Born and raised in Pennsylvania, he's leaving for New York at the end of his residency.

Frank: "When I can go to a state -- even a neighboring state -- and pay 20 percent for a malpractice premium, why wouldn't I do that?"

Frank is not alone. A survey by the Pew Charitable Trusts shows three-quarters of the medical residents plan to leave Pennsylvania. They simply can't afford to stay.

Again, this isn't a problem for just one Pennsylvania hospital, but for all. Pittsburgh hospitals are on red alert. They're full, and can't take any more patients.

Doctors say it's eventually going to mean less quality care for all of us. Wilberger says that's already starting to happen.