A few days ago I put my amateur free market economist hat on, and recommended that everyone listen to a Budweiser commercial. Following a tip from the medskool blog, I passed on news that Texas is dealing with a sudden influx of doctors and it was possible this was the result of tort reform.

In my view, this is just common sense. People will tend to gravitate toward work where it gets easier rather than harder. Living under the threat of lawsuits that you are convinced may be used against you even when you do a good job is a hard thing. Thus, doctors are, all things being equal, going to prefer being doctors in a place where they are protected from such lawsuits. I would confidently predict this was happening even if nothing had been reported.

But, we are not all comfortable with a priori economics. People want a lot of evidence before they agree to a general principle.

Well, here’s some evidence of the same economic forces working in the opposite direction. According to alternet, there are a growing number of vacancies in jobs requiring mammogram reading. Even though mammograms are lifesaving and there is a high demand for such readers it is still hard to find them. Not only are positions vacant, but also teaching fellowships are going unused. Finally, mammogram facilities are closing.

In short, radiologists are afraid of being sued, and there’s evidence that they have more reason to worry than providers in other areas of medicine.

Missed breast cancer is the most common basis for medical malpractice lawsuits in the United States, according to the Physician Insurers Association of America, a trade group of medical malpractice insurance carriers.

And it’s among the most expensive kind of malpractice cases. In a seven-year period ending in 2002, PIAA members spent almost $200 million on breast cancer malpractice cases. That was $30 million more than was spent during the previous six years.

But, experts say, the problem is not inept radiologists, although there are certainly some of those.

Instead, the problem is a misconception about the effectiveness of mammography.

The story goes on to explain how each woman is different and detecting anomalies is extremely tricky.

So, while in Texas tort reform means more doctors coming to serve Texans. In the mammography practice, high probabilities of an unavoidable lawsuit mean fewer doctors in that area.