Many people still do not understand the significance of the medical malpractice crisis in Missouri. I hear about it firsthand every day from family physicians across the state.

Insurance premiums coupled with low reimbursement are forcing family physicians to quit providing services or even leave Missouri. If we don't get some legislative relief this year, it will be harder for citizens to find a doctor, get obstetrical care and access other services.

Here's a real-life example:

I got a call recently from a family-practice physician who provides obstetrical care in rural Missouri. Although she has never had a malpractice claim filed against her, her malpractice insurance jumped to $69,000 from $35,000 on April 1. She cannot pass the increase on to patients, since most of her patients are covered by the Missouri Medicaid program, which compensates physicians at a rate of about 35 cents on each dollar of incurred care.

This doctor became a specialist in family practice because she wanted to care for everyone in the family, from delivering babies to treating parents and grandparents. For this one doctor, the choice is simple: She would rather leave the state than give up delivering babies.

A family-practice physician group in her area stopped providing obstetrical care last November. This means more patients will be displaced and forced to seek alternative care -- if they can find a provider. In this rural area, they may not.

Sixty-two percent of Missouri family physicians in a recent Missouri Academy of Family Physicians survey said they are discontinuing services because of problems getting or affording liability insurance for medical malpractice. The rise in insurance premiums is forcing doctors to cut obstetrical care, in-office surgery and emergency services. A significant number of family physicians say they are considering getting out of medical practice altogether.

Legislators need to pass House Bills 1304 and 1305 to keep physicians in Missouri and keep health-care access open for Missourians. Last year Gov. Bob Holden vetoed a tort-reform bill. House Bill 1304 contains many of the elements of legislation Holden said he could sign.

House Bill 1305, an insurance reform bill, includes is a 60-day notification of a rate increase. They are both essential to stop the white-coat flight out of Missouri.

Unfortunately, it will be too late for one family physician.

Diana M. Ewert is the executive director of the Missouri Academy of Family Physicians.