High malpractice insurance premiums are discouraging many new physicians from staying in Pennsylvania to pursue careers after they finish residency training here, a new study shows.

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Though physician supply isn't yet a problem in urban areas of Pennsylvania, the study's authors suggest this trend bodes ill for a state that already has one of the lowest numbers of doctors under 35 in the country.

The study, published last month in the journal Obstetrics and Gynecology, found that one-third of Pennsylvania residents in high-risk specialties said they planned to leave the state to practice because of the lack of affordable malpractice insurance. And 71 percent of residency program directors said they've experienced a drop in retention since the start of the liability crisis around 1999.

"Pennsylvania has been historically oversupplied with physicians in urban areas and in the eastern side, so we may not see an immediate impact," said Michelle Mello, co-author of the report. "But if those trends continue, it may be something to worry about."

The fear is that skyrocketing premiums will cause doctors to leave or limit their practices, which could lower patient access to specialists.

The study is a part of a larger project by The Pew Charitable Trusts into medical liability issues in the state. This was the first report in the project that explored the effects of premiums on young doctors in specialty areas like general surgery, anesthesiology and obstetrics.

The study surveyed 68 residency program directors and 360 residents near the end of their training. Mello, a Harvard University health policy and law professor, said she was surprised at the number planning to leave the state.

One resident surveyed wrote: "I'm leaving Pennsylvania the second my residency is finished. Why in the world would anybody want to practice in this state?"

Another wrote: "Everything about Pennsylvania other than the state of malpractice and litigation would encourage me to stay and practice here. I like Pennsylvania, but it's not worth it."

The researchers didn't receive any positive comments, the report noted.

Premiums in the state vary by county, but overall the costs are higher in eastern counties like Philadelphia.

Premiums reported by one company were $128,524 for general surgery physicians in Philadelphia County, almost $50,000 more than those in Allegheny County, the Medical Liability Monitor reports.

The liability crisis hasn't hit Pennsylvania alone. The American Medical Association says that 20 states are considered in a crisis, meaning lawsuit costs, settlements and jury awards have caused premiums to jump.

William Sage, a Columbia University law professor and lead investigator in the Pew project, said the study shouldn't be taken as comprehensive.

Rather, it's a "single snapshot in the midst of a malpractice crisis," he said.

It's a very clear snapshot for Matthew Neal, a fourth-year University of Pittsburgh medical student who plans to become a general surgeon. He may stay in the city for residency training, but won't work here.

The Pennsylvania native says the increasing malpractice costs that started around the time he entered medical school are the main reason.

"If I were finishing my residency tomorrow, there is a zero percent chance that I would stay in the state of Pennsylvania," he said. "It's not just about treating patients anymore, it's about making sure that you don't get sued."