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Friday, September 2, 2011

Malpractice Risk According to Physician Specialty

Blog Editor Note:

According to this study, only 1 in 5 malpractice claims against doctors leads to a settlement or other payout. While doctors and their insurers may be winning most of these lawsuits, there still remains a high amount of legal actions in medicine. This study indicates that, each year, about 1 in 14 doctors is the target of a claim, and most physicians and virtually every surgeon will face at least one in their careers. While these numbers may support those who believe there are a high number of frivolous lawsuits, the authors seek to understand the complexity of these issues.  Also, psychiatrists have one of the lowest lawsuit rates of the medical specialities and one of the lowest number of payouts.


Anupam B. Jena, M.D., Ph.D., Seth Seabury, Ph.D., Darius Lakdawalla, Ph.D., and Amitabh Chandra, Ph.D.
The New England Journal of Medicine


Despite tremendous interest in medical malpractice and its reform, data are lacking on the proportion of physicians who face malpractice claims according to physician specialty, the size of payments according to specialty, and the cumulative incidence of being sued during the course of a physician's career. A recent American Medical Association (AMA) survey of physicians showed that 5% of respondents had faced a malpractice claim during the previous year. Studies estimating specialty-specific malpractice risk from actual claims are much less recent, including a Florida study from 1975 through 1980 showing that 15% of medical specialists, 34% of obstetricians and anesthesiologists, and 48% of surgical specialists faced at least one claim that resulted in an associated defense cost or payment to a claimant (an indemnity payment) during the 6-year study period.

Each of these earlier studies has limitations, including the use of older data with limited geographic coverage, reliance on self-reports with limited sample size and low response rates, limited information on physician specialty, and a lack of information on the size of payments. Although the National Practitioner Data Bank includes most cases in the United States in which a plaintiff was paid on behalf of a licensed health care provider, it does not report the specialties of physicians and does not record information on cases that do not result in a payment.

Using physician-level malpractice claims obtained from a large professional liability insurer, we characterized three aspects of malpractice risk among physicians in 25 specialties: the proportion of physicians facing a malpractice claim in a given year, the proportion of physicians making an indemnity payment, and the size of this payment. In addition, we estimated the cumulative career risk of facing a malpractice claim for physicians in high- and low-risk specialties.

Part of the Discussion Section

Our results may speak to why physicians consistently report concern over malpractice and the intense pressure to practice defensive medicine, despite evidence that the scope of defensive medicine is modest. Concern among physicians over malpractice risk varies far less considerably across states than do objective measures of malpractice risk according to state (e.g., rates of paid claims, average payment sizes, malpractice premiums, and state tort reforms). For example, 65% of physicians practicing in states in the bottom third of rates for paid malpractice claims (5.5 paid claims per 1000 physicians) express substantial concern over malpractice, as compared with 67% of physicians in the top third (14.6 claims per 1000 physicians). Although these annual rates of paid claims are low, the annual and career risks of any malpractice claim are high, suggesting that the risk of being sued alone may create a tangible fear among physicians.

The perceived threat of malpractice among physicians may boil down to three factors: the risk of a claim, the probability of a claim leading to a payment, and the size of payment. Although the frequency and average size of paid claims may not fully explain perceptions among physicians, one may speculate that the large number of claims that do not lead to payment may shape perceived malpractice risk. Physicians can insure against indemnity payments through malpractice insurance, but they cannot insure against the indirect costs of litigation, such as time, stress, added work, and reputational damage.  Although there is no evidence on the size of these indirect costs, direct costs are large. For example, a Harvard study of medical malpractice suggested that nearly 40% of claims were not associated with medical errors and that although a low percentage of such claims led to payment of compensation (28%, as compared with 73% of claims with documented medical errors), they accounted for 16% of total liability costs in the system.

The entire article can be read here.