The word “malpractice” often elicits anxiety in the medical community, especially for physicians. Medical errors and adverse outcomes do happen. However, the distribution of medical malpractice claims across the healthcare industry has not historically been well understood. If claim-prone physicians account for a substantial share of all claims, and it is feasible to reliably identify those physicians at an early stage, there are clear implications for efforts to improve the quality and safety of care. Liability insurers and healthcare organizations could use the information to address risks posed by claim-prone physicians. Overall, very few physicians actually have claims; however, those physicians have increasing numbers of claims, which put the individuals at more risk regardless of their specialties.
A recent study analyzed malpractice claims paid against physicians between 2005 and 2014, calculated concentrations of claims among physicians, and sought to identify characteristics of physicians at high risk of “recurrent claims”. Using data from the National Practitioner Data Bank, 66,426 claims paid against 54,099 physicians were analyzed from 2005 through 2014. The study found that relatively few physicians account for a surprisingly large number of paid malpractice claims. In fact, approximately 1% of all physicians accounted for 32% of paid claims. The study’s findings also suggested that it may be feasible to predict who these physicians are before they accumulate troubling track records.
“Among physicians with paid claims, 84% incurred only one during the study period (accounting for 68% of all paid claims), 16% had at least two paid claims (accounting for 32% of the claims), and 4% had at least three paid claims (accounting for 12% of the claims). Male physicians had a 38% higher risk of recurrence than female physicians and M.D.s had a lower risk than D.O.s.”
Specialties with the highest number of paid malpractice claims, include orthopedic, neurosurgery, plastic surgery, obstetrician-gynecologist, and general surgery. Physicians in these specialties have twice the risk of recurrence compared with internal medicine physicians. The lowest risks were among psychiatrists and pediatricians. Again, physicians with multiple paid claims were at significantly increased risk of additional claims.
“In an environment in which a small minority of physicians with multiple claims accounts for a substantial share of all claims, an ability to reliably predict who is at high risk for further claims could be very useful. . . . If reliable prediction proves to be feasible, our hope is that liability insurers and health care organizations would use the information constructively, by collaborating on interventions to address risks posed by claim-prone physicians (e.g., peer counseling, training, and supervision).”
Indeed, this study draws attention to an area of great interest in current risk litigation and management, and many healthcare institutions are embarking on aggressive strategies for behavioral modification. However, the statement above about interventions implies that the physician is at fault and more data may be needed before administrators embark on such a campaign, especially given the potential “blood in the water” phenomenon as it relates to recurrence.
The study’s authors acknowledged some limitations of their analysis, including that not all paid malpractice claims are reported to the National Practitioner Data Base because doctors’ names are often not provided and instead replace with the institutions. Additionally, the study didn’t take into account doctors’ patient volumes, hours worked or patient case mix when evaluating their risk of facing paid malpractice claims. Lastly, the study did not include unpaid claims, which might still indicate problems in some situations.
The study (“Prevalence and Characteristics of Physicians Prone to Malpractice Claims“) can be found here.
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