Tara Haelle
Just 1% of physicians accrued a third of all paid malpractice claims over the course of a decade, according to a study published in the January 28 issue of the New England Journal of Medicine. An analysis of common risk factors among physicians with any paid claims included being male, being older, having a previous claim, and practicing as part of several subspecialties, such as surgical subspecialties and obstetrics-gynecology.
"The most important implications of these findings is that 'frequent flyers' are a significant problem, and identifying and remediating them early may help improve the quality of the healthcare system," lead author David Studdert, LLB, ScD, from Stanford Medical School and Stanford School of Law in California, told Medscape Medical News. "It suggests that there is some underlying factor that is predisposing certain physicians to malpractice claims," he continued. "Provision of substandard care is the obvious culprit. Poor communication skills is likely to be another factor in this mix."
Dr Studdert's team analyzed 66,426 claims in the National Practitioner Data Bank that were paid against 54,099 MDs and DOs in the United States from 2005 through 2014, excluding claims against physicians aged 65 years or older to remove the confounder of retirement for no additional claims.
In attempting to isolate characteristics of the physicians with multiple claims, the researchers considered covariates including previous paid claims, qualification, specialty, age, sex, trainee status, practice location, and medical school location (US or other). The authors further controlled for specialty-specific risk "by including a variable indicating the incidence of paid claims per 1000 physicians in each specialty and year."
Although only 6% of all 915,564 active US physicians during that decade, as estimated by the American Medical Association, had a paid claim, about 1% of physicians with at least two paid claims accounted for 32% of all claims. Further, 12% of all claims were attributed to just 0.2% of physicians, all of whom had at least three paid claims.
An analysis after adjustment for covariates revealed that each additional paid claim significantly increased the likelihood of another paid claim. Physicians with two paid claims, for example, were twice as likely to have another compared with physicians with just one paid claim (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.86 - 2.07). Similarly, the risk for another paid claim tripled for physicians with at least three existing paid claims (HR, 3.11; 95% CI, 2.84 - 3.41), and the risk for an additional paid claim was 12 times greater for physicians with at least six or more paid claims (HR, 12.39; 95% CI, 8.69 - 17.65).
A similar pattern emerged within subspecialties, but several specialties also showed an independent increased likelihood of recurrence. Neurosurgeons, orthopedic surgeons, general surgeons, plastic surgeons, and obstetricians-gynecologists had approximately twice the risk for an additional paid claim compared with internal medicine physicians.
"In general, the high-risk specialties tend to be the ones that involve invasive procedures, where risk of adverse outcomes is higher, irrespective of whether the care was appropriate or negligent," Dr Studdert told Medscape Medical News. Continue Reading
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