Thursday, September 29th 2011

Malpractice Risk According To Physician Specialty

Background
The details of the medical malpractice environment have been studied in detail. The risks providers face of a claim, the risk factors for such, the results of such claims and the like. But previously the risks of claims, indemnity and such physicians of different specialties faced had not been published.

A new study by Dr. Chandra and his colleagues in the New England Journal of Medicine puts some numbers to the malpractice risk faced by various physician specialties.

Jena, Anupam B., Seth Seabury, Darius Lakdawalla, and Amitabh Chandra. “Malpractice Risk According to Physician Specialty.” New England Journal of Medicine 365.7 (2011): 629-36. Print.

The group is done some of the most extensive work on medical malpractice and even a cursory search of this block is likely to show links to many of their previous publications.

The full text of this article can be found on the NEJM website.

Design

  • Database of all closed claims filled between 1991 and 2005 from a large physician owned malpractice insurer
  • Insurer covered 40,916 unique physicians over that time period who self reported more than 200 medical specialties
  • Looked at all claims for each individual year for each specialty to calculate per annum risk
  • Broke claims into those with indemnity and without
  • For those claims with indemnity looked at mean and median payments for each specialty
  • Broke specialties into ‘high risk’ and ‘low risk’ and by Kaplan-Meier estimator gave estimations of cumulative lifetime risk of any claim and any claim leading to payment

Results
There was unsurprising considerable variability amongst specialties for risk for claim.

Procedure based specialties topped the risk of any claim with the annual risk for a neurosurgeon standing at 19.1%

There was more variability for mean and median indemnity payments. Perhaps not surprising specialties in which harm occured to younger patients had larger mean and median payments, even if the risk of claim was low. Pediatrics had the largest payments, topping more than $500,000.

There was also considerable variability, perhaps more difficult to explain, amongst specialties for the risk of a claim leading to an indemnity.

Critique

  • Although a large insurer, the study looked at data from but a single one
  • “Our model assumes that the probability of being sued was unrelated to the duration of coverage by the insurer”
  • “[Our model assumes] that the probability of being sued at a given age was independent of being sued at an earlier age (after adjustment for physician random effects)”
  • The mix of specialties may not be representative

Conclusion

It’s an interesting article and provides good data on risk by specialty. It also provides tangential insight into how physician behavior might be influenced by risk of suit. The author’s discussion of such might be the most interesting thing in the article in fact.

As in other surveys the risk of indemnity was relatively low. Nearly 80% of claims resulted in now payments in this sample. That has been one of the major points by opponents who find no basis for defensive medicine based on the malpractice ‘crisis’. However, as the authors speculate,

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,1 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.

I’m in agreement. I would highly recommend a read of this article.

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