NEJM Study shows 1% of physicians accounted for one-third of all paid claims
A study in the January 2016 New England Journal of Medicine analyzed paid medical liability claims, (an indemnity payment made to an injured party), and the physician’s name was reported to the National Practitioner Data Bank (NPDB) to determine if the characteristics of claim-prone physicians could be identified.
David M. Studdert, LLB, ScD, of Stanford University and his colleagues analyzed 66,426 claims in the NPDB that were paid in the US from 2005 through 2014. Investigators calculated the cumulative distribution of paid claims in two physician populations: doctors with one or more paid claims and all active physicians.
The biggest predictor for claim-prone doctors was whether they’d had a prior claim. Of all paid claims, 82% involved male physicians. The specialists with the highest total number of paid claims, (not necessarily the highest frequency per individual physician, as there are more physicians in certain specialties), were internists (15%), Ob-Gyns (13%), general surgeons (12%), and family physicians (11%).
Approximately 1% of all physicians accounted for 32% of paid claims. Among those with paid claims, 84% had only one paid claim during the study period (68% of all paid claims), 16% had at least two (32% of the claims), and 4% had at least three (12% of the claims).
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,” said Dr. Studdert. “It suggests that there is some underlying factor that is predisposing certain physicians to malpractice claims. Provision of substandard care is the obvious culprit. Poor communication skills are likely to be another factor in this mix.”
When looking at this study, there are several things to consider:
- Not all malpractice settlements reach the NPDB; some physicians may be shielded from claims being reported individually in their name to the NPDB by their institutions or delivery systems.
- The authors used a simple head count. We know that there are physicians who practice longer hours and have a higher risk patient mix. This may make them more likely to be involved in litigation.
- There may have been self-censoring; a physician may have backed away from tough cases, retired, or lost his/her license.
- Not all paid claims have merit. Certainly a paid claim is more likely to have substandard care, but there are many reasons a physician might settle a claim and not all are because of poor or indefensible care.
Increased Risk of Reoccurrence of Claims
A physician’s specialty had a marked impact on the risk of future paid claims. Neurosurgeons, orthopedic surgeons, general surgeons, plastic surgeons, and Ob-Gyns had approximately twice the risk for an additional paid claim compared with internal medicine physicians. Psychiatrists and pediatricians had the lowest risks of recurrence. “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,” said Dr. Studdert.
There is also the issue of malpractice stress. Physicians may experience a significant psychological response to being sued, making litigation a high-risk time for another suit. MagMutual addresses this issue with lawsuit stress seminars and peer support through our Doctor2Doctor® peer support program.
A plethora of emotions may occur when you are being sued—fear, anger, rage, and shame are common. We have seen physicians who have not told their spouses of their lawsuit, and maladaptive behaviors might occur such as poor sleep, drinking too much, or self-medicating. Poorly coping physicians appear to be off their “game” and may not follow their usual and customary decision-making processes.
Certainly, some of the risk may come from poor cognitive and knowledge skills in a particular specialty or poor procedural skills if you’re a surgeon or interventionalist. In addition, communication is a major component of litigation. Significant literature has shown that poor communication often leads to more litigation.
What to do About the Findings of This Study?
Looking at the specifics of given paid claims—many of which involve complex situations, communications, and expectations—MagMutual believes that raising the quality and safety bar for all makes sense. Through proactive efforts, our goal is to support improved care so physicians don’t ever face a claim.
In the study, the researchers are clear that they have identified risk factors for repeated litigation. “This problem of physicians who accumulate multiple claims and continue to practice...is a significant policy problem and one that we need to address,” said Dr. Studdert. The authors of the paper call for further investigation into predicting which doctors are at risk and then implementing interventions such as training and supervision to improve their quality of care.
Targeted intervention resources offered by MagMutual include our risk management hotline, practice assessments, and an array of patient safety and risk management education activities available at www.magmutual.com/learning-center.
Created by MagMutual from materials provided by COPIC as part of MagMutual and COPIC’s alliance to improve patient safety and quality of care for all of our PolicyOwners.
 D. Studdert, LLB., Sc.D., M. Bismark, M.B., Ch.B., L.L.B., M. Mello, J.D., Ph.D., H. Singh, Ph.D., M. Spittal, Ph.D. The New England Journal of Medicine. 2016; 374:354-362.