Most Doctors Face a Malpractice Claim by Age 65


Major Finding: Among the 7.4% of physicians who face medical malpractice claims every year, only 1.6% result in compensation paid to the plaintiff.

Data Source: An analysis of the malpractice claims of 40,916 physicians from 25 different specialties, from 1991 to 2005.

Disclosures: The study received funding from the National Institute on Aging and the RAND Institute for Civil Justice; one coauthor received grant support from the RAND Institute for Civil Justice.

Although physicians in high-risk specialties face a near certainty of a malpractice claim at some point in their careers, only a small minority will end up making an indemnity payment to a patient.

The probability of facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier insuring more than 40,000 physicians in all 50 states and the District of Columbia.

Among physicians in high-risk specialties such as neurosurgery, general surgery, and obstetrics/gynecology, an estimated 88% were projected to face their first claim by age 45 and an estimated 99% by age 65. In low-risk specialties such as family medicine, pediatrics, and psychiatry, 36% of physicians were projected to face their first claim by age 45 years and 75% by age 65 years, Dr. Anupam Jena of Harvard Medical School and his colleagues wrote.

In contrast, the projected rates of indemnity claims paid to plaintiffs were lower. By age 45, 33% of physicians in high-risk specialties were projected to have had a claim paid, rising to 71% by age 65 years. For physicians in low-risk specialties, 5% were projected to have had a claim paid by age 45 years, rising to 19% by age 65 years (N. Engl. J. Med. 2011;365:629-36).

“If you've hit 65 and you haven't had a claim, that's rare; that's almost impossible in our data,” Dr. Jena said in an interview, adding that high-risk specialties often come with higher salaries, which could be what balances out the risk factor for physicians.

Overall, 7.4% of physicians were sued for malpractice each year of the study, with 1.6% having an indemnity payment made each year. Dr. Jena and colleagues also found that specialties in which physicians were more likely to face a malpractice claim were not the ones where indemnity payments were most prevalent.

While few claims resulted in payment, researchers said they were surprised by how many physicians face malpractice claims every year.

“A lot of those claims do not resolve in a payment to the patient, but they still involve significant monetary costs to both the physician and the insurer,” Dr. Jena said. “The physician has loss of productivity because they're not able to see patients as they defend cases … and then there are all sorts of nonmonetary costs that we simply cannot measure,” Dr. Jena said in an interview.

Among all specialties, neurosurgery had the yearly highest risk of being sued (19.1%), followed by thoracic-cardiovascular surgery (18.9%), and general surgery (15.3%). Specialties with the lowest yearly risk of facing being sued included psychiatry (2.6%), pediatrics (3.1%), and family medicine (5.2%). Cardiologists' risk fell in between the two categories, at about 9%. The average payment for all specialties was $273,887.

Some lawmakers and health care organizations have advocated for national medical malpractice reform, or tort reform, as a means of lowering health care costs; California and Texas already have $250,000 caps on noneconomic damages.

However, there's little evidence that proves these measures are lowering health care costs. Even without tort reform, Dr. Jena said that he believes the best solution is one that roots out frivolous claims.

Recommended Reading

IOM: Replace the 510(k) Device Process
MDedge Cardiology
Safety Net Still Active After State Reform
MDedge Cardiology
Dr. Bernadine Healy Dies of Recurrent Brain Cancer
MDedge Cardiology
CMS Proposes 30% Physician Pay Cut for 2012
MDedge Cardiology
Advanced Primary Care Practice Demo Project
MDedge Cardiology
Feds Preview Medicare Pay Bundling Plans
MDedge Cardiology
States Vary Widely in How They Spend Medicaid Dollars
MDedge Cardiology
Data Watch: Small Group Practices Lead E-Prescribing Adoption; Large Groups Are Most Likely to Use EHRs
MDedge Cardiology
Insurance Exchanges May Draw Sicker Patients
MDedge Cardiology
Money's Only Part of the COI Story
MDedge Cardiology