Among nearly 1 million active physicians in the U.S., about 6% were involved in at least one paid malpractice claim during a 10-year period ending in 2014, with a total payout of $13.6 billion, researchers said.
The vast majority of claims were for death or major or significant physical injury, according to David M. Studdert, LLB, ScD, of Stanford University’s schools of law and medicine in Palo Alto, Calif., and colleagues, writing in the New England Journal of Medicine.
Paid claims were mostly for patient death (32%), “significant” (severely disabling and permanent) physical injury (38%), and “major” physical injury (15%). (“Major” injuries could be either severe but temporary, or less severe but permanent.) The remaining claims were for minor physical injury (12%) and emotional injury only (2%).
Most of the physicians, 84%, paid only a single claim, but physicians who had at least two claims — 16% of the group — paid 32% of the total claims, the researchers found. The 4% of physicians with at least three paid claims accounted for 12% of the total number of paid claims; and 1% of group had at least four paid malpractice claims, which accounted for 5% of all paid malpractice claims.
Studdert’s team looked at paid malpractice claims in the National Practitioner Data Bank from 2005 through 2014. They found a total of 66,426 paid claims against 54,099 allopathic and osteopathic doctors.
The authors used an American Medical Association (AMA) estimate of 915,564 physicians working during the study period.
Four specialties accounted for about half of all paid claims: internal medicine (15% of the total): obstetrics and gynecology (13%), general surgery (12%), and general practice or family physicians (11%).
Virtually all of the paid claims came from out-of-court settlements: only 3% were the result of court verdicts. The median payment amount was $204,750, with a mean of $371,054.
Although 92% of claims involved MDs, their risk for having a paid claim was lower than for DOs (hazard ratio 0.80, 95% CI 0.75-0.86). Male physicians were more likely to have paid claims than were females (HR 1.38, 95% CI 1.30-1.46).
Physicians with a history of paid claims were also more likely to be hit with additional claims. Those with two previous paid claims were twice as likely to have another compared with physicians who only had one previous claim (HR 1.97, 95% CI 1.86-2.07).
The risks went up from there: for the 1% of physicians with six or more paid claims, the risk for an additional claim went up 12-fold compared with physicians having only one previous paid claim (HR 12.39, 95% CI 8.69-17.65).
The risk of recurrence varied considerably between specialties, with surgeons in various sub-specialties and ob/gyn physicians showing the highest rates. At the other end of the spectrum were psychiatrists and pediatricians.
Studdert and colleagues noted several limitations to the analysis, including the prospect of unreported claims data, which may have also caused a ripple of underreporting multiple claims for individual physicians. Also, other risk factors for claims, such as hours worked or volume of patient load, were not accounted for.
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