A small number of physicians account for a disproportionately large number of malpractice claims in the United States, Stanford medical and law researchers found after examining 10 years of medical data.
The ability to identify these claim-prone physicians early would be invaluable, the researchers write in a paper published today in The New England Journal of Medicine.
David Studdert, ScD, professor of law and of medicine, and Michelle Mello, JD, PhD, professor of law and of health research and policy — who are also core faculty members of Stanford Health Policy — conducted the study in collaboration with researchers from the University of Melbourne, Australia.
The team found that just 1 percent of practicing physicians accounted for 32 percent of paid malpractice claims over a decade. The study also found that claim-prone physicians had a number of distinctive characteristics. Studdert, lead author of the study, explains:
The degree to which the claims were concentrated among a small group of physicians was really striking. But the fact that these frequent flyers looked quite different from their colleagues — in terms of specialty, gender, age, and several other characteristics — was the most exciting finding. It suggests that it may be possible to identify problem physicians before they accumulate troubling track records, and then do something to stop that happening.
Male physicians had a 35 percent higher risk of recurring claims than female physicians, and the risk of recurrence among physicians younger than 35 years old was about one-third the risk among their older colleagues, the study found.
The most important predictor of incurring repeated claims was a physician’s claim history. Compared to physicians with only one prior paid claim, physicians who had two paid claims had almost twice the risk of another one; physicians with three paid claims had three times the risk of recurrence; and physicians with six or more paid claims had more than 12 times the risk of recurrence.
“Risk also varied widely according to specialty,” the authors noted. “As compared with the risk of recurrence among internal medicine physicians, the risk of recurrence was approximately double among neurosurgeons, orthopedic surgeons, general surgeons, plastic surgeons and obstetrician-gynecologists.”
The researchers analyzed information from the U.S. National Practitioner Data Bank, a data repository established by Congress in 1986 to improve health-care quality. Their study covered 66,426 malpractice claims paid against 54,099 physicians between January 2005 and December 2014. Here's Mello:
The concentration of malpractice claims among physicians we observed is larger than has been found in the few previous studies that have looked at this distributional question. It’s difficult to say why that is. The earlier estimates come from studies of single insurers or single states, whereas ours is national in scope. Also, the earlier numbers are more than 25 years old now, and claim-prone physicians may be a bigger problem today than they were then.
The authors recommend that all institutions that handle large numbers of patient complaints and claims should develop greater awareness of how these events are distributed among clinicians.
“In our experience, few do,” they wrote in the paper. “With notable exceptions, fewer still systematically identify and intervene with practitioners who are at high risk for future claims.”