The effect of physician malpractice on medical costs has been studied extensively. Less research has been done on whether and how physicians change their practice location or form after being sued for malpractice. Fresh research in the New England Journal of Medicine seeks to remedy that lack. (NEJM Article) The researchers examined malpractice claims against a national set of doctors aged 30 to 65 from 2008 to 2015 and linked that to changes in where and how they practiced. Of the over 480,000 doctors included in the analysis, 89% had no claims in the period, 8.8% had one and 2.3% had 2 or more. That 2.3% had 39% of all claims. These doctors were more likely to be male, older and to work in a surgical specialty. Having more claims was associated with leaving the practice of medicine altogether, but 93% of doctors with five or more claims continued to practice. Having more claims was not associated with number of services billed, although there may have been some relationship between number of claims and treating fewer Medicare patients. Number of malpractice claims was not linked to geographic relocation, but was associated with moving into a smaller practice setting. For example, doctors with five or more claims were twice as likely to go into solo practice than those with no claims. Now you might think that having a lot of malpractice claims may be a clear indicator of incompetence, but you really would have to look by specialty or even subspecialty. Ob/Gyn and emergency room doctors are particularly susceptible to claims. In some specialties it may be harder to tell whether treatment was up to expected standards of care, which can increase the likelihood of suits. Some states have favorable litigation environments and others don’t. Not sure what the research tells us that would help patients. Other quality measures paired with number of suits might be more helpful in ascertaining if a doctor has an actual competence problem. And showing how a doctor compares in number of claims to other physicians in the same specialty and same geography would be much more meaningful information.
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The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
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