Spot the risky surgeon and predict who might get sued

Certain characteristics may help you spot which surgeons are most likely to have malpractice suits filed against them, allowing you to focus your risk management education on those most in need of help, according to a physician who has studied the phenomenon.

Research has shown that surgeons sued for malpractice often share many traits that have little to do with their clinical skills, says DeWitt C. Baldwin Jr., MD, former scholar in residence at the American Medical Association and now scholar in residence at the Accreditation Council for Graduate Medical Education. Baldwin and colleagues researched the common traits of those sued and presented some resulting advice recently at the annual meeting of the American Society of Healthcare Risk Managers. Not all of the common traits relate to easily measured factors such as years of training or where a doctor when to school, he says.

"If I were an insurer or a risk manager, I’d be interested in looking at my surgeons with these characteristics and see which ones are going to be a better risk," he says. "That’s just good business."

Baldwin’s research has involved malpractice claims for years. In a 1997 study that Baldwin says still offers valid advice, he found that the likelihood of malpractice claims was affected by whether the physician was a solo practitioner, had a registered nurse working in his or her office, was a member of a clinical faculty, or was a member of professional societies. (WJM 1997; 166:276-283.)

The study looked at 427 surgeons, all members of a physician-owned malpractice trust. The 427 surgeons represented all those in the trust who had fewer than 0.13 malpractice claims per year and those with more than 0.54 claims per year, the best and worst in terms of malpractice claim frequency. They studied the relationship between the number of malpractice claims and the surgeons’ personal, educational, and practice characteristics, and found that the differences between the best and worst in malpractice claims frequency yielded useful lessons.

Terminated surgeons were less likely to have completed a fellowship, belong to a clinical faculty, be members of professional societies, be graduates of an American or Canadian medical school, have specialty board certification, or be in a group practice. The data also suggest that orthopedists with high numbers of claims may be less likely to have a religious affiliation or to have a registered nurse working in their office practice. The findings suggest that "surgeons with lower claim rates may be more likely to manifest exemplary modes of professional peer relationships and responsible clinical behavior," the researchers say.

Although not statistically significant, there was a trend suggesting that orthopedic surgeons with no or low claim rates more often reported church membership than those with multiple claims. Marital status had no relationship to claims status. More of the surgeons who had been terminated for malpractice claims had attended a medical school outside the United States or Canada, compared to those with fewer claims. There also was a trend suggesting that terminated surgeons were less likely to have completed a fellowship. All surgeons, and especially those in OB/GYN, were less likely to be board-certified than their colleagues with fewer or no claims.

Some factors related to academics had no relationship to malpractice claims. There were no significant relationships with undergraduate college major, medical school prestige, membership in the Alpha Omega Alpha society, or years of specialty training.

While much of his research has involved surgeons, Baldwin says he thinks the findings could be applied to any type of physician. The information can be put to practical use, Baldwin says.

"If I use these characteristics, the person I’m trying to identify is the loner, the guy who hires less professional help because they won’t question him," he says. "The physicians who are on faculty and members of professional societies are constantly learning from others, constantly getting feedback. They tend to be more responsive and responsible."

Baldwin says his research also has suggested that orthopedic surgeons who spend more time on the initial visit with a patient are less likely to be sued.

Those physicians who score well on tests of moral reasoning also are less likely to be sued, but Baldwin found that a superior medical education does not necessarily improve a doctor’s moral reasoning.

"Medical education, in fact, tends to inhibit moral reasoning," he says. "It tends to train people to think in terms of right and wrong rather than thinking out issues. You want someone who is aware that there sometimes are degrees of right and wrong, and that you have to consider each case on its own."

While physicians may come out of medical school without that kind of moral reasoning, Baldwin says risk managers can change that with about 20 hours of case-based, small group discussions of morally problematic issues. He suggests that risk managers could use these measures to screen physicians when they are first hired or granted privileges.

"If I saw someone with a low score on these tests, you might go to that physician and say, You need training in communication and conflict resolution,’" he says. "You could use these measures to determine where to focus your resources, who is most in need of your attention. Above all else, watch out for the loner rather than the physician in a group."