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MDs Likely to Pay Malpractice Penalties Have Distinct Characteristics

STANFORD, CA – The small percentage of physicians most likely to be involved in successful malpractice claims usually fit a profile distinctive from the average clinician, according to a new study.

The report, published recently in the New England Journal of Medicine, points out that that only 1.0% of practicing physicians accounted for 32% of paid malpractice claims over the decade measured.

"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," said lead author David Studdert, LLB, ScD, MPH, professor of medicine and of law at Stanford University. "It suggests that it may be possible to identify high-risk physicians before they accumulate troubling track records, and then do something to stop that happening."

In a Stanford press release, Studdert called the degree to which claims were concentrated within a small group of physicians “really striking.”

For the study, researchers analyzed information from the U.S. National Practitioner Data Bank, looking at a 66,426 malpractice claims paid against 54,099 physicians between January 2005 and December 2014. Almost a third of the claims were related to patient deaths, while another 54% were associated with serious injury.

Out-of-court settlements occurred in nearly all cases, with only 3% litigated with verdicts for the plaintiff. Settlements and court-ordered payments together averaged $371,054.

The study found that the physician’s claim history was the most important predictor of incurring repeated claims. Compared to physicians with only one prior paid claim, physicians who had two paid claims had almost twice the risk of another one. At the same time, 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 showed wide variation based on specialty. Compared to internal medicine physicians, results indicate that the risk of recurrence was almost double among neurosurgeons, orthopedic surgeons, general surgeons, plastic surgeons, and obstetrician-gynecologists. Psychiatrists and pediatricians had the lowest risks of recurrence.

Researchers also report that male physicians had a 40% higher risk of recurrence than female physicians, and physicians younger than 35 had about one-third the risk compared to their older colleagues.

"If it turns out to be feasible to predict accurately which physicians are going to become frequent flyers, that is something liability insurers and hospitals would be very interested in doing," Studdert said, adding that he hoped the information “would be used in a more constructive way, to target measures like peer counseling, retraining, and enhanced supervision.”