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And when a doctor has to pay out one claim, the chances are good
that the same physician will soon be paying out on another,
researchers report in the New England Journal of Medicine.
"I think people will be surprised about the extent to which the
claims are concentrated within a relatively small group of
practitioners. It's actually more concentrated than in earlier
studies," chief author David Studdert of Stanford University in
California told Reuters Health.
The result, he said, demonstrates that there are practitioners who
can accumulate large numbers of claims and continue to practice.
Earlier studies looked at malpractice claims that may or may not
have had merit. This study looked at all cases in the National
Practitioner Data Bank where payments were made.
Those other studies typically focused on a single insurer or a
single state, and repeat offenders may have been able to avoid being
tracked, by moving or switching insurers, Studdert said. "We have a
kind of national all-encompassing window, so we should have been
able to track the doctors wherever they go."
Physicians in specialties such as anesthesiology and neurology have
long been known to face an inherently higher risk for malpractice
claims.
"This study rather convincingly shows, however, that even within
specific specialties, malpractice claims are relatively concentrated
and that a strong predictor of subsequent claims is a prior history
of malpractice claims," said Dr. Anupam Jena, associate professor of
healthcare policy at Harvard Medical School in Boston, who was not
connected to the research.
In addition, "this is the most comprehensive exploration of the
hypothesis that individual physician malpractice risk may be
predictable," he told Reuters Health in an email. "To strengthen
prediction, there are important factors that future analyses will
hopefully consider such as patient volume, complexity of services
provided, experience, and specifics on medical school, residency,
and fellowship training."
Studdert's team analyzed 66,426 claims paid against 54,099 doctors
from 2005 to 2014.
Nearly all were out-of-court settlements. Almost one third of the
cases were sparked by a patient's death. About 1 percent of
physicians had at least two paid claims against them and those
doctors accounted for 32 percent of paid claims.
One hundred twenty six doctors had more than five paid claims
against them.
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The median payment among all claims was nearly $205,000.
Doctors who accumulated two lawsuits where money was paid out were
twice as likely to be successfully sued for malpractice a third time
compared to doctors who only had one paid claim against them.
Doctors with more than five paid claims were 12 times more likely to
face a subsequent claim.
Compared to general practitioners, recurrence rates were roughly two
times higher in the fields of obstetrics and gynecology, orthopedic
surgery, plastic surgery and general surgery. The recurrence rate
was highest for neurosurgeons, at 2.3 times that of GPs.
Researchers looked for other traits, beyond specialty, that might
predict which doctors are more likely to have malpractice claims.
They found that physicians under age 35 were two thirds less likely
to have to pay on a malpractice claim after an initial payment. The
odds of paying out on a subsequent claim were 38 percent higher
among male doctors than female physicians. Doctors trained outside
the United States were 12 percent more likely to have to pay out on
more than one claim.
If problematic physicians can be identified, it might be possible to
get them into programs designed to improve their practice and help
them avoid future claims.
"There's a question mark over whether interventions such as peer
coaching, supervision, placing conditions on practice and so forth
really are capable of returning high-risk physicians to safe
practice," Studdert said. "We need to learn a lot more about these
programs."
SOURCE: http://bit.ly/1OIeQ7s New England Journal of Medicine,
online January 27, 2016.
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