Higher prevalence of malpractice claims associated with prior paid claims and medical specialty

1. According to data from the National Practioner Data Bank (NPDB), a small proportion (1%) of all physicians accounted for a relatively larger number (32%) of paid claims. 

2. The risk of recurrence of physicians having to pay a malpractice claim increased based on the number of prior claims paid. 

Evidence Rating Level: 2 (Good)

Study Rundown: Current literature on malpractice has focused primarily on identifying qualifying differences in litigation-prone providers, and is often limited by using claims data from single insurers or the state. However, little headway has been made in evaluating the distribution of malpractice claims among physicians. In this retrospective cohort study, researchers attempted to characterize the distribution of malpractice claims on a national scale using data from the NPDB. Their results demonstrated that within a 10-year period, a disproportionately large number of paid claims came from a small group of physicians. The risk of incurring a future claim was significantly associated with both the number of previous paid claims and physician specialty – with surgical specialties typically conferring a higher risk. This study is limited primarily due to its data set, which may not capture all paid claims – particularly claims that are lawfully paid as settlements are made in dispute resolution. Additionally, the analysis does not take into account single claim physicians who may have retired early or stopped treating patients for personal or legal reasons. Overall, these findings are important in that they suggest that there may be ways to predict which physicians will be more claim-prone than others.

Click to read the study in published today in NEJM

Relevant Reading: Identifying malpractice-prone physicians

In-Depth [retrospective cohort]: In this retrospective cohort study, from the NPDB, researchers evaluated 66,462 paid claims that were made against 54,099 physicians between 2005-2014, to better understand the distribution of malpractice claims. Exclusion criteria included claims against physicians >65 years to eliminate bias from absent claims due to physician retirement. The primary outcome was a paid claim against a physician, given that the physician had a previous paid claim.

With regards to sample characteristics, 44,350 (82%) of the physicians were male, 21,133 (39%) were between the ages of 45-54 and over half the claims paid were made by providers in internal medicine (15%), obstetrics and gynecology (13%), general surgery (12%) and family medicine (11%). Additionally, 32% of claims were made due to patient death, while another 38% were due to significant physical injury, as defined by the National Association of Insurance Commissioners. In terms of distribution of claims, approximately 1% of physicians who had paid ≥2 claims over the 10-year period made up 32% of all paid claims, and 0.2% of physicians with ≥3 claims constituted 12% of all paid claims.

Multivariable analysis showed that physicians who had at least two prior claims had approximately double the risk of incurring another claim (HR=1.97; 95%[CI]: 1.86 to 2.08), and physicians with at least 3 claims had 3x the risk (HR=3.11; 95%[CI], 2.85-3.41). Among specialties, internal medicine (HR=2.32; 95%[CI]: 1.77-3.03) and other surgical subspecialties tended to be associated with the greatest risk of recurrent paid claims.

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