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22-08-2011 | Article

# Majority of physicians in high-risk specialties will face malpractice claims

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MedWire News: Almost all physicians specializing in high-risk areas such as surgery and obstetrics and gynecology will face a malpractice claim during their career, shows analysis of 14 years of US data.

Not all of these physicians will end up paying indemnity costs, however.

The findings also highlight that there is wide variation in the likelihood of malpractice suits and the size of indemnity payments according to specialty.

"High rates of malpractice claims that do not lead to indemnity payments, as well as a high cumulative career malpractice risk… may help to explain perceived malpractice risk among US physicians," say Amitabh Chandra (Harvard University, Cambridge, Massachusetts) and colleagues.

The team used data for 40,916 physicians covered by a large, nationwide professional liability insurer, to investigate the cumulative career risk for facing a malpractice claim and the size of possible indemnity payments.

Physicians were aged between 30 and 70 years, and high- and low-risk specialties were defined as the five specialties with the highest and lowest proportions of physicians with a claim during a 1-year period.

Overall, 7.4% of physicians had one claim annually, whereas only 1.6% made an indemnity payment after a claim of malpractice. There was a significant difference in the specialties of physicians who faced claims, ranging from 2.6% of psychiatrists to 19.1% of neurosurgeons.

The researchers note that the proportion of physicians with a claim did not correlate with the level of indemnity payment made, for example, gynecology came 12th in the annual average proportion of physicians with a claim, but these specialists paid out some of the highest amounts in indemnity.

The rate of indemnity did correlate with specialty. The mean amount was US$274,887 (€ 191,628), while the amount by specialty varied from US$ 344,811 (€ 240,436) for neurosurgeons, to US\$ 520,924 (€ 363,484) for pediatricians, even though neurosurgery was associated with a higher number of annual malpractice claims.

Physicians in low-risk specialties had an estimated 36% risk for facing a malpractice claim before the age of 45 years, whilst the estimate was 88% for those practicing in high-risk specialties.

Overall, 75% and 99% of low- and high-risk specialists will face a malpractice suit by the age of 65 years, write Chandra et al in the NEJM. The corresponding percentages of physicians expected to make an indemnity payment by this age were 19% and 71%.

"Our results may speak to why physicians consistently report concern over malpractice and the intense pressure to practice defensive medicine, despite evidence that the scope of defensive medicine is modest," says the team.

Three possible factors leading to this concern could be the fear of the claim itself, the probability of a claim leading to a payment, and the size of a payment, suggest Chandra and co-investigators.

Furthermore, while physicians can insure against indemnity payments through malpractice, they cannot insure against indirect costs "such as time, stress, added work, and reputational damage," they conclude.

By Sarah Guy