Neurosurgery tops malpractice risk

Author: Chi, John H.

Source: Neurosurgery. 2011 Dec;69(6):N18-20.

The author states that: "Dealing with malpractice lawsuits is no doubt one of the most challenging and unpleasant aspects of our jobs as physicians and surgeons. The shifting public opinion of the medical profession, lack of education and instruction on how to avoid and handle malpractice suits, and the general lack of reform in malpractice law make the situation more difficult and frustrating. Current data on malpractice rates and risk is difficult to ascertain from professional organizations due to reporting biases, as well as from government databases, which tend to only include cases leading to actual indemnity payments.

Using actual data from a single large national professional liability insurer, Chandra and colleagues (N Engl J Med. 2011;365(7):629-636) determined the rate and risk of being sued in over 25 specialties and the breadth and depth to which any of these suits resulting in indemnity payments (any monies paid to plaintiff). Insurance data from 1991 to 2005 included 40 916 physicians ranging over 25 specialties in both high and low risk specialties, with all 50 states and the District of Columbia being represented. Specialty-specific claim and payment rates were calculated and adjusted risk rates determined.

For each year in the study, a rate of 7.4% of physicians was sued with only 1.6% of those physicians having to make a payment to the plaintiff. An overwhelming 78% of all claims did not result in payments to the plaintiff, but obviously all claims incurred cost for defense of the suit.

The highest proportion of physicians facing a claim was neurosurgery at 19.1%, followed by cardiothoracic surgery (18.9%) and general surgery (15.3%). The lowest proportions were in family medicine (5.2%), pediatrics (3.1%) and psychiatry (2.6%). Indemnity payments varied by specialty, with neurosurgery-related indemnity payments ranking 4th with an average of $344 811. For high risk specialties such as neurosurgery, 88% of physicians were likely to be sued by age 45, with that number rising to 99% by age 65.

Despite the advances in the field of neurosurgery over the past several decades, neurosurgery tops the list of specialties with malpractice claims made against it. Despite the overall low rate of being successfully sued, average payouts for neurosurgeons still tend to be high. As a recognized high-risk profession, steps to try and avoid malpractice suits would include practicing defensive medicine and avoiding complicated cases. These measures can be, however, counter to one of the missions of our profession, which is to provide the highest level of care that is best for our patients. As healthcare policy and medical training evolve around us, incorporating this information on rates and risk of malpractice claims should impact how we prepare ourselves for the future to avoid and minimize malpractice suits altogether

Malpractice list

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