An article published in The New England Journal of Medicine on March 28, 2019 entitled “Changes in Practice among Physicians with Malpractice Claims” concluded: “Physicians with multiple malpractice claims were no more likely to relocate geographically than those with no claims, but they were more likely to stop practicing medicine or switch to smaller practice settings.”
The authors of the article linked an extract of the National Practitioner Data Bank to the Medicare Data on Provider Practice and Specialty data set to create a national cohort of physicians 35 to 65 years of age who practiced during the period from 2008 through 2015. They then analyzed associations between the number of paid malpractice claims that physicians accrued and exits from medical practice, changes in clinical volume, geographic relocation, and change in practice-group size.
The cohort consisted of 480,894 physicians who had 68,956 paid claims from 2003 through 2015. A total of 89.0% of the physicians had no claims, 8.8% had 1 claim, and the remaining 2.3% had 2 or more claims and accounted for 38.9% of all claims. The number of claims was positively associated with the odds of leaving the practice of medicine (odds ratio for 1 claim vs. no claims, 1.09; 95% confidence interval, 1.06 to 1.11; odds ratio for ≥5 claims, 1.45; 95% confidence interval, 1.20 to 1.74). The number of claims was not associated with geographic relocation but was positively associated with shifts into smaller practice settings. For example, physicians with 5 or more claims had more than twice the odds of moving into solo practice than physicians with no claims (odds ratio, 2.39; 95% confidence interval, 1.79 to 3.20).
The Agency for Healthcare Research and Quality, Patient Safety Network stated in an article published in July 2017 entitled “Doctors With Multiple Malpractice Claims, Disciplinary Actions, and Complaints: What Do We Know?”: “there is compelling evidence that the risk of future medicolegal events is significantly higher among physicians with markedly worse medicolegal event track records than their peers. Past isn’t always prelude, but it’s a useful marker of future risk … A corollary of the fact that prior medicolegal events are strongly and positively associated with risk of future medicolegal events is that these events tend to cluster in the physician workforce, with some physicians accounting for a disproportionately large share of all medicolegal events. In fact, medicolegal events appear to be extremely maldistributed. For example, one recent study of paid malpractice claims in the United States between 2005 and 2014 found that 1% of all physicians accounted for one-third of all claims … Available evidence suggests that, compared to physicians who experience no or few events, medicolegal event–prone physicians are more likely to be male, to be international medical graduates, and to work in certain high-risk specialties (e.g., orthopedic surgery, obstetrics and gynecology). Findings are mixed regarding whether physician age is a risk factor … With a few notable exceptions, there is scant evidence about what works to restore medicolegal event–prone physicians to safe practice, or, when necessary, to shepherd them away from patient care.”
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