Risk Management _ __________________________________________________________________________
For physicians in low-risk specialties (e.g., pediatrics, psychiatry), there is a substantial gap between physicians’ perceived risk of malpractice and their actual risk, with physicians perceiving a much greater risk of malpractice than has been documented for their specialty [15; 16]. For example, in a survey regarding malpractice concerns, 62.5% of pediatric physicians agreed or strongly agreed that they were at risk, compared with American Medical Association (AMA) data that indicated 17.8% of pediatric physicians had ever been sued [13; 17]. Similarly, radiologists have estimated their risk of litigation within five years as 35%, which compares with an actual rate of approximately 10% [15]. By contrast, using the same datasets, physicians in high-risk specialties (i.e., obstetrics/gynecology and surgery) had a much closer concern/ reality gap, with concern data showing 81% for obstetricians/ gynecologists and 75.3% for surgical specialists, compared with a lifetime malpractice claim rate of 63.6% and 63.2%, respectively [13; 17].
The risk of malpractice varies among medical specialties and typically increases with the frequency with which procedures are performed and with a greater potential for catastrophic injury [5; 18]. The rates of malpractice claims against family medicine and internal medicine physicians have historically been low, but the rates have increased since the late 1990s [19]. According to paid claims between 1992 and 2014, family medicine and internal medicine were the specialties with the second and third leading number of claims (behind obstetrics/gynecology), with 18,349 and 17,174 paid claims, respectively ( Table 1 ) [5]. It has been estimated that the typical family physician can expect to be sued about once every 7 to 10 years [20]. One study noted that by 65 years of age, 75% of physicians in low-risk specialties faced a malpractice claim, compared with 99% of physicians in high-risk specialties. It should be noted, however, that more than 75% of these malpractice claims do not result in indemnity payment [21]. In an analysis of overall paid malpractice claims between 1992 and 2014, it was found that the rate of paid claims decreased by 55.7%; however, the mean payment amount increased by 23.3% ( Table 1 ) [5].
ANNUAL PAID MALPRACTICE CLAIMS ACCORDING TO SPECIALTY, 1992–2014
Total Paid Claims a
Specialty
Mean Payment
Obstetrics and gynecology (includes surgery)
20,060 18,349 17,174 12,981 10,641
$432,959 $290,698 $318,071 $298,625 $258,763 $333,422 $309,411 $377,499 $413,974 $365,029 $231,622 $244,039 $23,290 $282,822 $189,219 $238,909 $349,013 $469,222 $411,529 $380,402 $431,049 $282,822 $189,065 $337,976
Family medicine Internal medicine General surgery
Orthopedics (includes surgery)
Radiology
9,079 8,007 7,892 5,799 5,378 4,435 4,044 3,631 3,226 3,156 3,115 2,881 2,797 2,372 2,179 2,156 1,081 1,717
Emergency medicine
Anesthesiology
Pediatrics
Cardiology (includes surgery)
General practice Ophthalmology
Urology (includes surgery)
Otolaryngology Plastic surgery
Psychiatry
Gastroenterology
Neurosurgery
Pathology
Thoracic surgery
Neurology (nonsurgical) Otorhinolaryngology
Dermatology
Colon and rectal surgery
549
a Includes physicians with more than one paid claim. Source: [5]
Table 1
22
MDMI1826
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