Research Paper
Malpractice risk at the physician level: Claim-prone physicians

https://doi.org/10.1016/j.jflm.2018.06.004Get rights and content

Highlights

  • Malpractice risk is conditioned by the kind of medicine or procedures we practice.

  • Specialty-based interventions should be carried out at high-risk specialties.

  • Physician's risk of future paid-claims increases after the second claim.

  • Risk management measures focused on physicians with previous paid claims may prevent patient safety events in this subgroup.

Abstract

Professional liability and patient safety are worldwide concerns and efforts to identify claimed physicians' characteristics cross borders. Interventions with “at risk populations” would help to better address the underlying problems that lead to many claims.

We analyzed physicians' characteristics of every paid claim between 2005 and 2014 in Catalonia region (Spain). We identified 808 physicians involved in 725 paid claims. A total of 12.38% physicians had at least two paid claims over the study period. Physicians' risk of future paid claims was increased if they had more than one previous paid claim (hazard ratio, 1.87; 95% confidence interval [CI], 1.67–2,1). More than half the claims were accounted for by physicians in four specialty groups: obstetrics and gynecology (20.4%), traumatology and orthopedic Surgery (17.5%), plastic surgery (10%) and general surgery (9.7%). The risk of recurrence was higher among surgery-related specialties than among non-surgery-related specialties.

Specialty is a particularly strong determinant of claim incidence, so the risk issue may not be so individually determined, but conditioned by the kind of medicine or procedures we practice. Nevertheless, physicians' risk of future paid-claims increases after the second claim. Management systems should take advantage of this information, in order to prevent patient safety events and malpractice claims. Our results support both specialty-based interventions in high-risk specialties, such us Plastic Surgery, as well as interventions at a physician level in those physicians with more than one paid claim.

Introduction

Professional liability and patient safety are worldwide concerns. Regulatory frameworks, national operative systems, and malpractice climate are certainly different from one country to another; so different scenarios need to be studied to achieve a comprehensive international picture.1,2 Specific concerns about claim-prone physicians, as well as efforts to identify claimed physicians' characteristics cross borders, and several studies have compared physicians who have multiple claims against them with colleagues who have few or no claims, but they are scarce in Europe.3, 4, 5 Previous literature suggests that claims history, as well as other issues such as training credentials, have a predictive value6,7 but prospective identification of claim-prone physicians is difficult.3 Our study aims to identify factors associated with recurrent claims at the physician level, on the basis that interventions with “at risk populations” better address the underlying problems.

Section snippets

Methods

The Professional Liability Department (PLD) of the Council of Medical Colleges of Catalonia (CMCC) collects information from the main physician's professional liability insurance company in Catalonia (a region with around 16% of the Spanish population). It insured more than 25,000 physicians in 2015 (about 80% of licensed physicians in the region). Expert physicians and lawyers collect information on patient and physicians' data, adverse events characteristics and procedure outcomes. The PLD

Results

The study sample consisted of 725 paid claims against 808 physicians, with a mean of 1.1 physicians involved in every claim. Over the 10-year study period only 3.2% of insured physicians had a paid claim. A total of 77.7% of the physicians were men (n = 628). More than half of the claims were accounted for by physicians in four specialty groups: obstetrics and gynecology (20.4%), traumatology and orthopedic Surgery (17.5%), plastic surgery (10%) and general surgery (9.7%) (Table 1). The mean

Discussion

Consistently with previous literature,3,5 a relatively small group of physicians in our region accounted for a disproportionately large share of paid malpractice claims over a recent 10-year period (0.3% of insured physicians were involved in 13.8% of all paid claims). Claims concentration over a given period of time is a function of two factors: an individual physician's propensity to attract claims and the baseline incidence of claims in the population.3 Therefore, in our particular scenario

Limitations

This is a single-insurer analysis, although some of the limitations reported for single-insurer analyses, such as physicians switching insurer or having their coverage terminated after a claim,3 do not apply to our model of professional liability insurance. Nevertheless, other limitations should be acknowledged, such as sample size and problems with the generalization of the results from a concrete region of Spain to different international environments.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References (21)

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