Research PaperMalpractice risk at the physician level: Claim-prone physicians
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.
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