To the Editor.
—The article by Messrs Bovbjerg and Petronis1 on the predictive value of physicians' malpractice claims experience and the excellent Commentary by Mr Smarr2 fail to consider an important determinant of a physician's risk of incurring a malpractice claim, namely, practice volume.It stands to reason that the more patients a physician treats, the more likely that physician is to have a bad result or unanticipated outcome, to encounter an angry or litigious patient, or to make a mistake. The larger the practice, the more the "exposure," and this exposure increases with each subsequent year in practice. As one of my surgery professors used to half joke: "Any surgeon who has been in practice 10 or more years and has not been sued simply isn't busy enough."It would be interesting to factor practice volume into the odds ratios of Bovbjerg and Petronis. If there is a
Wertkin MG. The Relationship Between Physicians' Malpractice Claims History and Later Claims. JAMA. 1995;273(19):1487-1488. doi:10.1001/jama.1995.03520430023015