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Original Investigation
Health Care Policy and Law
March 27, 2017

Rates and Characteristics of Paid Malpractice Claims Among US Physicians by Specialty, 1992-2014

Author Affiliations
  • 1Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 2Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 3Department of Medicine, Massachusetts General Hospital, Boston
  • 4National Bureau of Economic Research, Cambridge, Massachusetts
  • 5Department of Ophthalmology, University of Southern California, Los Angeles
  • 6Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
  • 7US Health Resources and Services Administration, Rockville, Maryland
JAMA Intern Med. Published online March 27, 2017. doi:10.1001/jamainternmed.2017.0311
Key Points

Questions  What are the trends in paid medical malpractice claims for physicians in the United States, and do they vary by specialty?

Findings  This database study linked National Practitioner Data Bank claims data with physician specialty and found that the overall rate of claims paid on behalf of physicians deceased by 55.7% from 1992 to 2014. Mean compensation amounts and the percentage of payments exceeding $1 million increased during that time, with wide differences in rates and characteristics across specialties.

Meaning  A better understanding of the causes of variation among specialties in paid malpractice claims may help reduce patient injury and physicians’ risk of liability.

Abstract

Importance  Although physician concerns about medical malpractice are substantial, national data are lacking on the rate of claims paid on behalf of US physicians by specialty.

Objective  To characterize paid malpractice claims by specialty.

Design, Setting, and Participants  A comprehensive analysis was conducted of all paid malpractice claims, with linkage to physician specialty, from the National Practitioner Data Bank from January 1, 1992, to December 31, 2014, a period including an estimated 19.9 million physician-years. All dollar amounts were inflation adjusted to 2014 dollars using the Consumer Price Index. The dates on which this analysis was performed were from May 1, 2015, to February 20, 2016, and from October 25 to December 16, 2016.

Main Outcomes and Measures  For malpractice claims (n = 280 368) paid on behalf of physicians (in aggregate and by specialty): rates per physician-year, mean compensation amounts, the concentration of paid claims among a limited number of physicians, the proportion of paid claims that were greater than $1 million, severity of injury, and type of malpractice alleged.

Results  From 1992-1996 to 2009-2014, the rate of paid claims decreased by 55.7% (from 20.1 to 8.9 per 1000 physician-years; P < .001), ranging from a 13.5% decrease in cardiology (from 15.6 to 13.5 per 1000 physician-years; P = .15) to a 75.8% decrease in pediatrics (from 9.9 to 2.4 per 1000 physician-years; P < .001). The mean compensation payment was $329 565. The mean payment increased by 23.3%, from $286 751 in 1992-1996 to $353 473 in 2009-2014 (P < .001). The increases ranged from $17 431 in general practice (from $218 350 in 1992-1996 to $235 781 in 2009-2014; P = .36) to $114 410 in gastroenterology (from $276 128 in 1992-1996 to $390 538 in 2009-2014; P < .001) and $138 708 in pathology (from $335 249 in 1992-1996 to $473 957 in 2009-2014; P = .005). Of 280 368 paid claims, 21 271 (7.6%) exceeded $1 million (4304 of 69 617 [6.2%] in 1992-1996 and 4322 of 54 081 [8.0%] in 2009-2014), and 32.1% (35 293 of 109 865) involved a patient death. Diagnostic error was the most common type of allegation, present in 31.8% (35 349 of 111 066) of paid claims, ranging from 3.5% in anesthesiology (153 of 4317) to 87.0% in pathology (915 of 1052).

Conclusions and Relevance  Between 1992 and 2014, the rate of malpractice claims paid on behalf of physicians in the United States declined substantially. Mean compensation amounts and the percentage of paid claims exceeding $1 million increased, with wide differences in rates and characteristics across specialties. A better understanding of the causes of variation among specialties in paid malpractice claims may help reduce both patient injury and physicians’ risk of liability.

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