By Gene Emery
(Reuters Health) – The more malpractice claims a physician accrues, the greater the likelihood that doctor will switch to a smaller practice or stop practicing medicine altogether, a new study suggests.
Data on nearly a half million practitioners didn’t yield evidence that doctors accused in more than four malpractice cases relocate to another part of the country to escape a bad reputation, perhaps because their history follows them, the authors report in the New England Journal of Medicine
“Physicians who accumulate malpractice claims are more likely to cease practice and that likelihood increases with each claim,” lead author David Studdert, a professor of law and medicine at Stanford University in California, told Reuters Health in a telephone interview.
“But there’s still plenty of physicians who may be a problem. Over 90 percent of the doctors who have racked up five or more paid claims continued to practice,” he said.
Studdert’s team undertook the study after finding that although 94 percent of doctors never had a malpractice claim during a 10-year span, 1 percent of physicians accounted for nearly a third of all claims.
“As we went around talking about that study, there were persistent questions asking, ‘Who are these people, how can they still be practicing, which hospitals credential them and who writes liability insurance for them?'” Studdert said.
To track the careers of doctors prone to malpractice allegations, the researchers obtained information from Medicare and from the National Practitioner Data Bank, a confidential database of paid malpractice claims created to make it harder for errant doctors to flee their malpractice allegations.
“There was concern in the 1980s and 90s about physicians leaving some locations to start somewhere else, to get to a new state regulatory system where they didn’t have a record of their past,” Studdert noted. “We’re surprised to find that these physicians were not more likely to relocate (than doctors with few or no claims).” The study looked at practice patterns from 2008 through 2015, which included nearly 69,000 paid claims. The odds of a physician giving up medicine or moving to a smaller practice increased with the number of claims against the doctor.
Compared to physicians with no claims, the odds of a doctor leaving medicine entirely increased 9 percent with one claim, 18 percent with two, 27 percent with three, 37 percent with four and 45 percent with more than four.
But nearly 93 percent of physicians with five or more claims kept practicing, the researchers found.
Another trend was the shift into a smaller practice. The odds rose 8 percent with one claim, 21 percent with two, 20 percent with three, 46 percent with four and 58 percent with more than four.
The tendency to move from a group practice into solo practice was even more pronounced. The odds rose 16 percent with one claim, 47 percent with two, 48 percent with three, 59 percent with four and 139 percent with more than four.
Although the study didn’t look at whether patients were actually harmed, “we think of these physicians as more risky if they’re flying solo,” Studdert said. “There’s less oversight, less ability to take advice from colleagues.”
Another finding: female doctors were far less likely to accumulate multiple malpractice claims. While females represented 26 percent of doctors with fewer than three claims, they made up only 10 percent of physicians with three or more claims.
Past research shows that doctors who communicate well with patients are less likely to be sued, Studdert said. “On average, female physicians are better communicators.”
SOURCE: https://bit.ly/2YrQ85r The New England Journal of Medicine, online March 27, 2019.