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OBJECTIVE: To assess whether there is a population of physicians who have consistently poor malpractice claims experiences over time.
DESIGN: Retrospective cohort study.
POPULATION: 12,730 physicians insured in New Jersey from 1977 to 1991.
MAIN OUTCOME MEASURES: After adjusting for specialty, the physicians were grouped according to who had the highest, very high, and high rates of malpractice claims, approximating 1%, 5%, and 10% respectively, of the insured population. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated comparing the physicians in these high-risk categories with the other physicians.
RESULTS: Of the 55 physicians who had the highest malpractice claims rates during the first four years, two (3.6%) were in the highest group during the subsequent three years (OR 2.8; 95% CI 0.7 to 10.8), five (9.1%) were in the very high group (OR 2.0; 95% CI 0.7 to 5.3), and 11 (20%) were in the high group (OR 2.3; 95% CI 1.1 to 4.6). Of the 260 physicians in the very high group during the first four years, 11 (4.2%) were in the highest group during the subsequent three years (OR 3.6; 95% CI 1.8 to 6.4), 26 (10.0%) were in the very high group (OR 2.3; 95% CI 1.5 to 3.6), and 46 (17.7%) were in the high group (OR 2.0; 95% CI 1.4 to 2.8). Of the 947 physicians in the high group during the first four years, 24 (2.5%) were in the highest group during the subsequent three years (OR 2.3; 95% CI 1.4 to 3.7), 62 (6.6%) were in the very high group (OR 1.5; 95% CI 1.1 to 1.9), and 118 (12.5%) were in the high group (OR 1.3; 95% CI 1.1 to 1.6). Similar results were found when using awards as the outcome.
CONCLUSIONS: Most physicians who have high malpractice rates during their first four years improve over time. Physicians who have high rates of malpractice during one period should not be subjected to disciplinary action. However, carefully evaluating physicians who consistently have high rates of malpractice during two periods may represent an effective strategy for identifying problem physicians.
- Black HC. Black’s Law Dictionary, Revised Fourth Edition. St. Paul, MN: West Publishing, 1968;1111.
- Steel K, Gertman P, Crescenzi C, Anderson J. Iatrogenic illness on a general medical service at a university hospital. N Engl J Med. 1981;304:638–42. CrossRef
- Pocincki LS. Dogger SJ, Schwartz BP. The incidence of iatrogenic injuries. Appendix, Report of the Secretary’s Commission on Medical Malpractice. Washington, DC: Government Printing Office, 1973. DHEW Publication No. (OS) 73-89.
- Iglehart JK. The professional liability crisis. N Engl J Med. 1986;315:1105–8. CrossRef
- Harness JK. A closer look at 1137 liability cases closed. Mich Med. 1987;86:522–4.
- U.S. General Accounting Office. Medical malpractice: insurance costs increased but varied among physicians and hospitals. Washington, DC: General Accounting Office, 1986. Publication no. GAO/HRD 86-112.
- Black N. Medical litigation and the quality of care. Lancet. 1990;335:35–7. CrossRef
- Rolph JE, Kravitz RL, McGuigan K. Malpractice claims data as a quality improvement tool. II. Is targeting effective? JAMA. 1991;26:2093–7. CrossRef
- Sloan FA, Mergenhagen PM, Burfield WB, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians, predictable or haphazard? JAMA. 1989;262:3291–7. CrossRef
- Phelps CE. Experience rating in medical malpractice insurance. Santa Monica, CA: Rand Corporation, 1978;P-5877-1.
- Ferber S, Sheridan B. Six cherished malpractice beliefs put to rest. Med Econ. 1975;52:150–6.
- Taragin MI, Willett LR. Wilczek AP, Trout R, Carson JL. The influence of standard of care and severity of injury on the resolution of medical malpractice claims. Ann Intern Med. 1992;117:780–4.
- Taragin MI. Carson JL. Wilczek AP, Karns ME, Trout JR. Physician demographics and the risk of medical malpractice. Am J Med. 1992;93:537–42. CrossRef
- Feinberg SE. The analysis of cross classified data. Cambridge, MA: MIT Press, 1977;9.
- Mantel N, Haenszel W. Statistical aspects of the analyses of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–48.
- SAS Procedures Guide, Release 6.03 Edition. Cary. NC: SAS Institute, Inc., 1988;441.
- Challoner DR, Kilpatrick KE, Dockery JL, Dwyer JW. Effect of the liability climate on the academic health center. N Engl J Med. 1988;319:1603–5. CrossRef
- Charles SC, Wilbert JR, Franke KJ. Sued and non-sued physicians’ self-reported reactions to malpractice litigation. Am J Psychiatry. 1985;142:437–40.
- Localio AR, Lawthers AG, Brennan TA, et al. Relation between malpractice claims and adverse events due to negligence. N Engl J Med. 1991;325:245–51. CrossRef
- U.S. General Accounting Office. Medical malpractice: characteristics of claims closed in 1984. Washington, DC: General Accounting Office, 1987. Publication no. GAO/HRD 87-55.
- American Medical Association. Physician Characteristics and Distribution. 1983 Edition. Chicago, IL: Department of Data Release Services, Division of Survey and Data Resources, 1984.
- Sloan FA, Hsieh CR. Variability in medical malpractice payments: is the compensation fair? Law Society Rev. 1990;24:997–1039. CrossRef
- U.S. General Accounting Office. Medical malpractice: six state case studies show claims and insurance costs still rise despite reforms. Washington, DC. General Accounting Office, 1987. Publication no. GAO/HRD 87-21.
- Physician malpractice
Journal of General Internal Medicine
Volume 10, Issue 10 , pp 550-556
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- risk assessment
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- 1. Division of General Internal Medicine, UMDNJ-Robert Wood Johnson Medical School, Clinical Academic Building, 125 Paterson Street, CN-19, 08903-0019, New Brunswick, NJ