Debates about reforming our civil justice system—particularly in the area of medical malpractice claims—are a hot topic for attorneys, physicians, insurance companies and politicians. The central issue is a dividing one: are doctors brought to court more than they should be or are patients just getting justice? Although accusations often flow in both directions, there is relatively little hard data to help us understand what’s really happening.
But now, a new study released by the New England Journal of Medicine in August might provide some guidance. The study steps into the tort reform debate concerning medical malpractice claims with an important analysis of just how often physicians are actually being brought into the courtroom and just how much of a monetary risk those physicians face. The researchers examined the medical malpractice claims that were submitted to a large insurance company, attempting to determine three things:
- The proportion of physicians who face a malpractice claim in a given year
- The proportion of physicians who actually make a payment on a claim and the amount of that payment
- The risk of a physician facing a malpractice claim during the entirety of their career
The scope of this study is impressive, especially in contrast to previous studies on similar issues. In total, the data that the researchers used included records for nearly 41,000 physicians nationwide and who represented at least 24 different specialties over a time span between 1991 through 2005. By looking at these physicians’ insurance records, the researchers were able to discern how many of them actually faced malpractice suits and how big—in terms of dollars—those suits were.
A few interesting things emerged from the numbers that the researchers looked at:
- First, each year, approximately 7.4% of the physicians faced a malpractice claim. But this number varied greatly depending on the specialty. For example, 19% of neurosurgeons faced a claim, but only 2.6% of psychiatrists did.
- Second, around 1.6% of physicians each year made some sort of indemnity payment. This number, too, varied depending on the specialty but did not always align with the likelihood of a claim. For example, gynecologists were the most likely to have paid a claim, but 12th most likely to face a claim.
- Third, the average amount actually paid was $274,887, another number that varied depending on specialty and that did not necessarily align with the likelihood of a claim. For example, neurosurgeons were most likely to face a claim, but the amount they would actually pay was less than other specialties.
Taken together, what the numbers showed is that the majority of doctors who practice in areas such as internal medicine, family medicine and pathology will never make a malpractice payment in their life. Another interesting finding that the researchers uncovered was whether patients are actually winning on the claims that they file and the numbers showed that insurance companies deny far more medical claims than they pay out.
While this study focused only on insurance claims, which don’t always lead to a lawsuit, it still contributes a lot to the tort reform debate if for no other reason than it demonstrates the complexity of the issue. Blanket statements such as “plaintiffs always win” or “doctors face too much liability” simply aren’t specific enough. Specialty matters. So does the amount doctors are actually paying. Being more specific—and using real data to actually make arguments—will help the debate respond to the needs of individual patients and the concerns of doctors.