Doctors with multiple paid malpractice claims against them are more likely to stop practicing medicine or move to a smaller practice, including going solo, according to a new study.
Physicians with five or more paid malpractice claims had more than twice the odds of moving into solo practice, according to the study by Stanford University researchers published today in the New England Journal of Medicine.
The study did find that physicians with repeated paid malpractice claims were no more likely to relocate geographically to get a fresh start, which is a long-standing concern that led Congress to pass legislation that led to the creation of the National Practitioner Data Bank to help track physicians, including paid malpractice claims and disciplinary actions.
But the fact that doctors are moving to solo practice did raise concerns among the researchers. “Compared to practicing in large group practices or hospitals, physicians in small or solo practices are subject to less oversight from administrators and peers,” said study author Michelle M. Mello, J.D., Ph.D., in an announcement from Standard University about the study results.
“Quality problems with solo practitioner may be more difficult to detect and report. From a patient safety standpoint, this is the study’s most troubling finding. Frankly, solo practice is the last place we want practitioners who pose patient safety risks to be working,” Mello said.
To determine what happens to physicians with poor malpractice liability records, the researchers reviewed data on 480,894 physicians who had 68,956 paid claims from 2003 through 2015. The research showed that 89% of the physicians had no claims, 8.8% had one claim, and the remaining 2.3% had two or more claims and accounted for 38.9% of all claims.
While some doctors with multiple claims decided to leave the practice of medicine, that was a small number. More than 90% of physicians who racked up five or more paid claims continued to practice.
After publication of earlier research into claim-prone physicians, the researchers decided to delve further into whether, how and where these physicians continued to practice.
“There is an emerging awareness that a small group of ‘frequent flyers’ accounts for an impressively large share of all malpractice lawsuits,” said David M. Studdert, LL.B., Sc.D., the lead researcher and professor at both Stanford Law School and Stanford University School of Medicine, in the university announcement. “This study confirms that and begins to shed light on the professional trajectories of these physicians.”
In analyses of a national database of paid malpractice claims from 2003 through 2015, physicians with multiple claims were not more likely to relocate geographically, but they were more likely to switch to smaller practices.— NEJM (@NEJM) March 28, 2019
When repeated claims are paid over a relatively short period of time, that may send a red flag that a doctor may pose a risk to patient safety.
“We think the study’s main message is that regulators and the companies that provide physicians with liability insurance should be paying closer attention to this signal,” Studdert said. “I wouldn’t want my family members to be treated by a physician who had paid out six malpractice claims in the past few years. Who would?”