Recently, The New England Journal of Medicine recently published a special article, Medical Malpractice Risk According to Physician Specialty. While there have been studies about medical malpractice liability in the past this one takes a slightly different approach and therefore is worth exploring. With the practice of defensive medicine and medical malpractice rates contributing to the high cost of medicine, understanding the data around medical malpractice is needed if solutions are to be developed. This study provides a practical glimpse into the world of medical malpractice, medical malpractice liability insurance, and how it applies to specific physician specialties.

Unlike other studies that focus on local results, or those that look to claims with payments, this new study looked at closed malpractice claims nationwide from 1991 to 2005. By looking at data from closed claims from a national malpractice insurer, the researchers were able to gather information about the ages, specialties, and location of claims, whether a payment was made or not. Data was gleaned from all 50 states and 24 distinct specialties were represented as has having a minimum of 200 claims. The study shed new light on how often claims are made regardless of whether a payment is made.

Having been in the medical malpractice liability insurance business for 30 years we are surprised by some of the findings.

This study specifically …

"… uncovered an important aspect of medical malpractice liability: the high likelihood of claims that do not result in payments to a plaintiff. Annual rates of claims leading to indemnity payments ranged from 1% to 5% across specialties, whereas rates of all claims ranged from 5% to 22%. Projections suggest that nearly all physicians in high-risk specialties will face at least one claim during their career; however, a substantial minority will not have to make an indemnity payment."

Pediatrics Led All Specialties in Loss Payments

There were some findings in this study that may seem surprising. For instance, specialties that were most likely to face indemnity malpractice insurance claims were often not those with the highest average payments. For example, Neurosurgeons were the most likely to receive a claim, however their average loss payment was significantly less than that of Pediatrics which was the least likely to receive a claim. In fact pediatrics led all specialties by a dramatic amount in loss payments. This fact was likely due to a higher sympathy factor for children and the longer life span that may require higher compensation. Nonetheless, the findings were interesting.

The top 6 specialties that were most likely to have a medical malpractice insurance liability claim brought against them included:

Neurosurgery

Thoracic-cardiovascular surgery

General Surgery

Orthopedic Surgery

Plastic Surgery

Gastroenterology

(Obstetrics and Gynecology was 7th on the list)

Conversely, the top 6 specialties that had the highest payments were:

Pediatrics

Pathology

Neurosurgery

Obstetrics & Gynecology

Internal Medicine

Pulmonary medicine

What seems unfortunately clear was that no matter what specialty, the likelihood of being named in a claim was relatively high. There was a clear discrepancy, however, among what are considered "low-risk" specialties where "36% were projected to face their first claim by the age of 45 years, as compared with 88% of physicians in high-risk specialties." Surprisingly the numbers jump significantly by the age of 65 years, when 75% of physicians in low-risk specialties and 99% of those in high-risk specialties were projected to face a claim.

High Risk of Being Involved in a Medical Malpractice Lawsuit

While the study points to the fact that many claims that are filed result in no payment to the claimants, the relative risk of being involved in a lawsuit is high. While medical malpractice liability insurance will cover you for the costs associated with trial and any possible payment, the intangible uninsurable costs such as time, stress, and reputational damage are hard to measure.