The American medical malpractice system is doing almost nothing to improve the quality of healthcare, research suggests. What may be more concerning is that there's very little discussion, much less action, on reform. That's the topic of this weeks Healthcare Triage.

[Intro]

Despite worries among doctors that they're at financial risk from large payouts to plaintiffs, it turns out that a small percentage are responsible for a huge number of claims. A new study, confirming earlier research, found that about 2% of doctors accounted for about 39% of all claims in the United States. The study contained other valuable information about a system that not only compensates patients who have been harmed, but is also supposed to identify physicians who may be performing poorly and need correction.

First, these doctors quit at higher rates than other physicians. That's good news for the medical profession. These doctors also tend not to pick up and move somewhere else to start fresh, which many thought they'd do given that licenses and malpractices is regulated at the state level.

But, the overwhelming majority of doctors who had five or more paid claims kept on going. And, they also moved to solo practice and small groups more often, where there's even less oversight, so those problematic doctors may produce even worse outcomes.

We have long known that some doctors are likelier than others to be sued. Those who practice in certain higher risk specialties, like surgery, obstetrics and gynecology, and emergency medicine, are more likely to be sued than those in lower risk specialties, like family medicine, pediatrics, and psychiatry. Men are more likely to be sued than women. Lawsuits tend to peak when doctors are around 40.

A few years ago, a study in The New England Journal of Medicine sought to examine this group of physicians specifically, and see what happens to them after lawsuits. The study's authors used the National Practitioner Data Bank, which houses information on actions taken against physicians by hospitals or licensing boards as well as any payments made on their behalf because of malpractice claims. Although researchers cannot obtain information about individual physicians through the database, anonymous identifiers allow them to see if more than one claim is attributed to the same physician.

Over a 10 year period, only 6% of physicians over all had a paid claim. This means that the vast majority had no paid claims at all. Only .2% of physicians, a very small minority, account for 12% of all paid claims. Logic would assume that these physicians with a large number of claims over a set period would be those who may need intervention. Certainly, we might expect changes in where and with whom they work.

Many of these same researchers went back to the practitioner data bank to see if this was the case, and have recently published their findings. This time they looked at records from 2003 to 2015, and, as before, they found that a small number of physicians accounted for most claims.

In this analysis, the researchers linked this group of doctors to another database, the Medicare Data on Provider Practice and Specialty, which contains information on practice location and type. This allowed researchers to look at whether physicians moved or changed jobs after claims. Those who accumulated more claims were more likely to stop practicing medicine. Even though they were more likely to retire, more than 90% of doctors who had at least five claims were still in practice.

Physicians with more claims were also not any more likely than those with fewer or no complaints to move to another state and continue practicing. This is actually one of the reasons the practitioner data bank was created- to prevent doctors from running away from their history by moving between states. In that respect, it does appear to be working.

But, physicians with more claims shifted their type of practice. Those with five or more claims had more than twice the odds of moving into solo practice. This makes sense in some ways. Doctors with many claims may find it harder to find employment in large groups or with big clinics. Anyone can, however, set up his or her own practice. The general public is much less likely than a potential employer to seek out information about prior lawsuits.

This may be the most disturbing finding. Doctors with a lot of claims could benefit from intervention to help them improve their practice or change what they do clinically. When they just go into private practice by themselves, that doesn't happen.

Research has shown that the malpractice system, in terms of being a deterrent, has limited effects on the quality of care. A National Bureau of Economic Research working paper from 2014 found that the system, which largely hold physicians to "standards of care," doesn't seem to lead to higher quality according to widely accepted metrics.

In theory, licensing boards could flag and address physicians who've had a worrisome number of claims against them. Too often, though, boards tend to focus on particular instances. They're not looking at the big picture.

Many in the medical profession spend time worrying about how unfair the malpractice system is to physicians and how it's overused to punish innocent doctors. They say the system is failing to help us reduce spending, and this may be true. But, it seems more attention should be paid to how it might improve the quality of care as well.

[Outro]

Hey did you enjoy this episode? You might might enjoy this other episode on how better communication might help doctors avoid malpractice suits.

We'd especially like to thank our research associate, Joe Sevits, and, of course, our surgeon admiral, Sam. And all of you can support the show at Patreon.com/HealthcareTriage.

And my book, The Bad Food Bible, is out in paperback. I'd really appreciate it if you buy a copy.