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Malpractice Risk According to Physician Specialty
Open accessAbstract
BACKGROUND: Data are lacking on the proportion of physicians who face malpractice claims in a year, the size of those claims, and the cumulative career malpractice risk according to specialty. METHODS: We analyzed malpractice data from 1991 through 2005 for all physicians who were covered by a large professional liability insurer with a nationwide client base (40,916 physicians and 233,738 physician-years of coverage). For 25 specialties, we reported the proportion of physicians who had malpractice claims in a year, the proportion of claims leading to an indemnity payment (compensation paid to a plaintiff), and the size of indemnity payments. We estimated the cumulative risk of ever being sued among physicians in high- and low-risk specialties. RESULTS: Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic-cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics. It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties. CONCLUSIONS: There is substantial variation in the likelihood of malpractice suits and the size of indemnity payments across specialties. The cumulative risk of facing a malpractice claim is high in all specialties, although most claims do not lead to payments to plaintiffs. (Funded by the RAND Institute for Civil Justice and the National Institute on Aging.).
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“Although psychiatry is at low risk of malpractice claims in comparison to other specialties 275 , surveys in different countries report that the majority of interviewed psychiatrists acknowledged having resorted to defensive practices, which, in their opinion, compromised the quality of the provided care 274,276,277 .”
From Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs (2024) · cites this paper as [275]
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“The number of medical disputes has more than tripled in 2005 compared with that of 1991.([7]) Such rapid growth violence has existed not only in European-American countries, but also has reported in Asian countries, such as Japan, where a 10-fold increase in medical malpractice litigation was reported, from 102 cases…”
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“claims that have completed all legal processing, including appeals) (1).”
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“There were three claims against delayed treatment: delayed admission of spinal cord injured patients from their local hospital (2) and delayed lumbar laminectomy despite progressive symptoms (1).”
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Analysis of Factors Associated With Rhytidectomy Malpractice Litigation Cases
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Hearing loss resulting in malpractice litigation: What physicians need to know
Reilly, B. K., Horn, G. M., & Sewell, R. K. (2012) · The Laryngoscope · doi:10.1002/lary.23608 · Cited by 48
“, this study demonstrated that the majority of malpractice claims do not lead to indemnity payouts.(9) Otolaryngologists are successful in most (70%) hearing loss litigation brought against them.”
BackgroundResultAn Analysis of the Number of Medical Malpractice Claims and Their Amounts
Bonetti, M., Cirillo, P., Tanzi, P. M., & Trinchero, E. (2016) · PLoS ONE · doi:10.1371/journal.pone.0153362 · Cited by 48
Reported Cases of Medical Malpractice in Direct-to-Consumer Telemedicine
Fogel, A. L., & Kvedar, J. C. (2019) · JAMA · doi:10.1001/jama.2019.0395 · Cited by 47
Harvey, H. B., Tomov, E. I., Babayan, A., Dwyer, K., Boland, S., Pandharipande, P. V., Halpern, E. F., Alkasab, T. K., Hirsch, J. A., Schaefer, P. W., et al. (2015) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2015.07.013 · Cited by 47
Groff, M. W., Heller, J. E., Potts, E. A., Mummaneni, P. V., Shaffrey, C. I., & Smith, J. S. (2012) · World Neurosurgery · doi:10.1016/j.wneu.2012.03.017 · Cited by 47
Bismark, M., Gogos, A., McCombe, D., Clark, R. B., Gruen, R. L., & Studdert, D. M. (2012) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2012.05.004 · Cited by 47
Galasso, A., & Luo, H. (2017) · The Journal of Law and Economics · doi:10.1086/694337 · Cited by 47
“24 Following Jena et al. (2011), we define specialties with high liability risk as anesthesiology, cardio vascular surgery, general and plastic surgery, neurology, obstetrics and gynecology, orthopedics, and radiology.”
InfluentialReview of Neurosurgery Medical Professional Liability Claims in the United States
Elsamadicy, A. A., Sergesketter, A. R., Frakes, M., & Lad, S. P. (2018) · Neurosurgery · doi:10.1093/neuros/nyx565 · Cited by 47
Simulation in neurosurgery—a brief review and commentary
Cobb, M. I.-P. H., Taekman, J. M., Zomorodi, A. R., Gonzalez, L. F., & Turner, D. A. (2016) · World Neurosurgery · doi:10.1016/j.wneu.2015.11.068 · Cited by 46
Identifying early warning signs for diagnostic errors in primary care: a qualitative study
Balla, J. I., Heneghan, C. J., Goyder, C., & Thompson, M. J. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-001539 · Cited by 46
“The relative importance of diagnostic errors to the widespread health problem of medical errors in general is unclear, yet several US sources suggest that they are a major contributor.(5) A systematic review of diagnostic error in primary care in the UK quoted diagnostic error accounts for the greatest proportion of m…”
BackgroundDefensive Medicine among Obstetricians and Gynecologists in Tertiary Hospitals
Asher, E., Dvir, S., Seidman, D. S., Greenberg‐Dotan, S., Kedem, A., Sheizaf, B., & Reuveni, H. (2013) · PLoS ONE · doi:10.1371/journal.pone.0057108 · Cited by 45
“4% of physicians [11] faced a malpractice claim during the year prior to the survey.”
BackgroundSalivary Gland Surgery and Medical Malpractice
Hong, S. S., Yheulon, C. G., & Sniezek, J. C. (2013) · Otolaryngology · doi:10.1177/0194599813475566 · Cited by 45
The medicolegal landscape of spine surgery: how do surgeons fare?
Makhni, M. C., Park, P., Jimenez, J., Saifi, C., Caldwell, J.-M. E., Ha, A. S., Figueroa-Santana, B., Lehman, R. A., & Weidenbaum, M. (2017) · The Spine Journal · doi:10.1016/j.spinee.2017.06.038 · Cited by 45
Confirmatory Testing Prior to Initiating Onychomycosis Therapy Is Cost-Effective
Gupta, A., Versteeg, S. G., & Shear, N. H. (2017) · Journal of Cutaneous Medicine and Surgery · doi:10.1177/1203475417733461 · Cited by 45
Mathew, R. G., Ferguson, V., & Hingorani, M. (2012) · Ophthalmology · doi:10.1016/j.ophtha.2012.01.009 · Cited by 44
Why do surgeons receive more complaints than their physician peers?
Tibble, H., Broughton, N. S., Studdert, D. M., Spittal, M. J., Hill, N., Morris, J. M., & Bismark, M. (2017) · ANZ Journal of Surgery · doi:10.1111/ans.14225 · Cited by 44
“Introduction Compared with doctors in other specialties, surgeons are at a higher risk of medicolegal events, including patient complaints(1) and negligence claims.(2,3) One possible explanation is that surgeons administer the riskiest treatments to the sickest patients; and therefore easily observable poor outcomes g…”
BackgroundCross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists
Reuveni, I., Pelov, I., Reuveni, H., Bonne, O., & Canetti, L. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-014153 · Cited by 43
“Psychiatry is considered a low-risk specialisation.(9) 10 However, data from recent years demonstrated that there”
BackgroundResultOveruse of Testing in Preoperative Evaluation and Syncope
Kachalia, A. B., Berg, A., Fagerlin, A., Fowler, K. E., Hofer, T. P., Flanders, S. A., & Saint, S. K. (2015) · Annals of Internal Medicine · doi:10.7326/m14-0694 · Cited by 43
Assessment of Malpractice Claims Associated With Acute Compartment Syndrome
DePasse, J. M., Sargent, R. E., Fantry, A. J., Bokshan, S. L., Palumbo, M. A., & Daniels, A. H. (2017) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-16-00460 · Cited by 43
Ali, A. A., Hummeida, M. E., Elhassan, Y. A., Nabag, W. O. M., Ahmed, M. A. A., & Adam, G. K. (2016) · BMC Medical Ethics · doi:10.1186/s12910-016-0095-3 · Cited by 42
“Gynaecology alone had the 12th highest average annual proportion of physicians with a claim, with the highest payment rate (38 %) [6].”
Does emergency physician empathy reduce thoughts of litigation? A randomised trial
Smith, D. D., Kellar, J., Walters, E. L., Reibling, E. T., Phan, T. H., & GREEN, S. M. (2016) · Emergency Medicine Journal · doi:10.1136/emermed-2015-205312 · Cited by 42
Association of Emotional Intelligence With Malpractice Claims
Shouhed, D., Beni, C. E., Manguso, N., IsHak, W. W., & Gewertz, B. L. (2019) · JAMA Surgery · doi:10.1001/jamasurg.2018.5065 · Cited by 43
Zhang, J. K., del Valle, A. J., Alexopoulos, G., Patel, N., van Nispen, J., Patel, M. S., Xu, E., Mercier, P., Kohn, N. A., & Mattei, T. A. (2022) · The Spine Journal · doi:10.1016/j.spinee.2022.03.015 · Cited by 41
Ford, K., & Cooper, L. R. L. (2016) · The Surgeon · doi:10.1016/j.surge.2016.03.009 · Cited by 41
Medical malpractice in spine surgery: a review
Medress, Z. A., Jin, M. C., Feng, A. Y., Varshneya, K., & Veeravagu, A. (2020) · Neurosurgical FOCUS · doi:10.3171/2020.8.focus20602 · Cited by 41
The Receding Tide of Medical Malpractice Litigation: Part 1—National Trends
Paik, M., Black, B. S., & Hyman, D. A. (2013) · Journal of Empirical Legal Studies · doi:10.1111/jels.12021 · Cited by 42
Fargen, K. M., & Friedman, W. A. (2014) · World Neurosurgery · doi:10.1016/j.wneu.2014.03.030 · Cited by 45
Medication Associated with Hearing Loss: 25 Years of Medical Malpractice Cases in the United States
Ruhl, D. S., Cable, B. B., & Martell, D. W. (2014) · Otolaryngology · doi:10.1177/0194599814536850 · Cited by 40
“Although pediatric malpractice is less frequent, it can result in higher financial awards compared to adults.(26) Previous studies have shown that pediatric patients receive more favorable jury verdicts than their adult counterparts.”
ResultLessons Learned in Otologic Surgery
Ruhl, D. S., Hong, S. S., & Littlefield, P. D. (2013) · Otology & Neurotology · doi:10.1097/mao.0b013e318298a8fb · Cited by 40
“Pediatric malpractice is low frequency but high severity (3).”
BackgroundThe Demography of Medical Malpractice Suits against Radiologists
Baker, S. R., Whang, J. S., Luk, L., Clarkin, K., Castro, A., & Patel, R. H. (2012) · Radiology · doi:10.1148/radiol.12110971 · Cited by 40
Patient safety in emergency departments: a problem for health care systems? An international survey
Petrino, R., Tuunainen, E., Bruzzone, G., & Garcı́a-Castrillo, L. (2023) · European Journal of Emergency Medicine · doi:10.1097/mej.0000000000001044 · Cited by 39
Metadata
- Authors
- Jena, A. B., Seabury, S., Lakdawalla, D., & Chandra, A.
- Affiliations
- Harvard University (US)
- RAND Corporation (US)
- University of Southern California (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2011-08-18
- Volume
- 365
- Issue
- 7
- Pages
- 629-636
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3204310
- OpenAlex
- W2148118870
- Cited by
- 1,180
- References
- 19
- Citations by year
- 2026: 59 · 2025: 71 · 2024: 83 · 2023: 101 · 2022: 84 · 2021: 95 · 2020: 86 · 2019: 106 · 2018: 97 · 2017: 89 · 2016: 71 · 2015: 75 · 2014: 55 · 2013: 58 · 2012: 42
- FWCI
- 122.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01ag031544-05)
- National Institute on Aging (7R01AG031544, RC4AG039036, P01 AG19783-02, R01 AG031544, P30AG043073, P01AG019783, P30AG024968)
- Topics
- Social Sciences › Law › Medical Malpractice and Liability Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- medical malpractice, malpractice claims, physician specialty, professional liability insurance, indemnity payments, neurosurgery, general practice, general surgery
- MeSH terms
- Malpractice, Medicine, Physicians, Risk, Specialties, Surgical, United States, Models, Statistical, Physicians, Primary Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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