Most doctors sued for malpractice never pay a claim

While most physicians are sued for malpractice at least once during their careers, the vast majority will never have to make an indemnity payment, a new study found.

Researchers analyzed malpractice data from 1991 through 2005 for all physicians covered by a single large professional liability insurer with a nationwide client base. The study covered nearly 41,000 physicians and nearly 234,000 physician-years. Because the study relied on one insurer's results, researchers compared their data to similar figures in the National Practitioner Data Bank. Results appeared in the Aug. 18 issue of the New England Journal of Medicine.

By the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, compared with 99% of physicians in high-risk specialties. Roughly 55% of physicians in internal medicine and its subspecialties were projected to face a malpractice claim by the age of 45 years. This contrasts with projections of 80% of physicians in surgical specialties, including general surgery, and 74% of physicians in obstetrics and gynecology. Among physicians in internal medicine, 89% were projected to face a malpractice claim by the age of 65 years.

Each year, an average of 7.4% of physicians had a malpractice claim filed against them. But only 1.6% of the physicians had to make an indemnity payment, so 78% of all claims did not result in payments. Annual rates of malpractice claims ranged from the top three specialties (19.1% in neurosurgery, 18.9% in thoracic-cardiovascular surgery, and 15.3% in general surgery) to the bottom three (5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry). Internal medicine was only slightly higher than the average among physician specialties for frequency of claims made and claims resulting in payment.

The authors wrote that, “Our 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.”

Overall, 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, which was by far the largest mean payment among all specialties. Pediatrics' mean payment was more than $100,000 more than the second-highest specialty of pathology, which was $383,509. There was little correlation between mean payments and rates of being sued. For example, the average payment for neurosurgeons was only $344,811, but neurosurgeons were the most likely to face a claim in a year.

Authors used their conclusions to interpret physicians' concerns about malpractice risk. “Although the frequency and average size of paid claims may not fully explain perceptions among physicians, one may speculate that the large number of claims that do not lead to payment may shape perceived malpractice risk. Physicians can insure against indemnity payments through malpractice insurance, but they cannot insure against the indirect costs of litigation, such as time, stress, added work, and reputational damage.”