NEJM: 18.9% of CV surgeons face malpractice claims annually

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Thoracic-cardiovascular surgeons are more than twice as likely to face a malpractice claim annually than physicians as a whole, according to a study in the Aug. 18 issue of the New England Journal of Medicine. For cardiologists, the likelihood was slightly higher than the 7.4 percent all-physician annual figure.

“Naturally, physicians in each specialty believe they are getting sued more often than average,” Anupam B. Jena, MD, PhD, of the Massachusetts General Hospital in Boston, said in a statement. “But while anecdotes abound, actual facts on who is getting sued more often than average have been unavailable until now. Identifying which specialties are most likely to face frequent litigation may help guide malpractice reform.”

Jena and colleagues obtained physician-level data on malpractice claims between 1991 and 2005 from a large single insurer that covered physicians in every state. The database encompassed 40,916 physicians between the ages of 30 and 70 years old and 233,738 physician years of coverage. The data included 437 thoracic-cardiovascular surgeons and 777 cardiologists.

They categorized physicians into one of 25 specialties and then calculated the proportion of physicians within each specialty who faced a malpractice claim in a year. They also calculated the proportion of claims that led to a payment to the plaintiff and the size of the payment.

They found that while annually 7.4 percent of all physicians had a malpractice claim filed against them, only 1.6 percent of physicians faced a claim that resulted in a payment to the plaintiff. Thoracic-cardiovascular surgeons were among those with the highest likelihood of a claim, at 18.9 percent annually. The only specialty that scored higher was neurosurgery, at 19.1 percent. The total of cardiologists facing a malpractice claim was closer to 8 percent per year.

In a projection, the researchers found that 88 percent of specialists in high-risk specialties such as thoracic-cardiovascular surgery would have a malpractice claim against them by age 45, and by the time they reached 65 years, 99 percent of them would have faced a claim.

“The projected career risk of making an indemnity payment was also large,” the authors wrote. “Roughly 5 percent of physicians in low-risk specialties and 33 percent in high-risk specialties were projected to make their first indemnity payment by the age of 45; by the age of 65 years, the risks had increased to 19 percent and 71 percent, respectively.”

Based on the study results, the mean indemnity payment was $274,887 and the median payment was $111,749. The authors pointed out that specialties facing the most claims did not necessarily pay the highest awards. The average payment for neurosurgeons, for instance, was $344,811, far less than the $520,924 average payment confronting pediatricians.

The authors noted that the use of a single insurer was a study limitation because the insurer might not be representative of the nation as a whole. They wrote that they compared their weighted estimates against claims data reported in the National Practitioner Data Bank and found only small differences.