The rate of paid legal claims against physicians dropped by more than half between 1992 and 2014, but the average claim payment amount rose, according to an analysis of the National Practitioner Data Bank.

Adam C. Schaffer, MD, of Brigham and Women’s Hospital, Boston, and his colleagues examined paid claims from the National Practitioner Data Bank from Jan. 1, 1992, to Dec. 31, 2014, accounting for specialty. Dollar amounts were inflation-adjusted to 2014 dollars using the Consumer Price Index.

To calculate the rate of paid claims per physician-year, investigators divided the number of physicians for whom a malpractice claim was paid in a given year by the number of physicians in each specialty from the American Medical Association Masterfile data in each year from Jan. 1, 1992, to Dec. 31, 2013. Data on the number of physicians in each specialty for 2014 were unavailable and were imputed based on a specialty’s average rate of growth from 2010 to 2013. Four interval time periods were chosen to smooth annual fluctuations.

From 1992-1996 to 2009-2014, the rate of paid claims decreased by 56%, ranging from a 76% decrease in pediatrics to a 14% rate decrease in cardiology. The mean payment increased by 23% from $286,751 to $353,473 between 1992-1996 and 2009-2014. The increases ranged from $17,431 in general practice to $138,708 in pathology (JAMA Intern Med. 2017 Mar 27. doi: 10.1001/jamainternmed.2017.0311 ).

The most common allegation was diagnostic error, followed by surgical error and medication or treatment error. The proportion of paid claims attributable to diagnostic error varied widely and was highest in pathology and radiology. Plastic surgery had the highest percentage of paid claims related to surgical errors. Specialties with the highest percentage of paid claims related to medication/treatment errors were psychiatry, general practice, and pulmonology.

While prior data have shown the overall trend of declining paid malpractice claims and increasing average payments, this study is the first to examine such trends by medical specialty, said Dr. Schaffer .

“We think it is important to try to understand the reasons for the variation among specialties in characteristics of paid malpractice claims, as understanding the reasons for this variation may provide insights about how we can provide the safest care possible,” he said in an interview.

Dr. Schaffer said that he hopes the findings make physicians more aware of the malpractice landscape and aid their future practice decisions.

“Medical malpractice is an issue that concerns many physicians, and physicians’ perceptions of their liability risk can influence the decisions they make in caring for their patients,” he said. “By performing an analysis of a national database of paid medical malpractice claims broken down by specialty, we hope to provide physicians with data that give them an accurate picture of the medical malpractice environment in which they are practicing.”

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