Medical malpractice insurance: a multifaceted problem.

I laud Dr. DeMaria’s efforts in summarizing the issues surrounding the medical malpractice crisis in the November issue of the Journal (1). However, I am struck by the lack of courage of state medical licensing boards in not advocating for stronger laws, policies, and procedures to focus on the 5% of physicians responsible for 50% malpractice payouts. Whereas the medical profession should be commended for its patient safety efforts—“an ounce of prevention is worth a pound of cure”—the community of physicians will not achieve credibility with patients unless we begin to review cases of those with the highest rates of payouts. If the medical profession can demonstrate success in this area, then we will have every right to demand that the insurance industry and malpractice lawyers come to the table for broader, more comprehensive, and more collaborative solutions to the medical malpractice crisis.