The frequency and severity of medical malpractice claims: high risk and low risk specialties.

T he paper (1) analyze malpractice data between 1991-2005 for 25 me dical specialties in USA. It is discussed the cumulative risk among phy sicians in high and low risk specialties. The age of physicians was 30-70 years (for estimate the cumulative risk career malpractice risk). The malpractice claim for all physicians was 7,4%/year and 1,6%/year of claim lead to a pay ments. 78% of all claim did not result in pay ments to plaintiffs. The data on malpractice claims were obtained from a nationwide insurance society that provided coverage to physicians (40,916 physicians, respectively 233,738 physicians/years of coverage). Between all 50 states of USA, California was overrepresented (12,2%). High risk medical specialties for claim/year are: Neurosurgery (19,1%), Thoracic Cardiovas cular Surgery (18,9%), General Surgery (15,3%), Orthopedic Surgery (14,8%), Plastic Sur ge ry (13%), Obstetrics and Gynecology (12%), Urology (10,5%). Low risk specialties are: pa tho logy, Dermatology, Family General Prac tice, Pediatrics, Psychiatry (mean 5%/year risk for claim). The proportion of physicians facing a malpractice claim by the age of 65 years is the next: 75% physicians in low risk specialties and 99% in high risk specialties and by the age of 45 years of physicians, 33% of physicians in high risk specialties and 5% in low risk specialties. 80% of physicians in surgical specialties and 74% of physicians in Obstetrics and Gynecology had claim at age of 45 years. The perceived threat of malpractice among physicians may do to three factors: the risk of claim, the probability of a claim leading to a payment and the size of payment. But there are also indirect costs of litigation as time lost, stress, added work, reputational damage. Nearly 40% of claim were not associated with medical errors. As conclusions, nearly all physicians in high risk specialties will face at least one claim during their career. That means that is a intense pressure to practice defensive medicine, despite evidence that the scope of defensive medicine is modest !!!