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I have often read posts on this forum that contain references to the litigation potential of PAs. The baseless contention seems to be that PAs are a litigation waiting to happen. That mid-level providers represent, as yet, an untapped source of revenue for the litigators that when tapped, will result in a reduction or change of the PA?s role in medicine. Although I and most of my colleagues know this to be untrue, I wanted to formulate a response that was based on evidence, not anecdotal speculation based on personal discussions with attorneys who think this, or radiologists who think that. As clinicians, we all strive to practice evidence based medicine. The same line of thinking should apply to this topic as well.

Admittedly, obtaining data on this topic is difficult, yet not impossible. According to the American Academy of Physician Assistants (AAPA), with whom I spoke last week, data is scant because the incidence of litigations against PAs has been, and continues to be, low. In 1986, The Healthcare Quality Improvement Act was passed by Congress requiring that all malpractice payments made on behalf of any clinician be reported to the National Practioner Data Bank (NPDB). That data is public record and has thus been used to publish papers on this topic. One such paper appeared in the June 1998 issue of The Journal of the American Academy of Physician Assistants (JAAPA) and was entitled, The malpractice experience: How PAs fare, Vol. 1, No. 6, pp 93-94. The following data was published at that time:

From 1990 (when the NPDB first started collecting data) to 1998, 100,750 paid claims for all physicians were recorded with an average of $188,773 paid for each claim. During the same period of time, a total of 240 paid claims on behalf of PAs were made with an average of $83,625 per claim. Assuming that each physician and PA were sued once and based on the fact that there were 792,445 physicians and 34,564 PAs practicing in the US in 1998, one can ascertain a 12.7% incidence of lawsuit payments for physicians versus 0.69% incidence for PAs. Current data from the NPDB published as recent as 4/02/02, suggests a statistically non-significant change in the proportion of medical malpractice payments since 1998.

As with every body of data presented, there are potential limitations that need to be acknowledged. First, many would argue that there are ways, although illegal, to avoid reporting to the NPDB and thus the statistics reported above may not be all inclusive. Assuming this is the case, I would argue that the flaw is applicable to both populations of physicians and PAs and thus if accounted for, would not make a statistical difference. Secondly, one might question that since physicians are liable for a PA?s actions, what percentage of the 100,750 claims paid were as a result of the PA?s negligence resulting in the physician being sued? According to the NPDB, distinction of such cases are acknowledged and were inclusive in the statistics published.

In summary, data from the NPDB (the current authoritative source) indicate that PAs have had, and continue to have, low rates of malpractice payments. Some studies have even indicated that physician practices who employ PAs in their practice actually have lower incidence of lawsuits involving medical malpractice. Why? Most contend that because of typical physician time constraints, PAs are able to spend more time with their patients, thereby cultivating better personal relationships with their patients. How does this translate into lower incidence of medical malpractice payments? Previously published data has indicated that upon interview of plaintiffs of medical malpractice suits, poor patient/physician communication was the major contributing factor in the initiation of the lawsuit (JAMA 1997; 277 (7) 553-559, Arch Int Med, 1989; 148 (10); 2190-2196).

I therefore submit that if one looks objectively at the current data available regarding medical malpractice in this country, not only are PAs not at increased risk for litigation, they are actually at decreased risk. This assertion is also reflected by the medical malpractice insurance rates for PAs. As we all know, insurance rates in this country are based upon the perceived risk of payment on the part of the insurance company. Current medical malpractice rates for PAs are approximately 1/5th that of physicians, despite the fact that the difference in coverage is typically only 20%. Furthermore, there is no body of evidence, nor is there any statistical trend, that would suggest that PAs will become a litigation risk in the future. For almost 40-years, PAs have provided a cost effective means with which to deliver quality medical care. We did not get to where we are today by delivering poor medical care, nor did we get here by being a litigation risk.
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