Best/Worst Speciality for Malpractice

[robnon]

Hello Everyone,
I was just curious about something. I realize this will be subjective (although perhaps some body of evidence that shows number of malpractice cases), but I was wondering what surgical specialty is the best and worst for malpractice risk. Thanks.

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[Chronic Student]

Nothing concrete, just anecdotal.

Ob is most likely the worst with birth complications (real or imagined by lawyers) as well as the fact that they can sue you until they are 18.

I would think plastics would be the least likely to get sued.

-Mike

 

[I am Hans]

Delay in diagnosis for breast cancer has now become the most common reason for medical malpractice suits. This of course affects surgeons, radiologists, pathologists, Ob-Gyn and PCPs in the process.

Traditionally, the higher med mal specialties are Neuro (esp Spine), Ob-Gyn and yes, Plastics. The aesthetic patients often have unrealistic expectations and when something doesn't go exactly right, they may sue. Hand has a pretty high rate as well, especially coming from workman's comp patients.

 

[medhacker]

Maybe not the highest, but plastics is by no means on the low end of malpractice spectrum.

 

[Chakrabs]

Neurosurgery. Not sure where I saw it, but I recently read an article that crunched the numbers and found that neurosurgeons had it worst by far (malpractice-wise) than any other specialty (over 3x as much) by virtue of the fact that there are much fewer neurosurgeons than most other high risk specialties.

 

[Blade28]

Don't forget the easy cases for the litiginous: decubitus ulcers and missed compartment syndrome.

 

[mh82ai3]

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

"Neurosurgeons ranked 10th in the top 10 specialties in terms of total loss indemnity paid out by the MLMIC during the 5-year period (Fig. 1 upper), with approximately $60,000,000 disbursed on behalf of an average of 83

insured individuals. The leading specialty in terms of total loss indemnity was obstetrics/gynecology, with slightly less than $450,000,000 paid out on behalf of an average of 1171 insured practitioners. However, if this chart is reconfigured to display the average loss indemnity per insured per specialty, the results are dramatically different (Fig. 1​

lower). Neurosurgery now becomes the most vulnerable specialty, exceeding obstetrics/gynecology by almost twofold and general surgery, the third-ranked specialty in terms
of sustaining losses, by almost threefold."

Average disburstment in this study was $600K per neurosurgeon in this 5-yr period. OB was next with $373K. But I believe this is based on mostly private practise physicians in New York.​

 

[robnon]

Thank you everyone for posting. This is very interesting. I agree, I believe FP and Psych would be low. What about among the surgical specialties, which one is at the bottom? Id say maybe Gen Surg?

 

[MossPoh]

So the bottom rung is who, then? I used to think it would be Path, but then one of my faculty pointed out that anyone reading pap smears is bound to get nailed at some point. Rads has mamos, which is brutal in court.

I'm going to vote for two: Psych and FP. Psych because the only major liability I see is failure to prevent suicide or failure to warn, both of which don't seem all that common to me. FP because there has to be a high volume of referrals for difficult cases, spreading out liability, and because they have the whole "family doctor" thing, and no one wants to sue someone they've known for years.

I'm not sure about FP...Relative to others maybe, but there are family practice guys that read chest xrays and miss some pretty obvious stuff...or they fail to see what drugs someone is on. (Happened to my sister)

I think the mentality of the state plays a bigger role than the speciality. Compare a doc in south florida to one in the midwest. I bet a low risk speciality in south florida is at a much higher risk for a lawsuit than the a higher risk midwest doc. My dad is a radiologist and average 2-3 lawsuits per year in south florida. We moved to indiana and all of a sudden he had 1 lawsuit he was named in in over 15 years.

Maybe derm if they play it safe..... or perhaps physical medicine/rehabilitation?

 

[Smurfette]

Thank you everyone for posting. This is very interesting. I agree, I believe FP and Psych would be low. What about among the surgical specialties, which one is at the bottom? Id say maybe Gen Surg?

My guesses would be rheumatology, derm, PM&R and urology.

I would also say that of surgical specialties, urology and ENT are probably the lowest.

Path and rads are still fairly low when compared to the rest of the specialties.

Many FPs do OB, which greatly raises their malpractice premiums, so they are not that low on the totem pole.

 

[BlackSails]

My guesses would be rheumatology, derm, PM&R and urology.

I would also say that of surgical specialties, urology and ENT are probably the lowest.

Id think Urology has fairly high malpractice premiums, espically for what they do. As a juror, I would not think much of pain and suffering for most lawsuits I read about. But being male, I would certainly understand a 10 million dollar reward for ****ing something up.

 

[Blade28]

What about among the surgical specialties, which one is at the bottom? Id say maybe Gen Surg?

I doubt it.

 

[Nick99]

I doubt it.

Why do you doubt it Blade?? I think the worst is cardio.

BTW, Blade good to see you again, it's been a while, how are you doing??

 

[46&2]

In the area I lived, the top 3 for total $$$ awarded were FP (due to OB duty), OB Gyn, and Pediatrics. Peds was due to a particularly heinous case (hospital really was at fault) where a big settlement was awarded. That one case really skewed the numbers.

General Surgery wasn't far behind (above all surgical specialties), while, surprisingly, neurosurgery and transplant were more middle of the pack. Urology, I think, was in the lower half. Transplant only had around 2 cases filed against it, and they settled out of court. Most cases don't reach court because it's cheaper to just settle. Neurosurgery can vary somewhat depending on if they choose to take trauma.

When looking at the numbers, it's important to look at location. Certain states (Texas) and even cities have different laws that make them more physician friendly. Also, what cases are covered? Does surgery take care of trauma or ship them to a Level I center? Are general surgery and surgical oncology distinguished from each other? Did one bad egg cause the numbers to jump or will cause them to jump?

 

[Krazykritter]

I saw an article that said that G. Surg was in the Top 10 (maybe 6 or 7) for number of suits/year, but interestingly enough was not on the list for money paid out.

Anecdotal, but interesting....wish I could find the article.

 

[Winged Scapula]

It should not be suprising that General Surgery is rather high on the list because the number one reason for lawsuits today are delay in diagnosis of breast cancer. The vast majority of breast cancer is managed in the community by general surgeons rather than specialists. Depending on referral patterns, patients may be sent right away to a surgeon for evaluation of a mass, skin/NAC changes or mammographic abnormalities. Other communities may refer straight to radiology and others may "observe" (which is where you get into trouble).

A recent issue of either General Surgery News or one of those other "throw away" journals had an article about this. Obviously, FPs, Radiologists and Pathologists are sued for this reason (see FM forum for a thread about this, with a link to an article in J of FP which states that delay in diagnosis for breast ca is the number one reason they are sued as well).

The payouts do tend to be lower than for anoxic birth injury and anything involving a child...lots of emotional big money payouts there.

 

[Nick99]

It should not be suprising that General Surgery is rather high on the list because the number one reason for lawsuits today are delay in diagnosis of breast cancer. The vast majority of breast cancer is managed in the community by general surgeons rather than specialists. Depending on referral patterns, patients may be sent right away to a surgeon for evaluation of a mass, skin/NAC changes or mammographic abnormalities. Other communities may refer straight to radiology and others may "observe" (which is where you get into trouble).

A recent issue of either General Surgery News or one of those other "throw away" journals had an article about this. Obviously, FPs, Radiologists and Pathologists are sued for this reason (see FM forum for a thread about this, with a link to an article in J of FP which states that delay in diagnosis for breast ca is the number one reason they are sued as well).

The payouts do tend to be lower than for anoxic birth injury and anything involving a child...lots of emotional big money payouts there.

Hi Kimberly,
it's very nice to see you after a long time. How you've been? I noticed you put hair on your picture, it's sort of cool.
I agree that gen surgery is high up by law suits. Also delays with diagnosis, I know the case when parents got multimillion award b/c their child was born with down's syndrome, and it was not discovered during pregnancy. Also cosmetic surgeries nowdays, as people are not realistic and have very high expectations and want to get movie star look rightaway. On the other hand, sometimes cosmetic procedures can put even someone's life in danger. I know the case when one woman almost died after liposuction. Her internal organs were perforated after botched liposuction.

 

[Winged Scapula]

Hi Kimberly,
it's very nice to see you after a long time. How you've been?

I've been great...finished training and am just hanging out, waiting for my Az license. You haven't been around here in a long time!

I noticed you put hair on your picture, it's sort of cool.

Actually that is the work of group_theory, one of the SDN Mods who likes to tinker with these things. I thought the hair was a little stringy compared to my real hair, but hey...it gives me that feminine look, eh?

I agree that gen surgery is high up by law suits. Also delays with diagnosis, I know the case when parents got multimillion award b/c their child was born with down's syndrome, and it was not discovered during pregnancy. Also cosmetic surgeries nowdays, as people are not realistic and have very high expectations and want to get movie star look rightaway. On the other hand, sometimes cosmetic procedures can put even someone's life in danger. I know the case when one woman almost died after liposuction. Her internal organs were perforated after botched liposuction.

Unfortunately, there are misguided lawsuits and there are many which are deserved because of malpractice. Talk to some neurosurgeons and see how they have limited what and where they will cover because of malpractice. There are several states which are very unfriendly to physicians in this realm (see PA and FL) and reform needs to happen or they will find themselves without key specialists.

 

[Blade28]

Why do you doubt it Blade?? I think the worst is cardio.

Why CT? You'd think G Surg (for all the reasons mentioned by KC), aesthetic fields (Plastics, ENT, OMFS), and NSGY would have higher rates.

 

[Winged Scapula]

Why CT? You'd think G Surg (for all the reasons mentioned by KC), aesthetic fields (Plastics, ENT, OMFS), and NSGY would have higher rates.

Yeah, I've never heard of CT being a particularly high malpractice field (all things being relative of course).😕

 

[tony montana]

There are several states which are very unfriendly to physicians in this realm (see PA and FL) and reform needs to happen or they will find themselves without key specialists.

Doesn't Florida now have that 100K cap for malpractice suits?

 

[Winged Scapula]

Doesn't Florida now have that 100K cap for malpractice suits?

I was under the impression it was a $500K cap. In addition there is the problem of the "3 strikes and you're out" rule (see http://www.foxnews.com/story/0,2933,139533,00.html) or "2 strikes and see ya" as it is also referred to as physicians with 2 strikes leave the state.

Regardless of the above, or whatever the cap is, I would prefer to live in a state which has a less litiginous population and legal system.