DO is a risk factor for malpractice

[mfred]

---

Members do not see this ad.

In the most recent edition of Texas Medicine (Jan 2004) you will find an article on page 84. It is entitled "Predicting risk for disciplinary action by a state medical board." This article pooled data over the last several years about disciplinary actions taken by the state (I assume this to be TX, but am not certain). There were various conclusions, analyzed for trends in race, sex, speciality, and yes, professional degree. As for the later, it was found that "osteopathic physicians were significantly more likely to be disciplined for negligence of incompetence and for prescribing practices." They were much more likely to be disciplined than both US and IMG of allopathic schools. This is quite concerning, and I have a number of ideas as to why this might be so, but all of them are absolute speculation. I have two questions for all reading this:
1. What are your thoughts as to the findings of the article and the root cause of the discrepency?
2. Is it possible that malpractice insurance could implement a stratified system where DO's are charged more (just as ob/gyn has a much higher "risk" when compared to derm for example).
*By the way, the data was analyzed and the article was written by 2 DO's, one of which is on staff at TCOM.

 

[dobonedoc]

I'd like to read the article. I couldn't get access to it, however, because I am not a member of the TMA. Any ideas?

 

[mfred]

I'm sorry, I don't know how to access the information. If it didn't get mailed to me I would have no clue where to get it. If you are in Texas (probably not) then you should be able to go to any hospital and find a copy or any library, especially a medical library. That probably won't help, I'm sorry. A long shot is to just search the internet for the title of the article (it is in my original post) or try www.texmed.org which i could be more help

 

[sophiejane]

Here is the abstract, which is all I could obtain even in the "members only" section of the TMA website.


A Publication of the Texas Medical Association

Abstract of Texas Medicine Journal Article -- January 2004
------------------------------------------------------------------------

Predicting Risk for Disciplinary Action by a State Medical Board

By Roberto Cardarelli, DO, MPH; John C. Licciardone, DO, MS; and Gilbert Ram?rez, DrPH

Disciplinary actions taken against physicians in the United States have been increasing over the last decade, yet the factors that place physicians at risk have not been well identified. The objective of this study is to identify predictors of physician disciplinary action. This case-control study used data from the Texas State Board of Medical Examiners from January 1989 through December 1998. Characteristics of disciplined physicians and predictors of disciplinary action for all violations and by type of violation were the main outcome descriptors. Years in practice, black physicians, and osteopathic graduates were positive predictors for disciplinary action. In contrast, female physicians, international medical graduates, and Hispanic and Asian physicians were less likely to receive disciplinary action compared with male, US allopathic, and white physicians, respectively. Most specialists, except psychiatrists and obstetrician-gynecologists, were less likely to be disciplined than were family practitioners, whereas general practitioners were more likely to be disciplined. More studies are needed to corroborate these findings.

 

[LukeWhite]

I wonder if the article addresses the proportionally larger number of DO's in primary care, since primary care is cited in the abstract as a positive predictor for discipline. The number of DO FPs vs MD FPs disciplined and the number of DO FPs vs DO specialists disciplined would be useful info.

 

[bgibney]

Without reading the article, the first thing I can say is I would try not to fall into correlation = causality mode of thinking, ie, yes a trend is identified but the cause may or may not be that trend. There are a multitude of factors that I presume weren't controlled, so therefore I would be wary of speculating DO = higher disciplinary action.

I also don't believe that instituting higher premiums for DOs v. MDs is a solution. If the article is correct, and there is causality between the DO degree and higher disciplinary action, I would think the best place to start is to find out why, and find out fast. Is it substandard pre-clinical training? Is it substandard clinical training? Is it substandard residencies?

In short, I think more information is needed before we can make a definitive conclusion - I would like to see the article to see how they analzyed the data, and how they controlled the study.

BG

 

[LovelyRita]

What if you are a female DO?

You should edit your thread title to say "DO is a risk factor for malpractice IN TEXAS". You do realize you are stirring the pot, yes?

M.

 

[sophiejane]

I think a lot of it has to do with public perception and prejudice (racial and otherwise). Why else would black physicians in this study have more than 3x the number of disciplinary action against them for negligence/incompetence as white physicians, and DOs twice as many as MDs? I mean, who files the complaints in the first place? The patients do. So if Mrs. X has a problem with the fact that the Dr. that treated her is either a DO (she may feel slighted that there was not an MD behind the ER doc's name, even though the care she received might have been totally competent) or african-american (let's say we still have some ugly issues in this realm in Texas, unfortunately), she is more likely to file a complaint for negligence or incompetence, whether or not the doc ever really did anything wrong. I am not saying this is what happened in each case, but it may account for some of the higher numbers.

 

[andrea]

I wonder if the doctors on the Texas disciplinary boards are all younger Hispanic female international allopathic specialists.....

 

[LukeWhite]

Originally posted by sophiejane
I think a lot of it has to do with public perception and prejudice (racial and otherwise). Why else would black physicians in this study have more than 3x the number of disciplinary action against them for negligence/incompetence as white physicians,

I wouldn't be so quick to jump to racial prejudice as a "why else...?" answer. African-Americans ARE granted preferential admissions to medical schools, and there are traditionally black medical schools as well. These med schools have in the past, if I recall my SDN threads rightly, suffered from poor student outcomes and teaching/accreditation problems.

So while it might be more sensitive to blame racial prejudice, which certainly isn't nonexistent, affirmative action *by definition* means that the pool of AA-benefiting groups will contain a higher proportion of less qualified students. The same's true with DO admissions, though obviously for other reasons. And primary care docs have, on the whole, worse academic records than specialty docs.

There are obviously lots of exceptions, but I'd be more inclined to pin the higher incidence of malpractice among physicians from an AA-benefiting group more on training and ability than on racial prejudice.

 

[mfred]

I agree that there may be some bias involved in terms of pt recognition of the DO degree. However, while it is true that pts initiate the complaint/disciplinary process, ultimately discipline falls to the state medical board, who are all physicians, both black and white, both DO and MD. So, while blacks and DOs may feel a greater degree of pt complaints, the higher degree of discipline is due to mistakes, not just poor pt perception. I guess it would be true that a pt may be more willing to report a black or DO mistake, so that may correlate. I think the poster above is correct when stating that sub standard admissions and schools is a factor in the african american statistics. I saw a study several years ago about what schools have the most disciplinary actions, the top two were Meharry & Howard, both traditionally black schools that accept applicants with numbers far below the national average of both allopathic and osteopathic schools. Additionally, there board scores are also below the mean on average. Do these numbers make you a more efficient doctor? I don't think so but there seems to be some sort of relation. By the way, I know I am stirring the pot. That is what needs to done. Nobody involved in osteopathy should take these statistics lightly. If it is true for TX, I can promise you that it is true for many areas. TX is a very large state with a tremendous sampling population and a DO school.

 

[ckent]

Being female is definitely a decreased risk for your patients filing for malpractice mainly because patients usually perceive female physicians as being more "empathic" or caring. Studies have demonstrated this, and studies have also demonstrated that the number one reason that people even pursue malpractice suits is because patients are angry and they are looking for answers (they feel that their physician has not explained what went wrong to them), it's not because a medical error has actually occurred.

 

[sophiejane]

True, but we are talking about disciplinary action by the state medical board, not malpractice.

 

[ckent]

Originally posted by sophiejane
True, but we are talking about disciplinary action by the state medical board, not malpractice.

In general, disciplinary action by the state medical board is only taken after a malpractice lawsuit has been filed and the incident is investigated. That, or one of your colleagues turn you in (which I've heard is rare, unless you are mean to the nurses who will then turn you in).

 

[DrMom]

Originally posted by ckent
In general, disciplinary action by the state medical board is only taken after a malpractice lawsuit has been filed and the incident is investigated. That, or one of your colleagues turn you in (which I've heard is rare, unless you are mean to the nurses who will then turn you in).

There are a number of things that can lead a disciplinary action. I used to work for a professional medical organization that dealt with disciplinary actions. The largest # by far were drug/EtOH problems, although we also had sexual assaults, legal problems (there was a Dr that exposed himself in public, another that murdered his wife, a couple that handed out narcotics scripts for $$), and competence to practice/malpractice.

 

[mfred]

The article distinguishes b/t drug and alcohol disciplinary actions and negligence. DO's did not show increased risk of drug of etOH, however did show increased risk of negligence, prescribing errors, etc. I have asked our TOMA (texas osteopathic medical association) if they had an official reply and they have not yet replied. I am interested as to the way they look at it, and for that matter I wonder if the AOA has addressed this issue.

 

[group_theory]

It would be helpful if a copy of the article is posted so we can all read, and criticize it (just like Journal Club)

mfred - since you have access to the article (the names of the authors and email address should be listed), email the authors and request permission to repost his article (she/he might send you the pdf to post or a word file). Perhaps, to go even further, invite the authors to an SDN chat so that we may have an interactive chat (and get immediate responses to our queries)


Until then, it is hard to speculate on results, methodology, statistical analysis, etc

 

[daveyboy]

We can all speculate about the article ad nauseum, but the truth is that it is probably right on the money. All criticism is tough to swallow, but is very necesary to improve the profession.

Osteopathic medicine is very much at a crossroads today, and there is still quite a bit of house left to be cleaned. The only way to solve these problems is deal with them head on, without denial or a defensive posture. Unfortunately, I don't see enough of that happening.

 

[sophiejane]

You make a good point. Also, the data for this study only goes through 1998. That means that the youngest DOs implicated in the study would have graduated more than 10 years ago. A lot has changed for the better since then in osteo. medical education, I think.

 

[bigmuny]

I don't find it surprising unfortunately. There are numerous reasons why this could be. First, DO students generally have academic qualifications similar to AA"s(I remember that article about about Howard/Meharry) though I'm not sure if there is casaul effect there. Second, DO schools generally have lousy clinical education(relative to MD schools which do novel things like pay faculty to teach and have educational standards for 3rd/4th years). Third, DO post graduate training sucks(I'd like to see if they looked at where the docs did their post grad training i.e. MD vs DO). Finally, lets face it there are some flakey DO's out there(i.e. the "celebrated" viola fryman, the whole cranial crowd, ect..) who quite frankly deserve to get sued and disciplined.

 

[daveyboy]

Originally posted by bigmuny
Finally, lets face it there are some flakey DO's out there(i.e. the "celebrated" viola fryman, the whole cranial crowd, ect..) who quite frankly deserve to get sued and disciplined.

This is exactly the problem! These guys have ridden the gravy train long enough. They make the whole profession look bad. Down with the "cranial-chapman" quacks.

 

[mfred]

1. Will see what I can do about getting the article posted or something. Right now I am busy enjoying the amazement that is heme and have a test Fri. So after then I will email them, their email is in the article. If anybody is just nawing at the bit, here is the email address from that article: Dr. Robert Caradarelli, DO [email protected]
2. Some of you seem to be insinuating (spelling?) that in general osteopathy needs some reform. What do you suggest? Do you feel that some of these areas that are lacking are at the root of the higher DO disciplinary rates?

 

[deleted9493]

I know several patients who have gone to DO's for alternative therapies and ended up being very dissatisfied. Shoot, I have an uncle who used to be a PA for a DO and he hated it because the patients were often made promises...or given expectations that were simply not met by these alternative therapies. Since DO's use alternative (less proven) modalities much more frequently than do MD's, it should follow that patient satisfaction would be less. I certainly don't think that this is an all inclusive reason. I'm sure it's a combination of factors mentioned previously....but my bet is this alternative proclivity of DO's certainly doesn't help.

Bottom Line: I think a DO who takes the time to get to know his/her patients on a personal level and actually takes the time to listen and be thorough has a significantly smaller chance of being sued...than does an MD who doesn't do these things.

 

[sophiejane]

Originally posted by hudsontc
I know several patients who have gone to DO's for alternative therapies and ended up being very dissatisfied. Shoot, I have an uncle who used to be a PA for a DO and he hated it because the patients were often made promises...or given expectations that were simply not met by these alternative therapies. Since DO's use alternative (less proven) modalities much more frequently than do MD's, it should follow that patient satisfaction would be less. I certainly don't think that this is an all inclusive reason. I'm sure it's a combination of factors mentioned previously....but my bet is this alternative proclivity of DO's certainly doesn't help.

Bottom Line: I think a DO who takes the time to get to know his/her patients on a personal level and actually takes the time to listen and be thorough has a significantly smaller chance of being sued...than does an MD who doesn't do these things.

 

[sophiejane]

something weird happened there.

Well, what I wanted to say was that there are a few very successful DOs in Ft. Worth who include a lot of alternative therapies in their practice. When done well, these therapies attract an extremely loyal and growing patient base that is more than willing to pay cash for the services.

Anyone who does not recognize this trend hasn't been paying attention the past few years. There has been an explosion in interest in alternatives to conventional (allopathic) medicine. Lots of practitioners/providers have become wealthy because of this and lots of patients swear by these therapies. I don't want to discuss the merits or downfalls of alternative medicine, I just think that has very, very little to do with the reason there is more disciplinary action against DOs. Far fewer DOs than you think are doing "alternative" therapies, by the way. The vast majority are indistinguishable from MDs.

 

[daveyboy]

sophiejane,

You make a really good point.

I think much of the problem lies in the fact that DO's are the minority profession with a really wild, wacky history. Whenever a DO is associated with quackery, stereotypes are confirmed in many minds. I realize that this does not explain the actual numbers of this study, but it does explain the dilema we face as a profession.

Perhaps that study can be explained by the low total numbers of DO's in Texas as compared to MD's. A small amount of bad apples could have a seemingly disproportionate effect. Maybe not. Maybe there was a higher percentage of shady characters who graduated from DO schools 15-20 years ago. Who knows?

The only action that makes sense is to accept the criticism and improve. The medical students that are currently in school now can solve this problem, if it exists, by going out of their way to make sure that they are ethical physicians. Nothing bad can happen by taking that path.

 

[sophiejane]

Originally posted by daveyboy


The only action that makes sense is to accept the criticism and improve. The medical students that are currently in school now can solve this problem, if it exists, by going out of their way to make sure that they are ethical physicians. Nothing bad can happen by taking that path.

This might be the single most intelligent and sane post I have ever seen on SDN.

Not much more needs to be said.

With that, I am off to bed for a restful 4 hours of sleep....