er malpractice
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Although I will likely not divulge "how er malpractice works," I will tell you that it is considered slightly above average in most respects (completely varying on state-by-state differences) compared to most specialties. Sometimes it is quoted as "average". Obviously it cannot compare to psychiatry, but it is by some considered a "moderate-risk specialty." I'm sure some of the residents or attendings can mention more about that...
And take it from me (I worked throughout medical school as a medical malpractice defense paralegal) that lawsuits are common in any field. Geriatrics, pediatrics, EM, Surgery, Anesthesia, Interventional Psychiatry...
Q
And take it from me (I worked throughout medical school as a medical malpractice defense paralegal) that lawsuits are common in any field. Geriatrics, pediatrics, EM, Surgery, Anesthesia, Interventional Psychiatry...
Q
Med mal is a very complicated thing. Med mal and lawsuits are not about medicine, they are about money. Consequently they are as complicated as any other business/finance issue. It's like asking how investments work. I'll try to give you a few thoughts to mull over.
There are a number of ways to structure your med mal. You can buy it yourself or have it paid by the hospital or practice group. This usually depends on your type of employment, e.g. employee vs. independent contractor. Sometimes it is negotiable when you sign your contract.
There are two main types of protection. Claims made vs. occurrence. Occurrence is better. The only way to explain the difference is with an example:
You work as an EP at an ER for 1 year then you resign and move on. You can be sued for what you did at that ER until the statute of limitations runs out, 6 years in most states, longer in regards to peds. Let's say you have been gone for 3 years and you get a nasty gram from some shyster. Claims made insurance only covers you for claims made while you are under policy. So in this case you are screwed. You have no coverage, you have to hire your own shyster, at your own expense and if they win they get your house and car. Occurrence coverage covers you for anything the occurred during the policy period. It's much more expensive.
You can cover yourself if you have claims made by buying a tail when you leave. These run in the neighborhood of $20,000 per year covered. Sometimes it's not so bad to be under claims made if your employer will buy the tail. If you have to pay for it yourself it will get pricey.
For all the med students and residents out there I suggest learning as much about med mal and the business of EM as possible. During residency you are shielded from many of the realities and they become very important 2 hours after you start your first job.
There are a number of ways to structure your med mal. You can buy it yourself or have it paid by the hospital or practice group. This usually depends on your type of employment, e.g. employee vs. independent contractor. Sometimes it is negotiable when you sign your contract.
There are two main types of protection. Claims made vs. occurrence. Occurrence is better. The only way to explain the difference is with an example:
You work as an EP at an ER for 1 year then you resign and move on. You can be sued for what you did at that ER until the statute of limitations runs out, 6 years in most states, longer in regards to peds. Let's say you have been gone for 3 years and you get a nasty gram from some shyster. Claims made insurance only covers you for claims made while you are under policy. So in this case you are screwed. You have no coverage, you have to hire your own shyster, at your own expense and if they win they get your house and car. Occurrence coverage covers you for anything the occurred during the policy period. It's much more expensive.
You can cover yourself if you have claims made by buying a tail when you leave. These run in the neighborhood of $20,000 per year covered. Sometimes it's not so bad to be under claims made if your employer will buy the tail. If you have to pay for it yourself it will get pricey.
For all the med students and residents out there I suggest learning as much about med mal and the business of EM as possible. During residency you are shielded from many of the realities and they become very important 2 hours after you start your first job.
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EM professional liability premiums are fairly high. Premiums are on par or slightly lower than various surgical fields, and higher than all nonsurgical fields. Most emergency docs pay somewhere it the $20,000-$50,000 range, but it will vary tremendously by state and county (generally due to tort reform meausres in place and trial lawyers per capita). If you've had several claims against you and you are in a high risk location, you may be paying six figures or not be able to get coverage at all.
EM docs get sued more often than almost all other fields, including most surgical fields. There are several reasons for this, such as: the many different patients seen each shift, the acuity of the patients, the lack of a prior doctor-patient relationship, the fact that uninsured and trauma patient populations have been shown to sue more often, the increased incidence of mistakes due to incomplete information and resources that can be easily overwhelmed (mass casualty incident), and of course, that a common trial lawyer tactic is to name every physician even marginally involved in a patient's care in a lawsuit (you admit a patient with chest pain...on day 4 of admission, patient has a bad outcome which may have been due to something done by their attending during the inpatient stay...but you're often still named in the lawsuit).
Still, even though EM docs are sued more often, the judgments and settlements are considerably lower than OB-GYN, neurosurg, and many other surgical fields, because the bad outcomes aren't typically as severe. There is a very strong correlation between the type and severity of injury and whether there is an award and the size of the award, with birth defects/CP and paralysis topping the list (well ahead of death).
As an EM doc, it is likely that you will be sued several times during your career. As the professional liability crisis continues to worsen, premiums will really begin to cut into your earning power, especially as Medicare and manged care reimbursements remain stable or fall, Medicaid reimbursements continue to be negligible, and the level of uncompensated care rises.
Everyone should take 5 minutes of their time, go to the AMA website (www.ama-assn.org), click on professional liability reofrm, and use the website tool to send out a letter to your Congressmen.
EM docs get sued more often than almost all other fields, including most surgical fields. There are several reasons for this, such as: the many different patients seen each shift, the acuity of the patients, the lack of a prior doctor-patient relationship, the fact that uninsured and trauma patient populations have been shown to sue more often, the increased incidence of mistakes due to incomplete information and resources that can be easily overwhelmed (mass casualty incident), and of course, that a common trial lawyer tactic is to name every physician even marginally involved in a patient's care in a lawsuit (you admit a patient with chest pain...on day 4 of admission, patient has a bad outcome which may have been due to something done by their attending during the inpatient stay...but you're often still named in the lawsuit).
Still, even though EM docs are sued more often, the judgments and settlements are considerably lower than OB-GYN, neurosurg, and many other surgical fields, because the bad outcomes aren't typically as severe. There is a very strong correlation between the type and severity of injury and whether there is an award and the size of the award, with birth defects/CP and paralysis topping the list (well ahead of death).
As an EM doc, it is likely that you will be sued several times during your career. As the professional liability crisis continues to worsen, premiums will really begin to cut into your earning power, especially as Medicare and manged care reimbursements remain stable or fall, Medicaid reimbursements continue to be negligible, and the level of uncompensated care rises.
Everyone should take 5 minutes of their time, go to the AMA website (www.ama-assn.org), click on professional liability reofrm, and use the website tool to send out a letter to your Congressmen.
There are 2 types of malpractice insurance:
Claims made and Occurence based.
In claims made you are only covered while you are paying premiums, when you go to move you have to buy a tail policy with premiums several times the usual rate.
Occurence based is more expensive on the front end, but you are covered for any suits filed for care provided while you were paying premiums.
Some states (Fl for one) has extremely high claims made premiums, and when you try to leave the state you may end up paying 1/4 - 1/2 million to get out of the state. (Sorry Q)
Unfortunatly lawsuits are the cost of doing business. One figure I heard was that 1/6th of EM physicians will be sued in any given year.... one study done in Colorado did sho a decreased rate of lawsuits in EM Residency trained physicians...
Claims made and Occurence based.
In claims made you are only covered while you are paying premiums, when you go to move you have to buy a tail policy with premiums several times the usual rate.
Occurence based is more expensive on the front end, but you are covered for any suits filed for care provided while you were paying premiums.
Some states (Fl for one) has extremely high claims made premiums, and when you try to leave the state you may end up paying 1/4 - 1/2 million to get out of the state. (Sorry Q)
Unfortunatly lawsuits are the cost of doing business. One figure I heard was that 1/6th of EM physicians will be sued in any given year.... one study done in Colorado did sho a decreased rate of lawsuits in EM Residency trained physicians...
Since the malpractice environment is one of the main aspects of modren EM I'll bump this thread and add some more stuff.
You may hear talk about "the cap" being a good thing. Many states (California is the prototype - its cap is called MICRA) limit the amount of money a disgruntled patient can receive for intangible damages like "pain and suffering." In CA the "cap" is $250,000 for that kind of angle. Consequently, you don't have as much of a chance of having some career ending judgement handed out. Because of this, malpractice insurance is much cheaper here. Bush has been pushing a national version of this. All doctors should be for it.
Another important difference in med mal from state to state is who can testify against you. In CA only another EP can testify against you. This is important because in many states the plaintiff can get a specialist to testify. This in effect holds you to the standard of that specialty and that's a tough standard.
You may hear talk about "the cap" being a good thing. Many states (California is the prototype - its cap is called MICRA) limit the amount of money a disgruntled patient can receive for intangible damages like "pain and suffering." In CA the "cap" is $250,000 for that kind of angle. Consequently, you don't have as much of a chance of having some career ending judgement handed out. Because of this, malpractice insurance is much cheaper here. Bush has been pushing a national version of this. All doctors should be for it.
Another important difference in med mal from state to state is who can testify against you. In CA only another EP can testify against you. This is important because in many states the plaintiff can get a specialist to testify. This in effect holds you to the standard of that specialty and that's a tough standard.
It does not matter who (physician, group, or hospital) actually writes the check to cover medical liability premiums...the physician always ultimately pays in the end.
Some emergency physicians are paying $100,000+ for medmal premiums. If their group "pays" their premiums, the group will more or less reduce each emergency physician's salary by the average cost of the premiums.
Even for independent contractors, the hospital or group will typically write the check for the medmal premiums, as this is more favorable to the physician since it reduces their taxable income. But don't think this makes medmal premiums "free."
Some emergency physicians are paying $100,000+ for medmal premiums. If their group "pays" their premiums, the group will more or less reduce each emergency physician's salary by the average cost of the premiums.
Even for independent contractors, the hospital or group will typically write the check for the medmal premiums, as this is more favorable to the physician since it reduces their taxable income. But don't think this makes medmal premiums "free."
If you really examine the proposed legislation, it actually allows for more money than most people already sue for.
California's insurance premiums are cheaper mainly because insurance companies can't jack up rates at free will based on how bad their investments were.
emdoc21 is correct. Whoever actually writes the check the money is coming out of physician billing - YOUR MONEY. It's the minority of EPs that write their own med mal checks, it's usually paid by groups or hospitals but it's all money out of your pocket.
Geek Medic - Everyone that I know thinks that MICRA and anything like it at the national level is a good thing. I guess a person's view of it comes down to if you think the med mal crisis is due to insurance companies or lawyers. I place it squarely on the lawyers and the suing public.
Geek Medic - Everyone that I know thinks that MICRA and anything like it at the national level is a good thing. I guess a person's view of it comes down to if you think the med mal crisis is due to insurance companies or lawyers. I place it squarely on the lawyers and the suing public.
docb, it's really a combination of both.
If you look at the numbers adjusted for inflation, patients aren't suing more or getting more than they were 5 years ago. (Of course this can't be said about comparing malpractice today with 40 years ago.)
😕 Actually not true. They are getting more. Once worse the increase has come fully as part of the "non-economic" (or 'punitive') damages. In this regard, not only has the average award gone up, but the burden of proof has gone down, since non-ecomonic damages are difficult to quantify. 😡
I hghly encourge everyone to visit this site;
http://www.isms.org/realmedicine/info/history.html
or this one which matches the award increases to the cost of living;
http://www.isms.org/realmedicine/info/book/graphs_ver.html
or this one that compares EM malpractice rates in Illinois to those paid in L.A. County, CA.
http://www.isms.org/realmedicine/info/book/graphs_em.html
"Reality Medicine" is an effort, started by the Illinois State Medicial Society to educate patients on the cost to society of the current legal system. The statistics they have complied are astounding.
The "Reality Medicine" program also offers educational material to enlist our patients in this fight. As doctors are forced out of practice, or forced to relocate their practces, this is rapidly evolving into an issue of access to care. For us in EM, that means more and more patients dumped on our dorstep for primary care!
BTW - I'm not exactly looking at these data with innocent eyes. My undergrad degree is in health policy, and I hold an MPH degree. IMHO ( 🙄 ); unfortunately, the numbers are solid.
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