Psych is 4th Highest in Malpractice?! How come?

[Blitz2006]

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http://www.medscape.com/features/slideshow/malpractice-report/public#3


According to the link above

Why is the litigation so high?

Psych only makes up 5% of physicians, yet 8% malpractice... on par with OBGYN

 

[postbacpremed87]

This can't be right

 

[johnhoedack]

.

 

[Leo Aquarius]

-correction-

"The survey, part of the 84th Continuing Study conducted by Medical Economics, consists of data collected from physicians in June via the Internet (see "About the survey" for more information). In addition to internal medicine and family/general practice, specialties covered in the survey and their median annual premiums were:

• Obstetrics/gynecology: $43,400
• Surgery: $30,000
• Plastic surgery: $27,700
• Urology: $23,500
• Gastroenterology: $20,000
• Cardiology: $19,400
• Neurology/neurosurgery: $17,500
• Emergency/acute care: $15,000
• Hospitalists: $15,000
• Ophthalmology: $12,300
• Dermatology: $10,300
• Pediatrics: $10,300
• Psychiatry: $4,700

"

I disagree that neurology and neurosurgery are the same.

(Neurosurgery tops malpractice risk. Indemnity payments varied by specialty, with neurosurgery-related indemnity payments ranking 4th with an average of $344,811. For high risk specialties such as neurosurgery, 88% of physicians were likely to be sued by age 45, with that number rising to 99% by age 65.
[http://journals.lww.com/neurosurgery/Fulltext/2011/12000/Neurosurgery_Tops_Malpractice_Risk.8.aspx])
Another example: Chicago neurosurgeons pay $4500/wk in med-mal premiums.

 

[Blitz2006]

So lowest overhead fees, lowest litigation, 6% pay increase.... lucrative specialty?

 

[postbacpremed87]

So lowest overhead fees, lowest litigation, 6% pay increase.... lucrative specialty?

Psych will probably get another boost the next few cycles. I wouldn't be surprised at all.

 

[Leo Aquarius]

So lowest overhead fees, lowest litigation, 6% pay increase.... lucrative specialty?

I only report the news; I don't make it.

 

[notdeadyet]

Medscape is mistaken.

"The survey, part of the 84th Continuing Study conducted by Medical Economics, consists of data collected from physicians in June via the Internet (see "About the survey" for more information). In addition to internal medicine and family/general practice, specialties covered in the survey and their median annual premiums

The meds cap slide with psych at 8% has nothing to do with malpractice rates.

 

[Leo Aquarius]

Ah, agreed. Thanks notdeadyet.

 

[Leo Aquarius]

Medscape didn't normalize this data, which overstates the lawsuit rate for higher volume specialties like anything related to primary care. Here's how that makes a difference.

Say in Town A you have 95 psychiatrists and 5 surgeons. If 6 psychiatrists are sued that year, and 1 surgeon is sued, then withOUT normalization the conclusion is out of all the doctors in Town A, psychiatrists account for 6% of the lawsuits filed, while surgeons account for only 1%.

But if you normalize the data (which is what Medscape hasn't done) then you can more accurately conclude that 6.3% of psychiatrists are sued while 20% of surgeons are sued in the above example.

Medscape didn't weigh the number of doctors per specialty into the equation in this study it appears.

 

[Leo Aquarius]

Another way to think about this is:

Since there are so many more psychiatrists (over 38,000) than, say, Allergists (around 4,300), then the total number of lawsuits filed against psychiatrists will far outnumber the number of lawsuits for small fields like Allergy. Duh. Thanks Medscape for telling us something quite intuitive.

 

[neurodoc]

It would be useful to know what the malpractice suits were for (not mentioned in the article). Also, how many of the suits led to judgments for the plaintiffs? Did these lawsuits allege preventable bad outcomes (e.g. failure to prevent suicidal or homicidal behavior)? Did they allege physician sexual misconduct?

It could be that psych patients are more likely than non-psych patients to sue. The fairly low malpractice insurance rates for psychiatrists despite the higher rate of lawsuits also needs to be explained.

One possibility is that patients or their families sued for harm caused by prescribed medications (e.g. metabolic syndrome and other physical medication side effects, or behavioral medication side effects...such as they guy who is prescribed Halcion and gets violent on a plane trip...). It's important to realize that psychotropic medications have potentially serious side effects and you need to be aware of these and document that you have discussed these with your patients, and you need to monitor your patients for adverse medication effects. I think that the drug companies have to some degree mislead psychiatrists into believing that their 2nd and 3rd generation psych meds are "safer" than the "older" (and off-patent) APD's and antidepressants. Ain't necessarily so...