The Facts
The Health Care Quality Improvement Act, passed by Congress in 1986, requires that all malpractice payments (losses, paid claims) made on behalf of any clinician a state licenses, registers, or certifies must be reported to the NPDB. Since the data bank began collecting statistics in 1990, it has recorded a total of 100,750 paid claims for all physicians of every type, with an average paid claim of $188,773. During the same period, the NPDB recorded a total of 240 paid claims for PAs, with an average paid claim of $83,625.[3]
Perspective on these data can be gained by noting that, in 1998, an estimated 272.8 physicians and 11.7 PAs exist for every 100,000 people; 23.4 physicians exist for every PA in this country. We can surmise that, all other things being equal, the number of physician-related paid claims is 23.4 times that of PA-related paid claims. In reality, the number of physician-related paid claims approaches 420 times that of PA-related paid claims. A further disparity is noted when mean losses are compared over this period: Mean physician-related losses are 2.26 times greater than PA-related losses.
Another way of examining the differences between the malpractice experience of PAs and physicians is to calculate how many providers of each type exist for each malpractice claim. Data from 1996 show that one claim was paid for every 46.6 physicians and one for every 808.1 PAs.
A similar disparity was revealed when the total number of dollars expended in all physician-related paid claims were compared with all PA-related paid claims. During the entire period that the NPDB has been collecting data, the total for physicians was 946.6 times the total for PAs.
That PAs affect a practice?s liability one way or another is not indisputable on the basis of the evidence; the NPDB data show, however, that a relatively small number of malpractice payments are being made on behalf of PAs.
Impact of PAs on Malpractice Claims
Studies show that effective communication with patients is the best way to avoid a malpractice suit.[4-6] PA education has always focused on interviewing skills and techniques to improve communication ? two skills that can enhance any practice.
Since early in the PA profession, it has been speculated that a PA could reduce the risk of malpractice judgments because the PA?s presence allowed the supervising physician to concentrate on more complicated cases. It is assumed that employing a PA reduces waiting time and provides patients with greater attention, which enhances patient rapport and satisfaction. Recent studies show that scheduling enough time to talk with a patient in the examining room and to answer telephone calls personally and promptly lowers the risk of malpractice claims.[7]
Adding a PA to a practice may prevent patients from feeling rushed or deserted during an office encounter.[8] These observations emphasize that what a clinician says may be less important the tone and process of the visit in predicting malpractice claims.[1] One commentator observed: ?Good communications skills are not only good medicine ? they are good for the bottom line.?[9] Interviewing and communication skills probably translate, over the long run, into fewer malpractice suits and reduced fees for professional liability insurance.
The Priority is Quality Care
As changes in health care delivery force shorter patient visits and other restraints on care, one hopes that PAs? traditional strengths as excellent clinicians and communicators will continue to validate a conviction expressed early in the history of the profession by the American Medical Association?s assistant general counsel: ?PAs probably hold the potential for being one of the best malpractice tools available....?[10]
REFERENCES
1. Levinson W, Roter DL, Mullooly JP, et al. Physician-patient communication: The relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997;277(7):553-559.
2. Shapiro RS, Simpson DE, Lawrence SL, et al. A survey of sued and nonsued physicians and suing patients. Arch Intern Med 1989;149(10):2190-2196.
3. The National Practitioner Data Bank Research File of September 30, 1997, as maintained by the Division of Quality Assurance, Bureau of Health Professions, Health Resources and Services Administration, US Department of Health and Human Services.
4. Lester GW, Smith SG. Listening and talking to patients. A remedy for malpractice suits? West J Med 1993;158(3):268-272.
5. Kaplan SH, Greenfield S, Gandek B, et al. Characteristics of physicians with participatory decision-making styles. Ann Intern Med 1996;124(5):497-504.
6. Frankel RM. Communicating with patients: Research shows it makes a difference. AAPA NEWS 1995;16(2):8.
7. Charles SC, Gibbons RD, Frisch PR, et al. Predicting risk for medical malpractice claims using quality-of-care characteristics. West J Med 1992;157(4):433-439.
8. Beckman HB, Markakis KM, Suchman AL, et al. The doctor-patient relationship and malpractice: Lessons from plaintiff depositions. Arch Intern Med 1994;154(12):1365-1370.
9. Trafford A. When paying medical bills, how about a tip for caring? The Washington Post March 25, 1997, p. 206.
10. Ryser J. Claims rate low: PAs seen as asset in liability crisis. Am Med News 1976;April 26:1,11-12.
