Physician spending and subsequent risk of malpractice claims: Observational study

Abstract

Study question: Is a higher use of resources by physicians associatedwith a reduced risk of malpractice claims? Methods: Using data on nearly all admissions to acute care hospitals in Florida during 2000-09 linked tomalpractice history of the attending physician, this study investigated whether physicians in sevenspecialties with higher average hospital charges in a year were less likely to face an allegation ofmalpractice in the following year, adjusting for patient characteristics, comorbidities, and diagnosis. Toprovide clinical context, the study focused on obstetrics, where the choice of caesarean deliveriesare suggested to be influenced by defensive medicine, and whether obstetricians with higher adjustedcaesarean rates in a year had fewer alleged malpractice incidents the following year. Study answer and limitations: The data included 24 637 physicians, 154 725 physicianyears, and 18 352 391 hospital admissions; 4342 malpractice claims were made against physicians (2.8% per physician year). Across specialties, greater average spending by physicians was associated withreduced risk of incurring a malpractice claim. For example, among internists, the probability ofexperiencing an alleged malpractice incident in the following year ranged from 1.5% (95% confidenceinterval 1.2% to 1.7%) in the bottom spending fifth ($19 725 (£12 800; €17 400) per hospital admission) to0.3% (0.2% to 0.5%) in the top fifth ($39 379 per hospital admission). In six of the specialties, a greateruse of resources was associated with statistically significantly lower subsequent rates of allegedmalpractice incidents. A principal limitation of this study is that information on illness severity waslacking. It is also uncertain whether higher spending is defensively motivated. What this study adds: Within specialty and after adjustment for patientcharacteristics, higher resource use by physicians is associated with fewer malpractice claims. Funding, competing interests, data sharing: This study was supported by the Office of the Director, National Institutes of Health (grant 1DP5OD017897-01 to ABJ) and National Institute of Aging (R37 AG036791to JB). The authors have no competing interests or additional data to share.