Characteristics of Paid Malpractice Claims Among Resident Physicians From 2001 to 2015 in the United States

Abstract

Purpose Limited information exists about medical malpractice claims against physicians-in-training. Data on residents’ involvement in malpractice actions may inform perceptions about medicolegal liability and influence clinical decision-making at a formative stage. This study aimed to characterize rates and payment amounts of paid malpractice claims on behalf of resident physicians in the United States. Method Using data from the National Practitioner Data Bank, 1,248 paid malpractice claims against resident physicians (interns, residents, and fellows) from 2001 to 2015, representing 1,632,471 residents-years, were analyzed. Temporal trends in overall and specialty-specific paid claim rates, payment amounts, catastrophic (> $1 million) and small (< $100,000) payments, and other claim characteristics were assessed. Payment amounts were compared with attending physicians during the same time period. Results The overall paid malpractice claim rate was 0.76 per 1,000 resident-years from 2001 to 2015. Among 1,194 unique residents with paid claims, 95.7% had exactly 1 claim, while 4.3% had 2–4 claims during training. Specialty-specific paid claim rates ranged from 0.12 per 1,000 resident-years (pathology) to 2.96 (obstetrics and gynecology). Overall paid claim rates decreased by 52% from 2001–2005 to 2011–2015 (95% confidence interval [CI]: 0.45, 0.59). Median inflation-adjusted payment amount was $199,024 (2015 dollars), not significantly different from payments made on behalf of attending physicians during the same period. Proportions of catastrophic (11.2%) and small (33.1%) claims did not significantly change over the study period. Conclusions From 2001 to 2015, paid malpractice claim rates on behalf of resident physicians decreased by 52%, while median payment amounts were stable. Resident paid claim rates were lower than attending physicians, while payment amounts were similar.

Characterizing malpractice cases involving emergency department advanced practice providers, physicians in training, and attending physicians

“…The observed final diagnoses, allegations, and contributing factors among trainee cases highlight the expense and complexity involved in medical training. The high gross indemnity paid among trainees is corroborated in prior studies which demonstrated that the proportion of catastrophic claims among trainees was significantly higher than for cases without trainee involvement 16 . Prior research on malpractice characteristics of EM cases involving trainees suggests that clinical judgment, communication, and documentation are the most prevalent contributing factors to malpractice risk and should be monitored closely in any teaching setting 17 …”

A review of medical malpractice cases involving trainees in the emergency department

“…Previous literature of resident-centered litigation across all specialties has highlighted that over half of cases involved claims of inadequate supervision, 8 and residents have repeatedly reported lack of supervision as a contributing factor in medical errors occurring in their own patients, 9 highlighting the veracity of this finding and the need to address the issue.…”

“…For example, creating systems that truly carve out the time for attending physicians to provide direct supervision during procedures, especially high‐risk ones like central line placement, could mitigate these risks. At least 1 meta‐analysis suggests that directly supervising invasive procedures does actually decrease mortality rates 10 . The Accreditation Council for Graduate Medical Education defines supervision on a spectrum ranging from in‐person direction for entry‐level trainees to indirect oversight on an as‐needed basis for more senior trainees, and since 2010 has called for more uniform and augmented supervision requirements for residency programs 11 .…”

Medical Malpractice Lawsuits Involving Trainees in Obstetrics and Gynecology in the USA

“…Further, the highest paid-claim rates per 1000 resident-years were in ob/gyn (2.96), followed by neurological surgery (2.01), and plastic surgery (1.43). The highest proportion of catastrophic payments (>$1 million) were also in ob/gyn (18%) [ 3 ]. These numbers highlight the importance of better understanding factors that increase ob/gyn trainees’ liability risks.…”