Provider and Practice Factors Associated With Emergency Physicians' Being Named in a Malpractice Claim

Abstract

Study objective: We examine the association between emergency physician characteristics and practice factors with the risk of being named in a malpractice claim.

Methods: We used malpractice claims along with provider, operational, and jurisdictional data from a national emergency medicine group (87 emergency departments [EDs] in 15 states from January 1, 2010, to June 30, 2014) to assess the relationship between individual physician and practice variables and being named in a malpractice claim. Individual and practice factors included years in practice, emergency medicine board certification, visit admission rate, relative value units generated per hour, total patients treated as attending physician of record, working at multiple facilities, working primarily overnight shifts, patient experience data percentile, and state malpractice environment. We assessed the relationship between emergency physician and practice variables and malpractice claims, using logistic regression.

Results: Of 9,477,150 ED visits involving 1,029 emergency physicians, there were 98 malpractice claims against 90 physicians (9%). Increasing total number of years in practice (adjusted odds ratio 1.04; 95% confidence interval 1.02 to 1.06) and higher visit volume (adjusted odds ratio 1.09 per 1,000 visits; 95% confidence interval 1.05 to 1.12) were associated with being named in a malpractice claim. No other factors were associated with malpractice claims.

Conclusion: In this sample of emergency physicians, 1 in 11 were named in a malpractice claim during 4.5 years. Total number of years in practice and visit volume were the only identified factors associated with being named, suggesting that exposure to higher patient volumes and longer practice experience are the primary contributors to malpractice risk.

Figure

Predicted Probabilities of a Physician Being Named in a Malpractice Claim by Years in Practice and Total Number of Visits Points represent the probability of being named in a malpractice claim as predicted by the logistic regression model for the 1029 physicians in this study. Lines represent the predicted probabilities holding other independent variables constant at average or most common value. Number of visits and years in practice (starting at <1 year, represented as 0) are reported as median values during the study time period.