Few issues in medicine cause as much worry and angst among physicians as the fear of being sued. The concern about medical malpractice litigation is one the leading causes of career dissatisfaction among physicians.1 Remarkably, little is known about why various subspecialties become involved in litigation, and a PubMed search reveals no articles written specifically on the topic of rheumatology lawsuits.
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I have a unique perspective. As a risk manager at Colorado Physician Insurance Company (COPIC), I’ve had an insider’s opportunity to analyze and prevent lawsuits. As a board-certified rheumatologist, I have a particular interest in our subspecialty. I reviewed the claims against all rheumatologists that COPIC has insured during the last seven years, and I believe you will find this analysis revealing.
Many believe that there is a malpractice crisis in the United States. According to the American Medical Association (AMA), there are only eight states where there is not a crisis malpractice situation. This means there is access to insurance for all specialties and a stable rate environment. Malpractice premium rates vary greatly from state to state, and there are no specific studies on rheumatology premiums. However, rheumatology rates are based on Internal Medicine (IM) physician premiums. In the 2006 survey, IM premiums varied from yearly rates around $3,000 in Nebraska to a high of almost $75,000 in Dade County, Fla.2 The variation is caused by the presence or absence of malpractice caps, state-funded supplemental funds, juries willing to make large awards, high administrative costs, and legal fees.
Malpractice lawsuits are typically filed under conventional tort law. This means that physicians need to be proven negligent to a reasonable degree of medical certainty (greater than 50%). There were few medical malpractice lawsuits prior to the 1970s. In fact, doctors were often covered under their own personal insurance. Not anymore. Litigation has forced physicians to carry malpractice insurance. To win their cases, plaintiffs need to prove: 1) the doctor had the duty to provide care; 2) the physician was negligent and delivered medical care below the standard of care; 3) the patient suffered an injury that was caused by the negligence claimed; and 4) the negligence lead to damages. Jury trials typically revolve around issues two and three.
Here’s the bad news: The risk of getting involved in a malpractice claim approaches 65% over the course of your career.3 Here’s the good news: There is a very small chance that you will end up in court in a lengthy, expensive jury trial. In the course of a given year, only about 40 of the 6,000 physicians that COPIC insures go to trial, and these cases tend to be in more highly sued specialties, such as obstetrics and neurosurgery. Overall, doctors win 80% of their cases when they go to court.