Facing the malpractice crisis: academic physicians' willingness to accept quick fix solutions.Background: We sought to determine the willingness of academic physicians to accept strategies to contain institutional malpractice malpractice, failure to provide professional services with the skill usually exhibited by responsible and careful members of the profession, resulting in injury, loss, or damage to the party contracting those services. costs.
Methods: We surveyed all 270 Department of Medicine physicians at a large academic center. Respondents were asked about their knowledge regarding malpractice premiums, willingness to reduce patient-care activities and accept decreases in compensation.
Results: The response rate was 80%. Respondents estimated the annual increase in malpractice premiums from 2004 to 2005 to be 29%. The true increase was 28% (P = 0.55). Almost all opposed eliminating patient care (95%) or providing patient care every other year at double effort and withdrawing from patient care on alternate years (97%). Seventy percent would limit their clinical procedures. Most physicians opposed salary reduction (97%) or decreases in fringe benefits fringe benefits,
n.pl the benefits, other than wages or salary, provided by an employer for employees (e.g., health insurance, vacation time, disability income). (99%).
Conclusions: Few academic physicians are willing to limit patient care or accept decreases in compensation to recoup recoup
To sell an asset at a price sufficient to recover the original outlay or to offset a previous loss. institutional malpractice costs.
Key Words: medical malpractice Improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional. , academic medical centers, physician compensation
Research, teaching, and patient care encompass the core mission of academic medical centers; however, increasing malpractice rates may threaten this mission. (1) Current efforts to address the crisis have focused primarily on tort tort, in law, the violation of some duty clearly set by law, not by a specific agreement between two parties, as in breach of contract. When such a duty is breached, the injured party has the right to institute suit for compensatory damages. reform. This involves complicated legal processes, multiple stakeholders Stakeholders
All parties that have an interest, financial or otherwise, in a firm-stockholders, creditors, bondholders, employees, customers, management, the community, and the government. , and will take time to result in meaningful change. (2-4) In the interim, academic medical centers are faced with the challenge of paying rapidly escalating malpractice premiums. Because of the unique setting in which academic medical centers provide care, creative ways to manage the malpractice crisis may be needed until more long-term solutions are developed. Consideration for the academic physician as clinician clinician /cli·ni·cian/ (kli-nish´in) an expert clinical physician and teacher.
n. , teacher and investigator will need to be paramount. Possible quick fix solutions might involve eliminating patient care responsibilities for faculty who spend the majority of their time in nonclinical roles or reducing salaries and fringe benefits.
The purpose of this study was to determine the willingness of physicians at a large academic medical center to accept various strategies designed to rapidly contain institutional malpractice costs.
In May 2004 we surveyed all 270 clinically active physician faculty in the Department of Medicine at Johns Hopkins University School of Medicine The Johns Hopkins University School of Medicine, located in Baltimore, Maryland, USA, is a highly regarded medical school and biomedical research institute in the United States. (Johns Hopkins Hospital
2. Medicine Institutional Review Board.
We developed a 27-item questionnaire. The survey obtained information on participants' personal and professional characteristics, their estimates of current malpractice fees, attitudes about malpractice premiums and willingness to accept changes to their clinical practice and compensation (salary and benefits) in an effort to reduce institutional malpractice costs. Questions were formatted as multiple choice, short answer, yes/no and 5-point Likert scales Likert scale A subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc .
Descriptive statistics descriptive statistics
see statistics. were used to characterize physician demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. and responses. Responses to 5-point Likert scales were dichotomized and analyzed an·a·lyze
tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es
1. To examine methodically by separating into parts and studying their interrelations.
2. Chemistry To make a chemical analysis of.
3. as proportions. t tests were used to compare physician responses with actual malpractice premium values. Data were analyzed using Stata Statistical Software: 8.2 (Stata Corp., College Station, TX, 2004).
Respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests. Characteristics
Two-hundred and seventeen faculty completed the survey for an 80% response rate. Fifteen respondents were excluded from the analysis because they spent 0% of their time in patient care. The personal and professional characteristics of the respondents are presented in the Table. Thirty percent of the faculty spent 50% or more of their time on patient care. There were no significant differences between respondents and nonrespondents in terms of gender and rank (P > 0.05).
Knowledge and Attitudes About Current Malpractice Rates
Almost all respondents (99%) correctly reported that malpractice rates for the institution had increased in the last year. Respondents estimated the annual increase in malpractice premiums to be 29% from 2004 to 2005. The true premium increase was 28% (P = 0.55). Faculty estimated the mean rate per physician in the Department of Medicine in 2004 at $13,724.50: the actual mean rate was $10,453 (P < 0.001).
Most faculty believed that the following factors place academic medical centers at a greater risk for malpractice claims compared with nonacademic hospitals: higher expectations from patients and society (81%), sicker patients (81%) and the presence of trainees (62%). Forty-one percent of physicians in our sample thought that escalating malpractice premiums was the most important financial challenge facing academic medical centers.
Willingness to Accept Reductions In Patient Care Responsibility, Salary and Benefits
When asked if they would be willing to give up patient care responsibilities completely, almost all physicians opposed or strongly opposed this measure (95%), (Fig.). A similar number opposed or strongly opposed the option of providing patient care every other year at double the effort and withdrawing from patient care on alternate years (97%). Seventy percent of respondents were willing to limit their clinical procedures to only those that they regularly performed. Almost all physicians opposed or strongly opposed salary reductions (97%) and decreases in fringe benefits (99%) as ways to help the institution cover escalating malpractice costs.
Academic physicians in our study appear to be aware of the magnitude of the current malpractice crisis. Almost all knew that costs were increasing. Many reported that increasing malpractice costs represent the most important financial challenge facing academic medical centers. Despite this knowledge, very few were willing to limit or eliminate patient care activities or accept a decrease in salary or benefits in an effort to help recoup institutional malpractice costs.
To our knowledge, this is the first survey asking academic physicians what changes they would be willing to make in response to the malpractice crisis. One possible explanation for this unwillingness to limit or give up clinical roles may be that academic physicians recognize and are committed to their unique roles as clinicians, teachers and investigators. Another reason may be that academic physicians remain relatively cushioned from the pressure of increasing malpractice costs because they do not pay their own premiums. In contrast, many private physicians who must pay their own malpractice premiums, have responded to increases in malpractice costs by limiting or relocating their practices or retiring from clinical medicine. (5,6)
Physicians in our study were even less likely to accept decreases in salary or benefits in an effort to defray de·fray
tr.v. de·frayed, de·fray·ing, de·frays
To undertake the payment of (costs or expenses); pay.
[French défrayer, from Old French desfrayer : des-, institutional malpractice costs. It is well documented that the salaries of academic physicians are lower than those of doctors in private practice. (7) Fringe benefits, including malpractice coverage, may reduce the magnitude of the discrepancy DISCREPANCY. A difference between one thing and another, between one writing and another; a variance. (q.v.)
2. Discrepancies are material and immaterial. in salaries. Furthermore, the potential solutions proposed in our study are not without limitations. For example, faculty who conduct clinical research but who may not care for their own patients would still require malpractice coverage.
The academic physicians in our study believed that many factors place them at a greater risk for being sued than non-academic physicians, such as higher societal so·ci·e·tal
Of or relating to the structure, organization, or functioning of society.
Adj. expectations, sicker patients and the presence of residents and fellows. The complex structure and multiple functions of academic medical centers create unique liability issues and the literature shows that litigation An action brought in court to enforce a particular right. The act or process of bringing a lawsuit in and of itself; a judicial contest; any dispute.
When a person begins a civil lawsuit, the person enters into a process called litigation. , including malpractice claims, has increased over the last half century. (8) Existing efforts to reduce the risk of litigation including systems approaches to enhance patient safety and reforms to graduate medical education may help control malpractice costs in the long term but are unlikely to have immediate effects. (9-11) However, if malpractice premiums continue to account for an increasing percentage of clinical income generated at academic institutions, academic physicians may no longer feel as sheltered from these costs. (1)
Several limitations of this study should be considered. First, our survey posed hypothetical questions A mixture of assumed or established facts and circumstances, developed in the form of a coherent and specific situation, which is presented to an expert witness at a trial to elicit his or her opinion. . Faculty may have chosen different responses under more pressing real-life circumstances. Second, although we had a high response rate from faculty at a large institution, our findings may not be representative of the experiences of faculty in other departments or at other academic institutions. The Johns Hopkins Institutions are insured as part of an academic group consortium, and therefore, our malpractice premiums may not reflect national trends. Finally, we were unable to make comparisons based on amount of time spent in patient care due to the size of our sample. However, because of the high response rate, the percentage of faculty willing to accept the changes proposed in the survey would be unlikely to change even with a larger sample.
While academic physicians are aware of the magnitude of the current malpractice crisis, very few are willing to limit or eliminate patient care activities or accept a decrease in salary or benefits in an effort to help cover institutional malpractice costs at this time. Understanding physicians' perspectives will be important as academic medical centers consider potential quick fix solutions to address the rapidly rising costs of malpractice premiums.
Dr. Wright is an Arnold P. Gold Associate Professor of Medicine. Drs. Kravet and Wright receive support as Miller-Coulson Family Scholars through the Johns Hopkins Center for Innovative Medicine.
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6. Brehm J, Hannah K, Ruddick P, et al. Physician supply in key medical specialties Medical Specialties
See also anatomy; disease and illness; drugs; health; remedies; surgery.
the science of the description of glands. — adenographic, adj. in West Virginia West Virginia, E central state of the United States. It is bordered by Pennsylvania and Maryland (N), Virginia (E and S), and Kentucky and, across the Ohio R., Ohio (W). Facts and Figures
Area, 24,181 sq mi (62,629 sq km). Pop. hospitals, 2001-2004. W V Med J 2004; 100:132-135.
7. Academic Practice Compensation and Production Survey for Faculty and Management: 2004 Report Based on 2003 Data. Medical Group Management Association, 2004.
8. Helms LB, Helms CM. Litigation involving medical faculty and academic medical centers, 1950-1991. Acad Med 1993;68:7-19.
9. Brennan TA, Mello MM. Patient safety and medical malpractice: a case study. Ann Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine.
in·tern or in·terne
n. Med 2003;139:267-273.
10. Kachalia A, Studdert DM. Professional liability issues in graduate medical education. JAMA 2004;292:1051-1056.
11. Schoenbaum SC, Bovbjerg RR. Malpractice reform must include steps to prevent medical injury. Ann Intern Med 2004;140:51-53.
Rachel B. Levine, MD, MPH, Steven J. Kravet, MD, Darcy A. Reed, MD, MPH, Donna M. Windish, MD, MPH, Leah Wolfe, MD, and Scott M. Wright, MD
From the Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD; the Division of Primary Care Internal Medicine, Mayo Clinic Mayo Clinic: see Mayo, Charles Horace.
voluntary association of more than 500 physicians in Rochester, Minnesota. [Am. Hist.: EB, 11: 723]
See : Medicine College of Medicine, Rochester, MN; and the Department of Internal Medicine, Yale University Yale University, at New Haven, Conn.; coeducational. Chartered as a collegiate school for men in 1701 largely as a result of the efforts of James Pierpont, it opened at Killingworth (now Clinton) in 1702, moved (1707) to Saybrook (now Old Saybrook), and in 1716 was School of Medicine, New Haven New Haven, city (1990 pop. 130,474), New Haven co., S Conn., a port of entry where the Quinnipiac and other small rivers enter Long Island Sound; inc. 1784. Firearms and ammunition, clocks and watches, tools, rubber and paper products, and textiles are among the many , CT.
Reprint reprint An individually bound copy of an article in a journal or science communication requests to Rachel B. Levine, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, B2N B2N Back to Normal
B2N Business to Nobody (E commerce) , Rom 235, 4940 Eastern Avenue, Baltimore, MD 21224. Email: firstname.lastname@example.org
Accepted March 15, 2006.
RELATED ARTICLE: Key Points
* Increasing malpractice costs may limit the ability of academic medical centers to fulfill their commitment to research, teaching, and patient care.
* Academic physicians appear to be aware of the magnitude of the current malpractice crisis.
* Very few academic physicians are willing to significantly limit or eliminate patient care activities or accept decreases in salary or benefits in an effort to help contain institutional malpractice costs.
Table. Characteristics of the 202 Department of Medicine faculty physician respondents Characteristics Mean age +/- SD, yr 46.0 +/- 9.8 Women, n (%) 61 (30.0%) Academic rank Instructor, n (%) 19 (9.4%) Assistant Professor, n (%) 81 (40.1%) Associate Professor, n (%) 52 (25.7%) Professor, n (%) 50 (24.7%) Average percentage of time spent in research and patient care Research 39.5% Direct patient care (no learners present) 21.0% Supervising patient care (learners present) 18.3%