• David M Studdert, Marie M Bismark, Michelle M Mello, Harnam Singh, and Matthew J Spittal.
• From Stanford University School of Medicine and Stanford Law School, Stanford, CA (D.M.S., M.M.M.); Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (M.M.B., M.J.S.); and the Health Resources and Services Administration, Department of Health and Human Services, Rockville, MD (H.S.).
• N. Engl. J. Med. 2016 Jan 28;374(4):354-62.

BackgroundThe distribution of malpractice claims among physicians is not well understood. If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them at an early stage could guide efforts to improve care.MethodsUsing data from the National Practitioner Data Bank, we analyzed 66,426 claims paid against 54,099 physicians from 2005 through 2014. We calculated concentrations of claims among physicians. We used multivariable recurrent-event survival analysis to identify characteristics of physicians at high risk for recurrent claims and to quantify risk levels over time.ResultsApproximately 1% of all physicians accounted for 32% of paid claims. Among physicians with paid claims, 84% incurred only one during the study period (accounting for 68% of all paid claims), 16% had at least two paid claims (accounting for 32% of the claims), and 4% had at least three paid claims (accounting for 12% of the claims). In adjusted analyses, the risk of recurrence increased with the number of previous paid claims. For example, as compared with physicians who had one previous paid claim, the 2160 physicians who had three paid claims had three times the risk of incurring another (hazard ratio, 3.11; 95% confidence interval [CI], 2.84 to 3.41); this corresponded in absolute terms to a 24% chance (95% CI, 22 to 26) of another paid claim within 2 years. Risks of recurrence also varied widely according to specialty--for example, the risk among neurosurgeons was four times as great as the risk among psychiatrists.ConclusionsOver a recent 10-year period, a small number of physicians with distinctive characteristics accounted for a disproportionately large number of paid malpractice claims.

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