Identifying Malpractice‐Prone Physicians

• Author: John E. Rolph,John L. Adams,Kimberly A. McGuigan
• DOI: http://doi.org/10.1111/j.1740-1461.2007.00084.x
• Date: 01 March 2007
• Published date: 01 March 2007

Identifying Malpractice-Prone

Physicians

John E. Rolph, John L. Adams, and Kimberly A. McGuigan*

We analyze the claims database of a large malpractice insurer covering more

than 8,000 physicians and 9,300 claims. Applying empirical Bayes methods

in a regression setting, we construct a predictor of each physician’s under-

lying propensity to incur malpractice claims. Our explanatory factors are

physician demographics (age, sex, specialty, training) and physician prac-

tice pattern characteristics (practice setting, procedures performed, prac-

tice intensity, special risk factors, and characteristics of hospital(s) on staff

of). We divide physicians into medical and surgical/ancillary specialty cat-

egories and fit separate models to each. In the surgical/ancillary specialty

group, physician characteristics can effectively distinguish between more

and less claims-prone physicians. Physician characteristics have somewhat

less predictive power in the medical specialty group. As measured by pre-

dictive information, physician characteristics are superior to 10 years of

claims history. Insofar as medical malpractice claims can be thought of as

extreme indicators of poor-quality care, this finding suggests that easily

gathered physician characteristics can be helpful in designing targeted

quality of care improvement policies.

I. Introduction

A statistical approach to quality assurance is based on the premise that

understanding what factors are related to good and poor outcomes of medical

care will give policymakers direction in where and how to fix problems and

otherwise increase the quality of medical care. For example, an ongoing body

of work at RAND is aimed at measuring the quality of medical care and, of

specific relevance to this study, relating the characteristics of providers to the

quality of care (e.g., Keeler et al. 1992). Our earlier work used medical

*Address correspondence to John E. Rolph, Information and Operations Management Depart-

ment, USC Marshall School of Business, Bridge Hall 401, Los Angeles, CA 90089-0809; email:

JRolph@marshall.usc.edu. Adams is with the RAND Corparation. McGuigan is with Pfizer Inc.

Journal of Empirical Legal Studies

Volume 4, Issue 1, 125–153, March 2007

©2007, Copyright the Authors

Journal compilation ©2007, Cornell Law School and Blackwell Publisher, Inc.

125

malpractice information for quality improvement by focusing on the type of

errors in malpractice claims (Kravitz et al. 1991; Rolph et al. 1991). Here, our

primary focus is on the physician and how his or her characteristics correlate

to the propensity to be the target of malpractice claims.

A. Medical Malpractice as the Tip of the Quality Iceberg

Meritorious medical malpractice claims, as indicators of negligence occur-

ring, can be thought of as extreme indicators of poor-quality care, at least

from the point of view of the patient. Malpractice claims are most commonly

made against physicians and hospitals. Malpractice claims against a physician

provide a window into quality of care. Our analysis is aimed at understanding

what physician characteristics and what factors describing a physician’s prac-

tice pattern are predictive of meritorious malpractice claims against the

physician. Specifically, why do various types of negligent incidents occur,

who is most likely to be responsible for them, and how might such incidents

be deterred?

The continuing discussion about medical malpractice claims and, more

generally, the concern in the medical community about how the threat of

claims affects providers, brings into sharp focus how little we know about the

underlying anatomy and physiology of medical malpractice itself. Many of the

legislative remedies and much of the academic research fall into the area of

tort reform; they simply deal with the consequences of suits (Kritzer 2004;

Mello & Brennan 2002; Struve 2003; Bovbjerg 1989). Examples include

capping awards for pain and suffering and mandating a sliding scale of

contingency fees. These measures do not deal with the fundamental problem

of reducing the frequency and severity of negligent acts. In contrast to efforts

directed toward tort reform, the aim of this study is to develop an in-depth

understanding of why various types of negligent incidents occur, who is most

likely to be responsible for them, and how such incidents might be deterred.

All doctors who are negligent are not, of course, cut from the same

cloth. At one end of the spectrum are competent physicians who are rarely

negligent; at the other end are those who are frequently negligent because

they are very unskilled, careless, or greedy. In between probably lie a host of

other types, including the physician who undertakes procedures for which

he or she is inadequately trained and the doctor who delays in responding to

an urgent telephone call from the hospital. It is our belief that until we

understand more about the various factors responsible for negligent behav-

ior, it will be difficult to target specific strategies for modifying the behavior

of negligence-prone physicians.

126 Rolph et al.