Studdert DM, et al. - Doctors with poor malpractice liability records could be a risk to the safety of patients and the fact that such doctors often relocate for a fresh start is cause for concern, so researchers assessed if, how, and where they continue to practice. Investigators found that doctors with numerous claims of malpractice against them were no more likely to relocate vs those without claims but were more likely to discontinue practicing medicine or change to smaller practices.

Methods

• The authors linked an excerpt from the National Practitioner Data Bank to the Medicare Data on Provider Practice and Specialty data set to generate a national cohort of doctors between the ages of 35 and 65 who practiced between 2008 and 2015.
• Associations between the number of paid malpractice claims that doctors accrued and exits from medical practice, changes in clinical volume, geographic relocation, and change in practice-group size were analyzed.

Results

• The cohort consisted of 480,894 physicians who from 2003 to 2015 had 68,956 claims paid.
• A total of 89.0% of doctors had zero claims, 8.8% had one claim, and the rest (2.3%) had 2 claims or more, representing 38.9% of all claims.
• The number of claims has been positively linked to the odds of discontinuing the practice of medicine (odds ratio for 1 claim vs. no claims, 1.09; 95% confidence interval [CI], 1.06 to 1.11; odds ratio for ≥5 claims, 1.45; 95% CI, 1.20 to 1.74).
• The number of claims was not correlated with geographic relocation; it was positively related to changes into smaller practices.
• Doctors with five or more claims had more than twice the odds of moving into solo practice vs doctors without claims (odds ratio, 2.39; 95% CI, 1.79 to 3.20).