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Release: March 16, 1999

Most knowledgeable family physicians may be sued the most, UI study indicates

IOWA CITY, Iowa -- Physicians who are sued more than once or twice for malpractice are generally assumed to be less competent than those who have never been sued. But a University of Iowa College of Medicine study shows just the opposite may be true for family physicians ­ the most knowledgeable of them may be sued the most. They are also more likely to have suits settled in their favor.

The study, which focused on Florida family physicians, revealed that the frequency of malpractice claims increased with evidence of greater medical knowledge. The findings also showed that among board-certified family physicians, sued practitioners who did not pay a plaintiff had higher board scores than practitioners who were never sued or were sued and paid damages.

Lead investigator John W. Ely, M.D, UI associate professor of family medicine, said, "Florida tracks physician malpractice claims and provides these data to the public as consumer health information. But using only malpractice data to avoid poorly skilled physicians may be the wrong thing to do."

Since 1974 the Florida Department of Insurance has maintained a database of closed medical malpractice claims made against all types of physicians. Using this and other data, the team assessed the malpractice rates of family physicians who practiced in Florida for one or more years between 1971 and 1994. The researchers found that graduation from medical school in the United States or Canada, family practice board certification, male gender and the American Medical Association Physician's Recognition Award were among the characteristics associated with an increased frequency of claims. There was also a trend showing residency-trained family physicians are sued more often.

Ely said the findings do not indicate a cause-and-effect relationship between knowledge and malpractice. "Other factors may be at work," Ely said. "For one, a study of medical students found the most knowledgeable of them had the lowest empathy scores. Other studies have shown that the less empathetic a physician seems, the greater the chance a patient who is unhappy with an outcome may take legal action."

Another possible explanation, Ely said, is that doctors with the best qualifications may take care of the highest risk patients, which includes those who are the sickest or most litigious. For example, board-certified family physicians, whose certification may rate them as more knowledgeable than their non-board-certified counterparts, are more likely to work in hospitals where they treat the most critically ill patients.

While malpractice claims and payment rates in Florida are similar to rates nationwide, the extent to which the investigators' findings apply to other states is not clear. "This study couldn't be done in most states, including Iowa," Ely said, "because they don't collect malpractice data."

In the mid-1970s malpractice claims skyrocketed in Florida, and physicians had difficulty getting malpractice insurance. The crisis prompted the state to pass a law in 1974 that mandated tracking of claims to determine whether some physicians accounted for a disproportionate number of suits. The law requires insurance agencies to report all malpractice claims made against doctors, regardless of outcome. The state-managed database now includes records of more than 52,000 lawsuits against physicians.

Ely said the National Practitioner Data Bank, established in 1990, collects malpractice data on physicians nationwide but this federally collected information is not available to researchers. Only hospital administrators, for example, may access the database when a physician applies for privileges at a hospital.

The UI research team included investigators from the Iowa City Veterans Affairs Medical Center, American Board of Family Practice in Lexington, Ky., and Oregon Health Sciences University in Portland. The study was supported by a grant from the American Academy of Family Physicians Foundation.