CONTACT: BECKY SOGLIN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-6660; fax (319) 335-9917
Release: March 16, 1999
Most knowledgeable family physicians may be sued the most, UI study
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
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
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
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.