Medical Malpractice and Physician Discipline: The Good, The Bad and The Ugly

Abstract

We study the overlap between the medical malpractice (med mal) and medical disciplinary systems using the records of almost 90,000 Illinois physicians who held an active license at any point from 1990–2016. We quantify the specialty‐specific risk of having a paid med mal claim or a disciplinary action; how many physicians have both; and the extent to which physicians with two or more paid claims or two or more disciplinary actions account for a disproportionate share of the activity of both systems. We also examine which factors are associated with paid claims and disciplinary actions, and whether physicians with multiple paid claims or disciplinary actions are concentrated at particular hospitals. Physicians with two or more paid claims account for only 2.37 percent of all licensed physicians, but they account for 53 percent of paid claims and payouts. Physicians with two or more disciplinary actions account for only 0.47 percent of physicians but 28 percent of all disciplinary actions. The risk of paid claims and disciplinary actions varies greatly by specialty. Physicians who attended non‐U.S. medical schools are more likely to have paid claims but (except for high‐disciplinary‐risk specialties) are not more likely to be subject to disciplinary action. Physicians with prior paid claims are more likely to be the target of disciplinary action—but not vice versa. A small number of Illinois hospitals are staffed by physicians with unusually high numbers of paid med mal claims, disciplinary actions, or both.

Physician Licensing and Discipline: Lessons From Indiana

“…Does it matter whether a physician attended medical school in the U.S. or elsewhere? Consistent with Hyman et al (2021) we find that physicians who attended non‐U.S. medical schools have the same overall disciplinary risk as physicians who attended U.S. medical schools (Appendix Table A5).…”

“…Paid claims (particularly those with large payouts (≥$100k, 2015$)) have a greater impact than unpaid claims on disciplinary risk. The risk of future paid claim increases with more severe disciplinary sanctions (Liu & Hyman 2019; Hyman et al 2021).…”

Should patients use online reviews to pick their doctors and hospitals?

“…In mid-2017, we collected the online reviews (both star ratings and textual reviews) for our 221 Questionable physicians and their matched controls from 5 For Indiana details, see Liu and Hyman (2019). For Illinois details, see Hyman et al (2021). Of note, IDFPR publicly reports medical malpractice payments only for the preceding 10 years (although our dataset is not so limited), while Indiana publicly reports medical malpractice payments since the inception of their patient compensation fund (1977).…”

“…18 Similarly, the mean number of years of practice of an Indiana Questionable physician in 2017 was 47 years, versus 31 years for all Indiana physicians. In fairness, physicians with more years of practice are generally older-and older physicians are more likely to have paid medical malpractice claims and disciplinary sanctions (Hyman et al, 2021;Liu & Hyman, 2019;Guardado, 2017). However, in both states, there are many physicians with identical practice duration in the same specialty who have clean records, so it is not just practice duration that explains why a physician is classified as Questionable.…”

“…What about hospitals? We compared the online ratings of 171 Illinois hospitals by a branch of the federal government (Hospital Compare) and by 2 private rating services (Healthgrades and Leapfrog) with a hospital ranking system based on the share of all hospital‐affiliated physicians with paid medical malpractice claims and disciplinary actions from Hyman et al (2021). Hospital Compare rates hospitals using a one‐ to five‐star rating system, and Leapfrog gives hospitals letter grades (A–F)—both based on various clinical performance measures.…”