Does Med School Affect Malpractice?

Ed Rabinowitz

Physician's Money Digest, January31 2004, Volume 11, Issue 2

Medical malpractice is significantly impactingthe American health care system. Recordpayouts are being awarded in malpracticelawsuits, insurance premiums have becomeprohibitively expensive in many states, and some physicianshave been forced to relocate or close their doorscompletely. Clearly, with nearly 20 states in crisis modeon this issue, steps must be taken to help curb a verynegative trend in health care.

Quality and Safety in Health Care

Examining the RecordsThe results of a recent study published in the peer-reviewedjournal (qhc.bmjjournals.com) may offer some direction. The studyexamined the medical schools that physicians attended asa predictor of medical malpractice claims. Researchersfound a consistent difference in the malpractice claim historyof physicians who graduate from certain schools.Their findings suggest that altering medical educationcould help reduce the rate of malpractice claims.

This study is not the first to seek a way of identifyingand reducing trends in medical malpractice. Accordingto the study, previous research has revealed that physicianswho are board certified are actually not less likelyto be sued. In some cases, they are even more likely towind up in court. In addition, two specialty categoriesare most at risk for being sued: anesthesiology andobstetrics/gynecology.

According to the recent med school study, researchersbelieve that there are several characteristics of medicalschools that could impact a physician's susceptibility tomalpractice claims. The first and most obvious is thatsome schools, the article notes, provide a lower quality ofmedical education than others, leaving a predictable proportionof graduates less prepared for the practice ofmedicine. Conversely, some medical schools are moreeffective than others in teaching students to handle thedemands placed on them by their patients and families.

Researchers also note that the training in interpersonalskills may vary significantly between medical schools,supporting the belief that malpractice claims are stronglyrelated to the quality of communication between physiciansand patients. In addition, differences in the types ofstudents that a medical school attracts, as well as the institutionalculture of a particular school, are also factors.

For the study, researchers analyzed malpracticeclaims closed between January 1990 and August 1997from the databases of three states: Florida, Maryland,and Indiana. Part of the reason for the selection was thatall three states require that any malpractice claim,regardless of the settlement amount, must be reported tothe appropriate state regulatory body upon closure andbe made available to the public.

One study objective was to attempt to determine ifa physician's likelihood of experiencing a malpracticeclaim is positively or negatively related to havinggraduated from a medical school where previousgraduates had been either rarely or frequently sued. Inother words, if past graduates of a medical schoolwere rarely sued, what was the experience of morerecent graduates?

Researchers found that physicians who graduatedfrom medical schools whose prior graduates had rarelybeen sued were less likely to have a claim filed againstthem than physicians who attended mid-range schoolswhere past graduates experienced a greater frequency oflawsuits. On the other hand, physicians who graduatedfrom medical schools where past graduates had experienceda greater susceptibility to being sued were morelikely to have a claim filed against them.

Consistency Analysis

Over time, the schools themselves showed a lowprobability of change. For example, researchers foundthat during the years for which data were collected, medicalschools that were classified as having fewer incidentsof malpractice suits against graduates in 1990 remainedin that category in 1997. Similarly, medical schools thatwere classified as having greater incidents of malpracticesuits against graduates in 1990 also experienced greaterfrequency of suits in 1997.

Researchers believe these findings are important togain a better understanding of why certain physiciansare sued, therefore better addressing the growingproblem of medical malpractice. They also note thatthe cost of medical malpractice claims, combined withthe implications of potential findings for quality ofcare, make further investigations in this area criticallyimportant.