A neurosurgeon has higher malpractice premiums than an internal medicine physician, but do they really take on more risk?
The Happy Hospitalist says no.
That’s a counter-intuitive take, as surgeons and proceduralists are perceived to take on more risk, and thus, pay higher malpractice rates.
“I don’t think any physician, who is trained in their scope of practice, takes on anymore risk than any other physician, regardless of what field of medicine they practice in,” writes Happy.”Higher rates of bad outcomes does not mean that more bad medicine or more negligence is occurring. Or that there is more risk involved.”
He goes on to compare the cases a neurosurgeon must take, such as a craniotomy in an emergency setting, with a complicated intensive care patient that a hospitalist often manages.
“Who carries the greater risk? Is a neurosurgeon, practicing within their scope doing anything more risky than an internist practicing within theirs?”
The answer isn’t as clear as you think, as doctors practicing what they’re trained to do shouldn’t be inherently risky. So, whether you’re a neurosurgeon or internist, all doctors theoretically are exposed to the same degree of risk.
Similar Posts:
- Doctor makes more money on eBay than practicing medicine
- Are emergency physicians best served to staff urgent care centers?
- Should general internal medicine merge with family practice?
{ 10 comments }
Parlor games.
The actuaries have cast their votes and think differently. Please provide a reason to think they are wrong.
There are different types of risk to consider, however – some of which are based on systems and others on the individual, and others based upon a doctor’s circumstances of practice.
A physician who takes call and is evaluating high acuity patients in the middle of the night, a doctor who performs invasive procedures on populations at high risks for HIV or HCV, a psychiatrist who works in a prison…there are lots of different ways to think about risk…
I agree with you. Risk should theoretically be similar, within one’s scope of practice. I imagine that liability premiums differ based on the risk that is generated by public perception and the likelihood of litigation. What we really need is a medical jury system.
but risk of an event is a combination of
1) the likelihood of occurrence
2) the cost if the event does occur
So, while the likelihood of a negative event might be the same for different specialties, it would be my guess that the costs probably differ by a statistically significant amount. Those costs would primarily be the jury-awarded dollar values in a malpractice suit.
For med mal, the risk is not that the doctor will actually be negligent (even though it should be).
The risk is that there will be a bad outcome that will generate a lawsuit.
That risk is substantially higher for a neurosurgeon than for an internist. This is why there is a discrepancy in premiums.
Malpractice insurance has nothing to do with likelihood of making a mistake based on the profession of the individual. It has everything to do with the likelihood of any given person of that profession practicing in that area to be sued, and how much of a payout that would involve. As a family doc, most of the mistakes I make will not have lethal consequences. If I miss something, more likely than not the patient will turn up again in a few days (though of course missing something like an MI would be much more immediately catastrophic). If a neurosurgeon makes a mistake, the consequences are much more likely to be quite bad given the severity of the illness he or she treats. In addition, I am not nearly as likely to get sued in the first place, because again the acuity of what I deal with is vastly different from the acuity dealt with by a neurosurgeon. More sick patients guarantees more bad outcomes, whether or not errors are made.
evan. My point exactly.
A bad outcome should not equal a lawsuit. But it does in America. And the whole thing feeds on itself in an irrational manner.
If bad outcomes where measure by death, then geriatricians who only treat 100+ year olds should have the highest malpractice premiums of all.
Of course we know that’s not true.
The American culture has grown into the perfect-result model of healthcare. This is inherently flawed because as humans, disease that is unpreventable and/or untreatable WILL occur, despite our best attempts and good-willed efforts to abate tragedy. Bad things do happen and negligence is not a necessary component of that; mother nature is.
No mention whatsoever of the risk involved to the patient. How surprising. It would seem the only risk posed by malpractice is the risk of a doctor being sued.
Most excellent tax-blogger Joe Kristan braved a fiery inferno to bring us this week’s Cavalcade of Risk, and your post is in it:
http://www.rothcpa.com/archives/004752.php#004752
Please let your readers know.
Thanks!
Hank Stern
Comments on this entry are closed.