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Surgeons Face Higher Risks for Malpractice Compared to Their Non-Surgical Colleagues

21 Pages Posted: 7 Apr 2023

See all articles by Wouter J. Dronkers

Wouter J. Dronkers

Erasmus University Medical Center Rotterdam - Department of Neurosurgery

Jan M. van Rees

Erasmus University Medical Center Rotterdam - Department of General Surgery

Désirée Klemann

Maastricht University - Department of Gynecology

Dennis R. Buis

Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections; University of Amsterdam - Department of Neurosurgery

Quirine JMA Amelink

Erasmus University Rotterdam (EUR) - Erasmus School of Health Policy & Management

Dirk J. Grünhagen

Erasmus University Medical Center Rotterdam - Department of General Surgery

Mostafa Mokhles

Utrecht University - Department of Cardiothoracic Surgery

W. Peter Vandertop

University of Amsterdam - University Medical Center; Maastricht University - Department of Gynecology

Marike LB Broekman

Leiden University - Department of Neurosurgery

Hendriks Aart

Leiden University - Leiden Law School

Eric Boersma

Erasmus University Medical Center Rotterdam - Department of Cardiology

Clemens M.F. Dirven

University of Amsterdam - Department of Neurosurgery

Markus Klimek

Erasmus University Rotterdam (EUR)

Jochem KH Spoor

University of Amsterdam - Department of Neurosurgery

More...

Abstract

Background: Malpractice claims can negatively influence the careers of physicians, contributing to the increased physician drop-out rates. It is assumed that surgeons face higher risks for a claim although this is not yet objectively determined. The objective of the present study was to determine the risk for malpractice claims for physicians from surgical specialties, specialties with surgical characteristics and non-surgical specialties.

Methods: A retrospective observational study using anonymized closed malpractice claims between 2007 up to 2021 from Dutch insurers (Centramed and MediRisk) that currently insure >85% of Dutch hospitals was carried out with an emphasis on surgical specialties. Main outcomes involved claim volume & outcome, and the estimated annual risk (EAR) for a claim per year for the individual physician from a particular specialty. Sustained or settled claims were considered unfavorable for the physician (UOP).

Results: Surgical specialties and specialties with surgical characteristics accounted for 77% (14,330/18,649) of the claims closed. Liability was denied in 51% of the claims (n=9,487). The remaining claims were sustained (n=4,600; 25%), settled (n=3,444; 18%) or closed without decision (n=1118; 6%). Surgeons faced an average EAR of 21.6% (range 6.5% - 28%) which was higher compared to colleagues from specialties with surgical characteristics (EAR 7.3%; range 2.9% - 10.1%) and non-surgical specialties (EAR 2.5%; range 0.9% - 4.4%). The average risk for an UOP was 9.3% per year for surgeons. Orthopedic- (EAR 28.3%; UOP 10.9%), General- (EAR 22.6%; 10.6%), and Plastic Surgeons (EAR 16.6%; UOP 5.7%) were most at risk for a claim, annually.

Conclusions: The present study is the first study to compare the risk for a malpractice claim for all major medical specialties over a fifteen-year period on a nationwide scale. Surgeons received more claims than their non-surgical colleagues. Relative to specialty size, surgeons faced a higher risk for a claim in general, as well as for a claim with an unfavorable outcome.

Funding: No external funding was received for this research.

Declaration of Interest: Clemens Dirven and Peter Vandertop gave independent medical advice in some of the claims that were included in the present study. Quirine Amelink contributed to the present study in a personal capacity, not in relationship with her current affiliation through the Dutch Health and Youth Care Inspectorate. Wouter Dronkers, Jan van Rees, Désirée Klemann, Dennis Buis, Dirk Grünhagen, Marike Broekman, Aart Hendriks, Eric Boersma, Markus Klimek, and Jochem Spoor have no disclosures.

Ethical Approval: The present study was approved by the Institutional Review Board of the Erasmus University Medical Centre, Rotterdam, (METC 2020-0972) and was performed in accordance with the Declaration of Helsinki.

Keywords: claim, error, health law, malpractice, medical litigation, negligence, second victim, surgery

Suggested Citation

Dronkers, Wouter J. and van Rees, Jan M. and Klemann, Désirée and Buis, Dennis R. and Amelink, Quirine JMA and Grünhagen, Dirk J. and Mokhles, Mostafa and Vandertop, W. Peter and Broekman, Marike LB and Aart, Hendriks and Boersma, Eric and Dirven, Clemens M.F. and Klimek, Markus and Spoor, Jochem KH, Surgeons Face Higher Risks for Malpractice Compared to Their Non-Surgical Colleagues. Available at SSRN: https://ssrn.com/abstract=4411411 or http://dx.doi.org/10.2139/ssrn.4411411

Wouter J. Dronkers

Erasmus University Medical Center Rotterdam - Department of Neurosurgery ( email )

Jan M. Van Rees

Erasmus University Medical Center Rotterdam - Department of General Surgery ( email )

Désirée Klemann

Maastricht University - Department of Gynecology ( email )

Dennis R. Buis

Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections ( email )

Netherlands

University of Amsterdam - Department of Neurosurgery ( email )

Quirine JMA Amelink

Erasmus University Rotterdam (EUR) - Erasmus School of Health Policy & Management ( email )

Dirk J. Grünhagen

Erasmus University Medical Center Rotterdam - Department of General Surgery ( email )

Mostafa Mokhles

Utrecht University - Department of Cardiothoracic Surgery ( email )

W. Peter Vandertop

University of Amsterdam - University Medical Center ( email )

Maastricht University - Department of Gynecology ( email )

Marike LB Broekman

Leiden University - Department of Neurosurgery ( email )

Hendriks Aart

Leiden University - Leiden Law School

Eric Boersma

Erasmus University Medical Center Rotterdam - Department of Cardiology ( email )

Clemens M.F. Dirven

University of Amsterdam - Department of Neurosurgery ( email )

Markus Klimek

Erasmus University Rotterdam (EUR) ( email )

Jochem KH Spoor (Contact Author)

University of Amsterdam - Department of Neurosurgery ( email )