Burnout and Litigation Against Primary Care Providers: Where Do They Overlap?

Jacqueline Ross, RN, PhD, Coding Director, and Robert Morton, MAS, CPPS, CPHRM, ARM, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company, Part of TDC Group

Certain trends in primary care suggest potential avenues for investigation into malpractice allegations. These include a worsening shortage of primary care physicians, an association between burnout and patient safety concerns, and the rise in both the number of women physicians and the rate of burnout among women physicians. The purpose of this analysis is to understand the recent medical malpractice experience of primary care providers, specifically in family medicine, internal medicine, and gastroenterology, from two angles of approach: (1) To identify the underlying clinical characteristics of the claims, and (2) To focus on the provider factors of gender, age, and other possible indicators of clinician burnout.

Study Design

This study was a descriptive study using data from 730 closed medical malpractice claims, with family medicine, gastroenterology, or internal medicine as the primary responsible service, that closed between the loss years of 2015 and 2022. The variables of injury severity, care location where injury was sustained, major injury/body part, contributing factors, roles, primary drivers, provider age, and provider gender were included. The cases were coded using an evidence-based clinical coding taxonomy from CRICO¹. Findings were analyzed using the Explore tool developed by Candello². The Candello Burnout Algorithm³ was applied to assess claims that may indicate provider burnout.

Results

• Among case types, medical treatment and diagnosis related were the most common.
• Among common diagnostic failures (missed, delayed, or wrong), malignancies were the most common.
• It is notable that 37 percent of the claims had a patient assessment issue.
• More than a quarter of the studied cases, 28 percent, involved technical performance factors, including known complications from procedures.
• Also found in more than a quarter of the studied cases, again 28 percent, were communication issues with the patient and/or with the patient’s family.
• There was no statistical significance found in the different rates of overall burnout between the genders. Factors related to technical performance were statistically higher for males in this study.
• Electronic health contributors, like EHRs, patient portals, and/or electronic systems failures were found as possible contributors in almost 18 percent of the potential burnout claims.

Conclusion

Primary care clinicians manage a range of responsibilities—and are called upon to diagnose a wide array of conditions. With primary care clinicians especially hard hit by the U.S. healthcare burnout crisis, and shortages of primary care clinicians expected to intensify, it is essential to develop a better appreciation of what may lead to malpractice claims in primary care, as well as understanding of potential mitigating strategies. For instance, issues around health literacy can be involved if the patient does not understand instructions, so clear communication with the patient and family regarding realistic expectations, including educating them about the known complications of procedures, can assist in mitigating the risk of claims.

We hope these insights will assist clinicians and healthcare systems to improve understanding of where to place attention, training, and resources when seeking to improve patient outcomes and mitigate liability risks.

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