The Doctor’s Advocate | Second Quarter 2019

An Analysis of Malpractice Claims by Physician Gender

David B. Troxel, MD, Medical Consultant to The Doctors Company

Introduction

One of many important trends in healthcare is the increasing delivery of care by female physicians.

In 2000, 23 percent of physicians were women. In 2015, women comprised 36 percent of the physician population. For the year 2013–2014, 47 percent of medical school matriculants were female.1 In December 2018, the Association of American Medical Colleges announced that more women than men had applied to U.S. medical schools and that in 2018—for the second year in a row—women were also the majority of new enrollees to medical schools.2

The American Medical Association’s 2016 Physician Practice Benchmark Survey found that, on average, women physicians experience approximately half as many allegations of medical malpractice over the course of their careers as men.3 This review of gender-specific medical malpractice claims was undertaken to document the claims experience of the nation’s largest physician-owned medical malpractice insurance company.

Definitions

Allocated loss adjustment expense (ALAE): Expense directly attributable to specific claims, e.g., payments for defense attorneys, expert medical reviews, investigation.

Claim severity: The cost of an average claim, i.e., for a given group of doctors, the total loss cost (indemnity) and ALAE for closed claims divided by the total number of closed claims.

Full-time equivalent (FTE)–based claim frequency: For a given group of doctors, the sum of claims divided by the total number of FTE doctors.

Loss ratio: For a given group of doctors, the total developed (estimated) loss cost (indemnity) and ALAE divided by earned premium.

Study Design

Our analysis of claims begins by reviewing the patient’s (plaintiff’s) allegations against the insured physician(s), giving us insights into the perspectives for filing the claim. Physician experts for both the plaintiff and the insured physician review the medical records to determine whether the standard of care was met and whether the alleged adverse event caused the patient injury. The factors that contributed to the patient’s injury are then identified.

This gender-specific analysis of 5,897 claims that closed between 2007 and 2016 focuses on actuarial data and claim allegations from six medical specialties. The data includes the full-time equivalent doctor count (converting the hours worked by several part-time doctors into the hours worked by a full-time doctor), the percentage of doctors in each specialty working part time, and claim frequency, severity, and ultimate loss ratio. The allegations studied are related to diagnosis, medical treatment, medications, and communication.

Four of the six specialties were chosen because they have higher percentages of female physicians than the average for all specialties.4 These specialties are pediatrics (62 percent female), obstetrics/gynecology (ob/gyn) (54 percent female), family medicine (38 percent female), and internal medicine (37 percent female). Although hospital medicine is a relatively new specialty and no data on female percentages was provided, it was selected because hospitalists are internists (37 percent female) who specialize in hospital medicine. Although general surgery has a lower percentage of female physicians than the average for all specialties (19 percent), it was selected to represent a surgical specialty.

Study Findings

Internal Medicine

Male internists’ 10-year FTE-based claim frequency was 56.1 percent higher, claim severity was 19.7 percent higher, and the loss ratio was 71.3 percent higher than female internists’.

Female internists worked part time more frequently than male internists. A 10-year average (2007–2016) of physicians working part time revealed that 22 percent of female and 13 percent of male internists worked part time.

We reviewed 1,059 closed claims containing gender identification. Diagnosis-related allegations were the most common, involving 40 percent of female and 43 percent of male physician claims. Medical treatment–related allegations involved 31 percent of female and 26 percent of male physician claims. Medication-related allegations involved 23 percent of female and 22 percent of male physician claims. There were few communication-related claims, involving just 3.0 percent of female and 0.3 percent of male physician claims.

Hospital Medicine

Male hospitalists’ 10-year FTE-based claim frequency was 10.5 percent higher, claim severity was 6.4 percent higher, and the loss ratio was 3.9 percent higher than female hospitalists’.

Female hospitalists worked part time more frequently than male hospitalists. A 10-year average (2007–2016) of physicians working part time revealed that 12 percent of female and 9 percent of male hospitalists worked part time.

We reviewed 360 closed claims containing gender identification. Diagnosis-related allegations were the most common, involving 59 percent of female and 43 percent of male physician claims. Medical treatment–related allegations involved 26 percent of female and 36 percent of male physician claims. Medication-related allegations involved 11 percent of female and 14 percent of male physician claims. There were few communication-related claims, involving just 0.8 percent of male and no female physician claims.

Family Medicine

Male family practitioners’ 10-year FTE-based claim frequency was 34.5 percent higher, claim severity was 5.2 percent higher, and the loss ratio was 37.2 percent higher than female family practitioners’.

Female family practitioners worked part time more frequently than male family practitioners. A 10-year average (2007–2016) of physicians working part time revealed that 23 percent of female and 19 percent of male family practitioners worked part time.

We reviewed 1,385 closed claims containing gender identification. Diagnosis-related allegations were the most common, involving 52 percent of female and 51 percent of male physician claims. Medical treatment–related allegations involved 19 percent of female and 22 percent of male physician claims. Medication-related allegations involved 15 percent of female and 17 percent of male physician claims. There were few communication-related claims, involving just 2 percent of both male and female physician claims.

Obstetrics/Gynecology

Male ob/gyns experienced a 17.9 percent higher 10-year FTE-based claim frequency, 5 percent higher claim severity, and 21.9 percent higher loss ratio than female ob/gyns

Gender-specific part-time data is not available because surgical specialties do not qualify for part-time coverage. 

We reviewed 1,070 closed claims containing gender identification. Ob/gyn-related medical treatment allegations were the most common, involving 80 percent of female and 79 percent of male physician claims. Diagnosis-related allegations involved 8 percent of female and 10 percent of male physician claims. Medication-related allegations involved only 0.7 percent of female and 0.5 percent of male physician claims. Few claims were communication related, involving just 0.7 percent of both male and female physician claims.

Pediatrics

Male pediatricians experienced a 78.6 percent higher 10-year FTE-based claim frequency (2.5 percent versus 1.4 percent), a 41.9 percent higher claim severity, and a 175.5 percent higher loss ratio than female pediatricians.

Female pediatricians worked part time more frequently than male pediatricians. A 10-year average (2007–2016) of physicians working part time revealed that 23 percent of female and 10 percent of male pediatricians worked part time.

We reviewed 196 closed claims containing gender identification. Diagnosis-related allegations were the most common, involving 62 percent of female and 63 percent of male physician claims. Medical treatment–related allegations involved 22 percent of female and 20 percent of male physician claims. Medication-related allegations involved 9 percent of female and 6 percent of male physician claims. There were few communication-related claims, involving just 4 percent of male and no female physician claims.

General Surgery

Male surgeons experienced a 24.3 percent higher 10-year FTE-based claim frequency and an 11.5 percent higher loss ratio than female surgeons. 

Female surgeons’ claim severity was 10.8 percent higher than male surgeons’—which may be a distortion resulting from a few high-severity claims divided by a small number of total claims incurred by the small number of female surgeons.

Gender-specific part-time data is not available because surgical specialties do not qualify for part-time coverage.

We reviewed 1,287 closed claims containing gender identification. Surgical treatment–related allegations were the most common, involving 73 percent of female and 70 percent of male physician claims. Diagnosis-related claim allegations involved 18 percent of female and 17 percent of male physician claims. Medication-related allegations involved 1 percent of female and 2 percent of male physician claims. There were few communication-related claims, involving just 1.4 percent of male and 0.6 percent of female physician claims.

See FIGURE 1 for a tabular presentation of the gender and specialty differences in claim frequency, claim severity, and loss ratio.

Discussion

Female physicians are sued less often than male physicians. Undoubtedly, multiple factors account for this difference, but those identified in this study suggest that a lower exposure to risk may be an important contributor.5 The factors include the following:

  1. In this study—with the exception of ob/gyns and general surgery (no part-time data is available for these surgical specialties)—female physicians in each specialty worked fewer hours than male physicians; i.e., a higher percentage of female physicians worked part time compared with male physicians. (See FIGURE 2.)
  2. Female physicians are younger than male physicians (per data from this study) and accordingly are closer to the early stages of their careers with fewer years of clinical practice. Therefore, their risk exposures are lower relative to those of male physicians. (See FIGURE 3.)
  3. Except for ob/gyn (a high-risk specialty), female physicians tend to enter lower-risk nonsurgical medical specialties.
  4. Physician gender differences in each specialty’s claim allegations—with the exception of hospital medicine—were minimal and may not be statistically significant. (See FIGURE 4.) However, note that there are no female physician communication-related claim allegations in hospital medicine and pediatrics. Female and male communication-related allegations were identical in family medicine and ob/gyn. Claim allegations related to communication were slightly lower for female physicians in general surgery. They were higher for female physicians only in internal medicine.
  5. To investigate communication-related allegations further, we analyzed the three gender-specific communication factors contributing to patient injury in each specialty’s claims. (See FIGURE 5.) While the gender-specific numbers for each specialty lack statistical significance (family medicine and general surgery are, however, notable), when we total the three communication factor categories for all specialties, 72 percent of “patient/family” factors, 75 percent of “between provider” factors, and 80 percent of “other” factors involved male physicians. When these three communication factor categories are combined, it is notable that 76 percent (52 of 68) involved male physicians.

Figure1 Tabular Presentation

Figure Two Part Time Work Compared Between Females and Males

Figure 3 Females Physicians are Younger

Figure 4 Female and Male Communication-Related Allegations

Figure 5 Further Communication-Related Allegations


References

  1. Women in medicine: a review of changing physician demographics, female physicians by specialty, state and related data [white paper]. Irving, TX: Staff Care, an AMN Healthcare Company; 2015. amnhealthcare.com/uploadedFiles/MainSite/Content/Staffing_Recruitment/Staffcare-WP-Women%20in%20Med.pdf.
  2. Women were majority of U.S. medical school applicants in 2018 [press release]. AAMCNews; December 4, 2018. https://news.aamc.org/press-releases/article/applicant-data-2018/.
  3. Guardado JR. Medical liability claim frequency among U.S. physicians. www.ama-assn.org/sites/default/files/media-browser/public/government/advocacy/policy-research-perspective-medical-liability-claim-frequency.pdf. American Medical Association Policy Research Perspectives. December 18, 2017.
  4. Active physicians by sex and specialty, 2015. Workforce Data and Analysis. Association of American Medical Colleges. www.aamc.org.
  5. Guardado JR. Medical liability claim frequency among U.S. physicians. www.ama-assn.org/sites/default/files/media-browser/public/government/advocacy/policy-research-perspective-medical-liability-claim-frequency.pdf. American Medical Association Policy Research Perspectives. December 18, 2017.

Special thanks for assistance from the Actuarial Department and Jacqueline Ross, PhD, RN, Analysis and Coding Manager, Department of Patient Safety and Risk Management, The Doctors Company.


The Doctor’s Advocate is published by The Doctors Company to advise and inform its members about loss prevention and insurance issues.

The guidelines suggested in this newsletter are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results.

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