Physicians Work Less When Medical Liability Risk Increases, Study Says

A new study says doctors work less when their risk of malpractice litigation is higher.

On average, doctors end up working 1.7 hours less per week when their expected medical liability risk increases by just 10%, according to a new study published in the latest issue of the Journal of Law and Economics.

"The effect of malpractice risk on hours worked might seem like a small item compared to physicians moving across state borders or avoiding high-risk specialties like obstetrics," said economist Mark Showalter of Brigham Young University, one of the researchers. "However, when you aggregate that across all physicians the total effect is quite large."

Physicians wrestling with malpractice issues have been a longstanding concern. This month, surgeon and writer Autul Gawande wrote in a blog "the fear of massive settlement fees has forced doctors to take a number of generally excessive precautions." Other studies in recent years also have pinpointed physician concerns about malpractice lawsuits and their reactions to them.

In 2002, a report in the Harris Interactive called "Fear of Litigation: The Impact on Medicine " noted, "concerns about liability are influencing medical-decision-making on many levels."

In the Journal of Law and Economics study, researchers Eric Helland of Claremont McKenna College and Showalter found fear of malpractice suits has an impact on physicians' work schedules.

When something changed the risk of medical liability—such as an adjustment in the maximum amount a jury could award in malpractice cases —doctors adjusted their workload, according to the study. When liability risk increased, physicians saw fewer patients each week to minimize their chance of a lawsuit. When liability risk went down, doctors saw more patients each week.

The economists calculated that physicians working 1.7 hours less per week is the equivalent to "one in 35 physicians leaving a workforce entirely, or about 21,000 physicians."

The study also said that doctor's aged 55 and older and those with their own practices are more influenced by liability risk.

The economists examined data gathered from insurers about medical liability risks in each state, broken out by medical specialty, as well as survey data from doctors about their workload and income.

Existing malpractice caps are also an issue of concern, the study states. Some states are considering legal challenges to existing malpractice caps.