Physicians are perpetually rushed. They have to see patients, learn how to use electronic medical records systems, and figure out the political vagaries of their own healthcare establishments. And that's all before lunch.
In the back of their minds or, in the worst case, the forefront, there's another nagging day-to-day concern: malpractice. Physicians spend a lot of time dealing with malpractice cases. And I mean a lot.
A Health Affairs report this month offers a startling stat: Doctors spend on average, nearly 11% of their time over a typical 40-year career with an "unresolved, open malpractice claim."
"You hear horror stories about the court system and how long it might take to resolve cases," the lead study author, Seth Seabury, a senior economist at RAND Corp told me. "One of the things that surprised us was, over the course of an entire career, how much [of a doctor's time] was spent on unresolved claims. Having a claim outstanding and unresolved, that hangs over someone's head."
Specifically, the RAND researchers analyzed data from 40,916 physicians covered by a nationwide insurer. They found that, over a presumed 40-year career, the average doc spends more than 4 years, or about 50 months of his or her time, with an unresolved malpractice claim.
Seabury, who is also associate director of the RAND center for health and safety in the workplace, and his colleagues analyzed the time physicians spent with open claims, and its impact on specialties, the severity of injuries, and whether malpractice was eventually found. The claims analyzed were from between 1995 and 2005.
Adding to the malpractice delays was the fact that a claim wasn't usually filed until 28 months after the incident in question. And the case wasn't resolved until 43 months after the incidents, often leaving a nagging shadow of the case over doctors and patients alike.
"Claims involving high-risk specialties can take an extremely long time to resolve, and some don't even result in actual compensation for the patient," Seabury says.
The report shows that pediatrics and obstetrics cases took the longest to resolve. Birth-related neurological damage cases often take a lengthy period of time to finalize. Neurosurgeons generally spend the most time with open malpractice claims, 27% of a 40-year career, the report shows. Yet, more than 102 months—or 21.13% of careers—were spent with an open claim in which no payment was made.
For physicians generally, claims that did not result in payments amounted to 7% of a four-decade career.
While RAND focused much on the four-decade career, there was some good news. The claims were resolved more quickly for younger physicians, but it was still a time-consuming process. The time to resolve a case was an average 16 months for doctors 30 to 39 years old, compared to more than 20 months for physicians 40 to 49; and 21 months for physicians 50 or older.
Probably to no one's surprise, the report found that malpractice claims involving death or permanent disability took the longest to resolve, about 18 months.
For claims with only emotional injuries, 51% took six months or more to resolve, 35% lasted at least one year, and 7% weren't resolved for at least three years. Meanwhile, for cases involving a temporary physical injury, 49% took at least one year to resolve, and 10% lasted three years or more.
The time of adjudication may be more distressing for doctors than even the potential damages. "Lengthier time to resolution affects physicians through added stress, work, and reputation damage as well as loss of time dealing with the claim instead of practicing medicine," Seabury and other co-authors write.
But there's more to it: if medical errors were truly involved, and yet it takes so long to resolve these cases, physicians may not really learn from any possible errors. They would delay implementing safety and quality measures to prevent similar adverse events, Seabury says. As for the financial issues, "the time it takes may be more stressful than the actual finances," Seabury adds.
There has been widespread recognition among political leaders that malpractice reform needs to be addressed, with a range of calls for tort reform, such as restricting punitive damage awards.
Seabury says the RAND study shows that the effort to address meritless, time-consuming claims needs to be among the top priorities. "There is a movement that recognizes inefficiencies in the system, that it does take a long time to address and imposes more costs on the healthcare system," he adds. Physicians aren't the only ones who suffer in delayed cases. As the researchers note in the report, patients and their families "faced with a lengthy malpractice process also suffer."
Suggestions for reducing malpractice litigation include proposals for special malpractice courts and a push for physicians to make apologies to derail litigation in the first place, if they are possibly liable, Seabury says.
"If the psychic costs of fear and uncertainty are a sizeable portion of the costs of malpractice to physicians, then the portion of physicians' time spent with an outstanding claim helps explain physicians' negative attitude toward the system, beyond the financial costs," the researchers write.
"The psychic burden that physicians in these circumstances bear also suggests that making the system resolve cases faster without sacrificing compensation to patients injured by the negligent care could have important benefits to physicians and patients."
While neurosurgeons spend the most time with open malpractice cases, those involving psychiatrists are over the quickest. Psychiatrists spend the least amount of time with open malpractice claims—a total of nearly 16 months or just over 3% of their careers. No explanation was offered.
Maybe politicians should spend more time on the couch to figure out the malpractice mess, and how they feel about it.