Published 1/1/2008
Charles D. Hummer III, MD

Survey reveals extent, impact of medical liability problem

Orthopaedists paid premiums averaging $42,200 in 2006

In 2007, the AAOS Medical Liability Committee, along with the AAOS department of research and scientific affairs, surveyed a sample of the AAOS fellowship regarding a broad range of issues related to medical liability. We hoped to compare the results of this survey with those of previous surveys on this topic (conducted in 2002 and 2004), as well as to compare the medical liability situation for orthopaedic surgeons in various states.

Survey results indicate that most orthopaedists in the United States use physician-owned or private, commercial insurance carriers, with claims-made (as opposed to occurrence) coverage. Approximately half of respondents noted that their policies include discounts for attendance at risk-management courses, and approximately one in four receive discounts inversely proportional to their claims history.

Most respondents had coverage levels of $1 million per claim/$3million aggregate per year. In most cases, orthopaedists were mandated, usually by a hospital or institution, to carry a minimum level of coverage.

Costs continue to increase
The average cost of professional liability insurance continues to increase, having risen to $42,200 overall in 2006, with a median cost of $38,000 (
Fig. 1). Cost for insurance was found to vary statistically based on the number of claims filed against a particular orthopaedist, by the degree of specialization of the orthopaedist, and the level of crisis of the state in which the orthopaedist practices.

Overall, 46 percent of respondents reported an increase in professional liability insurance cost compared with the previous year. Orthopaedists practicing in “crisis” states were more likely to report an increase in cost than those practicing in “stable” states.

More than half of respondents indicated that they participated in “the medical liability system” in some way during 2005, either as independent medical examiners (54 percent) or as expert witnesses (16 percent).

Those who served as independent medical examiners conducted a median of 50 examinations annually.

The impact on day-to-day practice
Most of the surveyed orthopaedic surgeons (88 percent) believe that their day-to-day practice of medicine is affected to some degree by medical liability issues. Similarly, nearly 9 out of 10 (87 percent) believe that patient care is affected to some degree by professional liability concerns. Those practicing in “crisis” states were more likely to report impact from medical liability concerns than those practicing in “stable” states.

Furthermore, approximately half of respondents rated the statement “I view every patient as a potential lawsuit” a 4 or 5 (agree or strongly agree) on a 5-point response scale (Fig. 2). Orthopaedists in “crisis” states (versus those in “stable” or “verging-on-crisis” states) had a higher level of agreement with this statement.

Although medical liability issues are certainly not the only ones that influence satisfaction with the practice of medicine, the 2006 survey found that more than a third (36 percent) of respondents disagreed with the statement “I am satisfied with the practice of medicine.” One quarter (26 percent) of respondents was neutral, and nearly 4 in 10 reported some degree of satisfaction.

Future plans
The 2006 medical liability survey indicates that most AAOS fellows believe that issues related to medical liability are important in their daily practice and in the care of their patients. For this reason, the Medical Liability Committee plans to conduct regular surveys of the fellowship on professional liability issues. Future surveys will be shorter, with an easy electronic-response mechanism to encourage an optimum response for state-by-state comparisons.

Charles D. (Chip) Hummer III, MD, is a member of the AAOS Medical Liability Committee. He can be reached at scope7@verizon.net

Survey method
The Professional Liability Insurance Questionnaire was distributed via fax and mail in October 2006 to a random stratified and cluster sample of 5,823 members. An Internet-based version of the survey was also made available. Several fax and e-mail reminders were sent, and state orthopaedic societies were asked to follow up individually with nonresponding members to encourage participation. A total of 1,074 completed questionnaires were received by June 2007, for an overall response rate of 18 percent.

Although a sample of this size allows generalization to the overall AAOS membership, it does not allow comparison of responses by state. To compare responses across states in varying levels of medical liability crisis, data were examined according to state level of crisis as determined in 2005 by Doctors for Medical Liability Reform: crisis states, verging-on-crisis states, states with serious problems, and stable states.