Abstract
BackgroundConcern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons’ perceptions of malpractice liability and defensive medicine practices.MethodsA validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices.ResultsA total of 1028 surveys were completed (31% response rate) by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a “major or extreme” burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns.ConclusionsConcerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.
Highlights
Over the past three decades, medical malpractice premiums have risen disproportionately compared to physician incomes
Physicians practice defensive medicine due to concern for liability risk, which contributes to an increase in healthcare expenditures
This paper is the first national survey aimed at investigating the impact of liability risk perception on access to healthcare
Summary
Over the past three decades, medical malpractice premiums have risen disproportionately compared to physician incomes. Malpractice crises have affected many parts of the country over the past several decades, influencing the locations in which physicians practice, the types of procedures offered, and access to healthcare. Physicians practice defensive medicine due to concern for liability risk, which contributes to an increase in healthcare expenditures. As these are politically sensitive topics, recent efforts to reform the healthcare system have largely ignored medical malpractice and tort reform. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. We present the first national survey of American neurosurgeons’ perceptions of malpractice liability and defensive medicine practices
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