Physicians with multiple paid medical malpractice claims: Are they outliers or just unlucky?

We extend Studdert et al. (NEJM, 2016). We examine to what extent a physician who has past paid medical malpractice ("med mal") claims in a defined prior period is more likely to have additional paid claims in a defined future period, relative to a physician with no prior-period claims. Our simulation implements a null hypothesis that paid claims are random events, with arrival risk depending on state, but not on physician-specific factors (such as technical ability, bedside manner, and communication skills). We show that even a single paid claim in the prior five years nearly quadruples the likelihood of a paid claim in the next five years, and dramatically increases the likelihood of 2+ future paid claims. More generally, the number of prior paid claims strongly predicts both the likelihood of having future paid claims and the expected number of future claims. By comparing actual to simulated probabilities, we can predict the likelihood that having a given number of paid claims is attributable to chance. We find that even for physicians in high-risk specialties in high-risk states, bad luck is highly unlikely to explain three or more claims in 5 years. Hospitals and state medical boards can use our approach to identify physicians that are likely to benefit from graduated interventions aimed at reducing future claims and patient harm. (C) 2019 Elsevier Inc. All rights reserved.