I know a lot of physicians who like to think that getting sued is just a matter of bad luck. Or, that it's inevitable. A new study at the NEJM has some data to shine on that belief. "Prevalence and Characteristics of Physicians Prone to Malpractice Claims":
BACKGROUND: The distribution of malpractice claims among physicians is not well understood. If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them at an early stage could guide efforts to improve care.
METHODS: Using data from the National Practitioner Data Bank, we analyzed 66,426 claims paid against 54,099 physicians from 2005 through 2014. We calculated concentrations of claims among physicians. We used multivariable recurrent-event survival analysis to identify characteristics of physicians at high risk for recurrent claims and to quantify risk levels over time.
Although there are issues with the NPDB, it's still of the major sources of malpractice data, especially when you want to look at paid claims. In this case, researchers looked at more than 66,000 claims against more than 54,000 doctors from 2005 through 2014. Most importantly, they looked at the concentrations of claims among physicians.
What they found is this: Most docs who were sued (84%) were only sued once. But they account for only 68% of paid claims. About a third of claims are accounted for by just 1% of doctors.
Docs who get sued more are more likely to get sued again. Even after adjusting for other factors, physicians were more likely to get sued again as the number of paid claims increased. Compared to physicians with only one paid claim, physicians with three paid claims had a 24% chance of winding up with another paid claim in the next two years. That's an absolute risk increase, not just a relative risk increase (which was more than three times).
A small number of doctors account for a rather large number of paid malpractice claims. You might think there might be something different about them. We should probably focus on fixing that, instead of focusing only on reforming"the system".
P.S. This is even more reason to believe that malpractice reform won't reduce health care spending. Defensive medicine is based on the idea that all physicians are spending more in order to avoid being sued. It assumes that reducing lawsuits would reduce the need for that spending. But if being sued is related to certain physician characteristics, not to whether they practiced "defensive medicine" then the theory of tort reform starts to fall apart.