Higher lawsuit risks tied to some medical schools

But the study of malpractice claims did not explore why rates differ.

By Myrle Croasdale, amednews staff. Nov. 17, 2003.

Teresa Waters, PhD, and her co-authors are carefully couching their research findings. They don't want to risk some U.S. medical schools being labeled as losers.

Dr. Waters, an economist at the University of Tennessee's Center for Health Services Research in Memphis, and two colleagues examined medical malpractice claim databases and found a connection between where a physician attended medical school and the likelihood of the physician being sued for malpractice.

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"Our analysis shows that physicians who graduate from high outlier or low outlier schools, their malpractice experience is influenced by that," Dr. Waters said.

Dr. Waters did not reveal which schools had the highest malpractice risk for graduates, but she did say that high outlier schools -- those that produced more graduates who were sued for malpractice -- were more likely to be public institutions and tended to be more recently established. Schools with graduates with the least risk for malpractice suits, the low outliers, tended to be those with fewer residents and fellows. The study was greeted with skepticism by medical school administrators.

Skeptics abound

Robert Watson, MD, senior associate dean for educational affairs at the University of Florida College of Medicine, Gainesville, and a site examiner for the Liaison Committee on Medical Education, said he doesn't see a fundamental difference between public and private schools, except for tuition.

"I hope that nobody takes it too seriously," Dr. Watson said of the study.

Jane Holman, vice president of risk management for Texas Medical Liability Trust, a medical liability insurance company, said the findings held only fleeting interest for insurers, since past studies had not revealed a significant link between medical schools and malpractice risk.

The study was published in the October issue of Quality and Safety in Health Care, part of the British Medical Journal publishing group.

The researchers examined databases from Indiana, Florida and Maryland, and looked at malpractice claims that had been closed from 1990 through 1997. The researchers then tracked down the medical schools from which the defendants graduated, and out of the 122 schools named, there were enough data to rank 75.

"We can rank them and we can show that this ranking matters," Dr. Waters said of medical schools. "It's strongly predictive of future claims."

Those that were high outliers ranked above the 90th percentile. The low outliers fell below the 10th percentile. Dr. Waters stressed that researchers only explored the connection between schools and malpractice claims. It did not delve into why a particular medical school had more graduates who ended up being sued.

"We know that medical malpractice is related to many things besides medical competence," Dr. Waters said. "This is a first-brush attempt, and the paper is only suggestive. The best thing we can say is that now that we know there is a relationship, we need to follow through to understand this connection."

A number of factors could be at play. Some schools may attract less-qualified students or students with other characteristics that make them more likely to be sued or a disproportionate number of students who end up in specialties or geographic areas where lawsuits are more likely.

Training in interpersonal skills may vary between schools, which would be consistent with findings that communication between physicians and patients and their families may play a role in whether or not a physician is sued. Some schools may provide a lower quality of medical education than others or the authors may have simply discovered a group of similar students between schools.

Basil Genetos, MD, cardiologist and president of Indiana University School of Medicine Alumni Assn., said he wasn't impressed with the suggestion that a public school, such as Indiana, produced physicians who were somehow substandard. "I've been in practice for 25 years in clinical cardiology and have yet to be sued," he said. "From my own personal standpoint, Indiana has an excellent reputation as a medical school."

Frank Sloan, PhD, director of the Center for Health Policy, Law and Management at Duke University, Durham, N.C., whose past research includes a study that didn't find a significant connection between board certification and a physician's malpractice experience and another that linked poor communication skills with malpractice, said he wasn't sure how much weight one could put on Dr. Waters' work.

"It's hard to believe that a school per se could be so important," he said, since residency also plays a large part in physicians' training. "This raises a lot of questions about why."

David Orentlicher, MD, co-director for the Center for Law and Health, University of Indiana in Indianapolis, said the important thing was to figure out the reasons behind these numbers. "Often rankings that you get turn out to be spurious, and that certainly is an important possibility in this case," he said.

The study's authors acknowledge that previous studies have shown strong links between physician characteristics and specialty and malpractice experience but had not shown a significant relationship between medical school attended and rate of malpractice claims or payments.

ADDITIONAL INFORMATION:

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"Medical school attended as a predictor of medical malpractice claims," Quality and Safety in Health Care, October (qhc.bmjjournals.com/cgi/content/full/12/5/330)