Study Analyzes How The Malpractice Environment Impacts Practicing Neurosurgeons
There are currently an estimated 3,229 active neurosurgeons in the United States certified by the American Board of Neurological Surgeons (ABNS). This corresponds to approximately one neurosurgeon for every 100,000 people in the United States. Neurosurgeons incur some of the highest annual malpractice premiums of any specialty, averaging more than $100,000 and as high as $300,000 per year in some states. In 2005 alone, neurosurgeons paid a total of $28 million in malpractice claims, with the highest average payment per specialist surgeon ($465,000), and the single highest payment of any claim in any specialty ($5.6 million).
In 2002, the Council of State Neurosurgical Societies (CSNS) performed a survey of practicing neurosurgeons to assess the impact of malpractice on the workforce. The results were published along with a joint position statement from the two leading professional societies in neurosurgery the American Association of Neurological Surgeons and Congress of Neurological Surgeons as a report titled Neurosurgery in Crisis. As a direct result of malpractice claims and increasing malpractice insurance premiums, nearly half of all respondents were likely to restrict their practice for example, limiting their practice to only spine, or not providing emergency or trauma coverage at a local emergency room. Nearly one third of respondents at that time stated that they were considering retirement, rather than continue to practice in the face of increasing insurance costs. One fifth stated that they were considering moving their practice to a state with "better" malpractice conditions. These changes in practice patterns would result in patients not being able to access lifesaving neurosurgical care, complex neurosurgical care or neurosurgical care close to home.
Based on the findings of the 2002 survey, researchers at Oregon Health & Sciences University in Portland, Ore., decided to analyze ABNS data from 2005-2007, examining 4,584 active and retired neurosurgeons to look for a correlation between numbers of practicing and retiring neurosurgeons and the malpractice environment of each state.
The results of this study, Impact of Malpractice Environments on the US Neurosurgical Workforce 2005-2007, will be presented by Zachary N. Litvack, MD, 11:30 to 11:44 a.m. on Monday, April 28, 2008, during the 76th Annual Meeting of the American Association of Neurological Surgeons in Chicago. Co-authors are Kim J. Burchiel, MD, FACS, and Matthew A. Hunt, MD.
"If malpractice has such a negative impact on practicing neurosurgeons, we hypothesized that states with high malpractice claims and high malpractice insurance premiums (so called "crisis" states) would see a decrease in the number of practicing neurosurgeons over time, and an increase in the number of neurosurgeons moving or retiring from practice in that state. Conversely, states without major malpractice issues would see an increase in practicing neurosurgeons," stated Dr. Litvack.
The authors analyzed the effect of the malpractice environment as classified by the CSNS in 2002 and the American Medical Association (AMA) in 2007 on changes in active and retired diplomates of the ABNS between 2005 and 2007 using Pearson's coefficient and two-tailed ANOVA. Findings were as follows:
-- Statistical analysis showed that states in "crisis" realized a 5 percent increase in the number of practicing neurosurgeons.
-- In the 10 states with the largest increases in the number of neurosurgeons, eight states were CSNS "severe" states and five were AMA "crisis" states.
-- Non-crisis states realized a 2 percent decrease in the number of practicing neurosurgeons.
-- The size of malpractice claims had no impact on the number of practicing neurosurgeons in that respective state.
Interestingly, these results were exactly the opposite of the hypothesis. The authors believe this is caused by neurosurgeons restricting their practices to limit malpractice liability. This means that additional neurosurgeons are needed in the same geographic area to cover the spectrum of diseases and surgical needs of the population. In other words, two neurosurgeons are now needed to perform the job that used to be performed by one.
"While malpractice claims do not on the surface appear to affect demographics alone, they inevitably erode the system of providing neurosurgical care to patients. As more neurosurgeons limit their scope of practice, patients will find it more difficult to obtain the expert care they need, and that is an issue that indeed needs to be addressed," concluded Dr. Litvack.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 7,200 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.
American Association of Neurological Surgeons (AANS)
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