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Malpractice- Academic vs Private Practice

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  • Malpractice- Academic vs Private Practice

    Hi All,

    I was hoping to get some input regarding this topic which I have been researching but can't seem to find any concrete answers. I am finishing fellowship in a surgical subspecialty and wondering if there is any benefit/disadvantage to joining academics vs private practice in regards to malpractice.

    Does being employed by a University provide any additional protection in malpractice cases/settlements vs being in a private practice? I would assume so, especially if one is putting oneself at increased risk working with in-training physicians (specifically wondering about Illinois).

    Thank you in advance!



  • #2
    Shouldn't matter.


    • #3
      Depends. Some states (I know Florida’s does) have state teaching hospitals that have sovereign immunity which makes it much more difficult to be sued. It also depends on the institution. My institution pretty much told me I won’t be sued unless I murder someone. They have a habit of trying to get the MD dropped and have the institution be the only defendant. Thankfully I don’t have personal experience and this could be something that institutions just say, but it seems to be true based on what I’ve heard from my colleagues.


      • #4
        I think it provides a little protection realized in 3 ways:

        1. I personally think the care delivered in academic centers is probably a little higher quality, I don't mean this to be some kind of flame statement at all, things are supposed to be done more carefully at major centers. When patient get complex or tough to handle they don't get shipped to St. Mary of the Small Town. Again not a dig at anyone's shop just my observation.

        2. Regardless of whether point #1 is true or not, patients/families who suffer bad outcomes at Mayo are probably more likely to view them as inevitable than those who suffer bad outcomes at St. Mary of the Small Town.

        3. Major centers usually have powerful risk mitigation and claims depts that can strong-arm plaintiff's firms into dropping doctors.

        The magnitude of the protection isn't such that it would weigh into my decision as to where to work at all, not one tiny bit.

        My observation would lead me to believe that if avoiding med mal was a primary goal I think you should try to find a relatively large and well-resourced hospital in a lower SES community, bonus if said shop is in a doctor-friendly state (TX, IN, etc). The issue there seems to be lack of plaintiff's attorneys circling the blood in the water as it doesn't seem to be worth it to them. I have no data for this just personal observation of some pretty wild stuff in my career.


        • #5
          From my experience on the hospital risk management committee....


          If you are a University Employee, you have a deep pocket (the University) as your defacto excess malpractice coverage.  E.g., your personal malpractice policy limit only covers you for 1.3MM on a 30MM brain damaged baby award.  The University picks up the other 28.7MM and your assets are not at risk.  Your employer covers that risk.

          In contrast, as a private practitioner, you will be on your own in some circumstances, and under other circumstances you could still have the hospital as backup coverage....

          In my state, if the patient comes in through the ED and you are the on call consultant, the hospital has vicarious liability for any award above your coverage.  That is based on the legal premise that the patient did not go to you as a private physician, but rather the hospital assigned you to take care of the patient as the on-call consultant.

          In contrast, if you admit your private office patient for outpatient surgery through the hospital ASU and there is a huge award in a malpractice case, the patient was directly your private patient and the hospital would not have vicarious liability for your tortious acts.  The hospital would only share liability under those circumstances for any direct tortious acts of the hospital staff, but not vicarious liability for your tortious acts.

          In sum, as a private practitioner, your personal asset risk in a malpractice suit would go from very low risk (<1% risk with standard coverage limits for a private practice physician) to essentially zero risk as a University employee.


          Now, my situation and my personal approach to this...

          My personal assets with over 20 years as an attending are more than an order of magnitude greater than the maximum malpractice coverage limit available in my state.  I am financially independent and have saved enough to FIRE, but I continue to greatly enjoy seeing patients part-time.  However, I am not seeing any private, office-based outpatients these days.  At the same time, I am privately employed while caring for patients at the hospital.  As I only see patients in the hospital, assigned to me by the hospital, I have my deep pocket defacto excess coverage from the hospital.  Otherwise I might feel compelled by malpractice risk to hang up my trusty old Littman stethoscope for the last time.


          • #6
            on average, I think that academic physicians have a lower malpractice cost because they tend to get sued less.  It is harder to find an "expert" witness to testify against an academic physician if the expert is some community doc looking to make an extra buck testifying for malpractice attorneys vs an academic physician whose job is to train other doctors.  When they do get sued, I think that the hospital system absorbs most of the cost, barring blatant malpractice by the attending physician, it is usually the hospital that ends up with the large payout.  That's just what I've heard, not sure if there is any evidence to back it up, but I've been told that malpractice insurance is cheaper for physicians in academics for these two reasons.  I certainly would not make any career decisions based upon malpractice risks, but I think that in general, your malpractice risk is probably higher in a private practice then it would be at an academic center.  If you really want to avoid the malpractice scene altogether, you should just work for the VA.   Otherwise, just try to see it as a price/cost of practicing medicine.



            • #7
              MPMD, there are data to back up your claims re: Medicaid patients suing less.

              However, I would disagree re: quality being better in Academia than in private practice. Perhaps better than podunk community hospital. I have seen some whacky stuff in Academic places where incompetence seems to be more sheltered.


              • #8
                I was working for the university when I was sued aloneg with several other docs. Our names were all dropped but we still have to report the outcome any time we get re credentialed. So I do think you are more protected. That said the whole experience has sucked and probably played a role in my decision to move to the va for a time and has made me very leery of ever doing PP.


                • #9
                  In our state, the university guys have protection under the state, a judgment cap.

                  Mpmd, I know what you're getting at, but don't conflate podunk practice and private practice. The housestaff will never commit malpractice and the attending will never be called to the party, right?

                  OP, can you explain why you're asking? If you're choosing a job based on liability, my understanding is that the federal system such as the VA is the bees' knees!


                  • #10
                    In my area the academic medical centers and practice plans are always sued along with the physicians. The med centers and docs use the same captive insurance company. The limits for the docs, practice plans and the centers are the same. The limits are high and the vast majority of payments are below the combined limits so no excess liability for any party. But there is no structure of the med center or practice picking up costs charged to the physician. Lawyers sue all three since that gives them 3 sets of limits to pay the awards.

                    I have no idea whether the academic docs are sued less. The academic centers all take Medicaid while many of the private groups do not. To the extent that it is true that Medicaid results in fewer suits the academic places may benefit from that.

                    Unfortunately, much of what docs would consider to be useful information would also be helpful to plaintiff's attorneys. Our carrier keeps reassuring the docs that we have excellent coverage and much better results than practices as a whole in our region. But they share little data.

                    When I called to ask about getting excess coverage beyond that payed by the standard policy I was told

                    1. They frequently get calls like this. When docs look at the prices and coverage available and compare to what they have already they never get the excess policies.

                    2. You have excellent insurance. Don't waste your money.

                    It makes sense to look at the malpractice climate where you are considering working, particularly if you are in a high risk specialty. You would need to investigate the conditions on the ground for each job. I doubt broad generalizations about academic vs private practice will be useful.


                    • #11

                      MPMD, there are data to back up your claims re: Medicaid patients suing less.

                      However, I would disagree re: quality being better in Academia than in private practice. Perhaps better than podunk community hospital. I have seen some whacky stuff in Academic places where incompetence seems to be more sheltered.
                      Click to expand...

                      I'm actually not talking about Medicaid so much as lower middle class blue collar areas. That's where I've seen the phenomenon.

                      See below, I agree with your point about incompetence being sheltered.

                      Mpmd, I know what you’re getting at, but don’t conflate podunk practice and private practice.
                      Click to expand...

                      I'm very much not doing that as I specifically tried to state. This is really hard to measure so it's just my opinion. Transfers only ever go in one direction though which seems like a explicit admission of capability if not quality.


                      • #12
                        More complex cases are more likely to end up at academic medical centers. As in private practice, there is a range of quality of individual docs. There is also a range in the quality assurance systems in place.

                        It is probably very difficult for a low quality doc to practice in one of the high complexity referral service lines at an academic place, since those cases are handled by entire teams and get referrals because the perceived overall quality. The teams will be aware of the quality of all of its members.

                        But for lower complexity work that could be done either in private practice or AMC and for which a single doc could do everything, there would be no reason to expect the academic place to be better than some private docs. AMCs tend to have more rigorous credentialing requirements, particularly now where they are large networks. Even those with pure office practices will need to justify any malpractice cases or medical licensing board citations. A bad doc in office private practice can keep going until their license in lifted.

                        So I could see an argument that the AMC's may weed out the worst of the worst. But for overall quality, particularly when it depends on a single doc, no reason to assume the AMC is better.

                        If it is true that AMC docs get sued less, then I wonder whether it is because the worst of the worst can't stick around and they represent a large portion of the suits?


                        • #13
                          i'm not sure what private practice means anymore.  i think for sure academics is more protected than a six person group, single specialty.  i do not think academics is more protected than kaiser, if that meets the definition of private practice.



                          • #14
                            The counter to this is that some private practice docs have a high volume and personally perform whatever the procedure is.  They become quite proficient.  This is hard to generalize.  I remember a saying   Those who can do.  Those who can't teach.  Devil's advocate position.