How many bad doctors are there among us?
How many have a proven record of hurting many patients more than the
average physician? This is my area of interest. I was a strict chief of staff
of two hospitals over a five year period and looked upon my mission as
protecting patients. If you reform or remove doctors who are identified as
being dangerous to the public, overall health care should improve because 61% of all
harms to patients in hospitals are attributable to the errors, diagnostic and
therapeutic, of individual physicians.
To answer my opening question, there is
an estimate of the proportion of bad doctors, 2%, a deceptively small number.
It is derived from a national registry of American doctors, the
National Practitioner Data Bank. It holds records of license actions by state
medical boards, hospital disciplinary actions and, most importantly,
malpractice suit payouts for America's 650,000 doctors. A retired former statistician
for the bank, Dr. Robert Oshel has shown that during the first twenty years of
the data bank's existence, roughly from 1990 to 2010, that 2% of US doctors are
responsible for 50% of the payouts in medical malpractice cases. The other half
of the payouts are the responsibility of what I call the competent but fallible
98%. The hard core 2% commit errors at a rate 49 times that of their
other colleagues.
A parallel study has been published in
the past week from Australia. Its methods and the data collected are
somewhat different but the numbers are remarkably similar to those derived from
the US National Practitioner Data Bank. A group of investigators headed by
Marie M. Bismark of the Melbourne School of Population and Global Health has
found in a national sample of nearly 19,000 formal healthcare complaints
lodged against doctors between 2000 and 2011 that "3% of Australia’s
medical workforce accounted for 49% of complaints and 1% accounted for a
quarter of complaints." The Australian statistics and ours fit each other
like a glove.
The 2 or 3% are a special group. They
are very hard to reform. Because 138,000 patients die each year of preventable
errors in American hospitals, we could potentially save half that number by
removing that hard core from our midst. The names of the 2% are a closely held
secret of the National Practitioner Data Bank. It would take congressional
action to disclose the identities of the doctors and to keep them from
practicing, Congress could do the latter by eliminating them from the Medicare and
Medicaid programs.
There is a financial side to the
problem. The former head of Medicare and Medicaid, Dr. Donald Berwick, has
estimated that 300 billion dollars each year are wasted on improperly
administered care and unnecessary care. We could take a big bite out of our
national medical bill by eliminating our 2% from practice.
The Australians are more sanguine than
I. They would re-educate their repeat offenders. My experience as a chief of
staff, anecdotal to be sure, tells me otherwise. These are incorrigible people
with little insight. They are, also anecdotally, responsible for a lot of
unnecessary care, not just inept care. There are a lot of blood and treasure at
stake. Any one of us could fall victim to one of the 2%. Leniency in this
situation is ill advised.
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