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.