Medical malpractice liability in clinical urology: a survey of practicing urologists.

PURPOSE: The current medical malpractice environment is in crisis. Costs associated with litigation as well as medical malpractice insurance premiums have increased during the last decade. In fact as of March 2004 the American Medical Association has identified 19 states as crisis states. We investigated the way in which the medical malpractice environment has affected urologists and the manner in which they practice medicine.
MATERIALS AND METHODS: A survey of 31 questions was electronically mailed to the American Urological Association's database of practicing urologists in the United States. Data were gathered on each urologist's malpractice history as well as their clinical practice. A total of 5,919 surveys were mailed and 683 (12%) were returned. Urologists from 47 states responded.
RESULTS: The mean medical malpractice premium in 2003 was 30,665 dollars (median 22,500 dollars, range 6,000 dollars to 120,000 dollars). Of responding urologists 63% report being named in a medical malpractice lawsuit a mean of 2.1 times. Mean length of time practicing urology was 19 years. Of the lawsuits 28% involved urological oncology, 12% involved endourology and 10% involved female urology. All other urological specialties individually generated less than 10% of the lawsuits. In only 3.5% of the cases was the patient successful at trial, compared to 13.2% of the cases where the urologist was successful at trial. The case was dropped or dismissed without financial settlement 46.9% of the time. However, 36.3% of the time the case was settled with a pretrial financial settlement. The mean amount awarded to a patient at trial was 213,855 dollars (median 100,000 dollars, range 2,400 dollars to 1,000,000 dollars). When a patient was awarded pain and suffering at trial, the mean amount awarded was 270,000 dollars (median 85,000 dollars, range 30,000 dollars to 900,000 dollars). The mean amount given to the patient as pretrial settlement was 196,706 dollars (median 70,000 dollars, range 1,500 dollars to 5,000,000). The mean time a urologist spent defending their first lawsuit was 21.8 days. Given the current medical malpractice environment, 58% of responding urologists are considering referring difficult cases, 60% are considering limiting the scope of their practice, 26% are considering changing the state in which they practice and 41% are considering leaving the practice of medicine.
CONCLUSIONS: Our experience has shown that the medical malpractice crisis has had a profound and real effect on the urological community. When the data are stratified according to those urologists who practice in a crisis state, we consistently see a pattern whereby the crisis state urologists are carrying a larger proportion of the malpractice burden. Most concerning is how the malpractice environment has changed the way in which urologists approach their practice. A larger percentage of urologists from crisis states are reporting that they are considering limiting the scope of their practice, moving their practice to a state with a more favorable malpractice environment and considering leaving the practice of urology altogether. Clearly the urologist is not immune from the current malpractice environment.