Do practice settings influence defensive medicine in orthopedic surgery?

Defensive medicine is often practiced out of fear of legal liability. We conducted a study to compare the costs of defensive medicine among US orthopedic surgeons by practice type and American Medical Association (AMA) state medical liability classification. Two thousand surgeons registered with the American Academy of Orthopaedic Surgeons were sent a survey on defensive medicine. Costs were analyzed using 2011 Centers for Medicare and Medicaid Services data. Of the 2000 surgeons, 1214 (61%) completed the survey. Results showed that defensive tests were ordered by a higher proportion of nonacademic physicians than academic physicians in all 8 categories of orthopedic care, with a mean difference of $2348 in monthly defensive expenditures between groups. A higher rate of defensive testing by orthopedists in AMA crisis states versus safe states was also observed in 6 of the 8 areas of care studied, with mean monthly defensive expenditures ranging from $9208 in crisis states to $6596 in safe states. Defensive orthopedics contributes significantly to health care costs, with marginal benefit to patients-especially in nonacademic and crisis-state orthopedics practices.