Malpractice Risks for Hospitalists

Mark Crane


March 21, 2013

In This Article


The number of hospitalists has skyrocketed over the past 10 years, and as their numbers grow, so do the number of lawsuits filed against these physicians.

Liability insurers have only recently separated the evaluation of hospitalists' risk from their claims experience with general internists. Up until the past few years, hospitalists, who are typically trained as internists, were insured (covered) at the same rate and with the same premiums as primary care physicians in private practice. But that may start to change, as insurers recognize the greater malpractice risks faced by hospitalists and may begin to factor that into their coverage and their premiums.

"We have seen a slightly higher frequency in number of claims and severity in cost of claims in lawsuits against hospitalists,' says Robin Diamond, RN, JD, senior vice president and chief patient safety officer at The Doctors Company, based in Napa, California, and the largest national insurer of physicians. "We believe that as hospitalists continue to fill more roles within the hospital and higher demands are placed on them, the risk for being sued may also increase."

Because the hospitalist field is relatively new, there's been little formal research as to how it stacks up against other specialists and internists for liability risk. In general, surgeons and obstetricians/gynecologists are more likely to be sued than internists, pediatricians, or psychiatrists -- and also hospitalists, said Diamond.

"Most of the liability carriers are now starting to accumulate a larger database of claims," said John R. Nelson, MD, a cofounder of the Society for Hospital Medicine and medical director of the hospitalist program at Overlake Hospital in Bellevue, Washington. "As claims for hospitalists work their way through the legal system, we'll soon have a lot more information and the risks will become clearer," he said.

Hospitalists are now the fastest-growing specialty in medicine, with almost 35,000 physicians, according to the Society of Hospital Medicine.

A Unique -- and Uniquely Vulnerable -- Specialty

"The exposure is obviously different for an internist in private office practice than for a hospitalist," said P. Divya Parikh, director of research and loss prevention of the Physician Insurers Association of America (PIAA). "We're encouraging insurers to weigh that risk in determining how they designate hospitalists and how they provide coverage.

"This is still a work in progress for insurers," Parikh said. PIAA studied over 93,000 closed claims over a 10-year period. They isolated 312 claims just for hospitalists, although there is some overlap because some physicians functioning as hospitalists aren't identified as such, she said. Of those 312 claims, 63 -- or about 20% -- resulted in some indemnity payment.