A sign of the times

One of the annoyances of becoming an attending is the need to sign up for managed care and insurance plans. The forms are all similar, but they are sufficiently different that you can’t just fill one out and be done with it. Every couple of years, a flood of paperwork comes through, asking for renewal. One disadvantage of working for a state institution is that I don’t have much say over what plans I have to sign up for. My cancer institute makes the deals and then distributes the applications. However, one advantage is that there is an office that fills out a lot of the simple “busy work” parts of this pile of applications. I supply the office with my CV and some information about my educational background, and then they send me the forms with most of the information filled out. However, one thing that I always have to fill out is a series of questions about my past, such as whether I’ve ever been disciplined by medical boards, had to reliquish hospital privileges, been convicted of anything worse than traffic violations, etc.

One question that is inevitable is whether or not I had ever been sued. The question usually asked (1) whether I had been sued in the last three to five years (the exact time depending upon the company) or (2) whether I had ever settled a case out of court. If the answer was “yes,” then inevitably would follow the request for full details of the case. Last week, I was filling out one of these forms, when I came across the usual question, but its form was vastly different than what I remembered from previous applications in the late 1990’s and early 2000’s.

Has there been, within the past five years, more than one malpractice judgment found against you or malpractice settlement made, with or without prejudice, in excess of $50,000?

Notice the difference. The insurance company no longer asks if you’ve been sued. It only asks if you’ve lost or settled more than one malpractice suit for more than $50,000 in the last five years. The assumption is clearly that many good physicians will not only have been sued in the last five years, but will have lost or settled one case for more than $50,000!

In fact, I have noticed this trend over the last several years. The malpractice questions on these forms seem to be getting less and less restrictive. I first noticed three or four years ago that most forms no longer asked just whether the applicant had been sued or not, but rather whether he or she had lost or settled a suit within the last five years. Then, a couple of years ago it progressed to such forms asking whether the physician had lost or settled more than one suit in the last five years.

Now they don’t seem to care about even that anymore. This insurance company, at least, only seems to care whether the physician applicant has lost or settled more than one big malpractice case in the last five years. It doesn’t even ask if you’ve settled for smaller cases. You can conclude one of two things here. Either the insurance company in question is lowering its standards (unlikely, given the lock they have on physician reimbursement in the area), or so many physicians are being sued and being forced to settle that the insurance company made a business decision that it has no choice but to accept physicians who have lost or settled one or more malpractice cases in five years, particularly in high risk specialties. More telling, it has decided that it no longer cares whether a physician has settled multiple cases for less than $50,000 over the last five years. It only wants to know if an applicant has lost or settled for $50,000 more than once. (I’m guessing it they would be less likely to reject an obstetrician or a neurosurgeon who lost a $50,000 settlement than a pediatrician or family practice doctor.) True, not all insurance companies are so lenient. For example, another recredentialing package I just dealt with asked simply if I had paid any malpractice settlement in the last three years. Even so, a few years ago, theses companies would have been asking me if I had ever been sued at all (regardless of winning, losing, or settling), and they would have wanted to know my history not in the last three years but in the last five to seven.

It’s a sign of the times.