On 21-Jun-05 John Whittington wrote:
> [...]
> [...].  The subscription rate depends upon medical speciality
> and professional income (gross, less allowable expenses up to 25%). 
> For consultants with such a professional income of £75,000 - £100,000
> p.a., the annual 'subscription rates' ('premiums') for 2005/6 are
> as follows:
> 
> Obstetrics                        £ 49,546
> Neurosurgery/Plastic Surgery      £ 22,058
> Gynaecology/Orthopaedics          £ 17,815
> Most other surgical specialities  £ 12,203
> Cardiology                        £  6,059
> Neurology                         £  5,263
> Anaesthetics                      £  4,507
> Most other medical specialities   £  2,626

I'm still waiting for this to sink in properly!
In passing, I wonder if "allowable expenses" includes the
subscription in question, so that the professional income
is £75,000-£100,000 after payment of the "premium". Otherwise,
it seems as though obstetricians could lose 1/2-2/3 of their
disposable income through payment, which seems gross.

> It looks as if we are becoming 'American'!  I was somewhat
> amazed to see the figures in the upper part of that list,
> and wonder who 'can afford to' practice in those specialities! 
> However, this illustrates that, at least in terms of the
> financial risk, obstetrics is in 'a class of it's own' as 
> regards litigation risk, with 'premiums' more than double that
> of the nearest competing speciality, and nearly 20 times greater
> than that for most non-surgical specialities.

Looking through the list and trying to identify a general common
factor for the high ones, it seems to me that they are all such
that, owing to events occurring during care (whether due to
the practitioner's fault or not), the patient could readily
emerge with a clearly identifiable physical damage which they
did not have before (give or take where orthopaedics is concerned:
hip replacement is one thing, fracture repair after an accident
is another).

A damage so clearly associated with the intervention obviously
offers a more solid base for litigation, and becomes more difficult
to defend, while death say of a cardiology patient is more difficult
to pin down. So one might expect (a) a greater tendency to embark
on litigation for the "top 4" (> £12,000); (b) greater expense
in defending the action.

I still have difficulty grasping the enormous disparity for
Obstetrics, however, in these terms. As John says, it seems to
be in a class of its own.

Data which we are missing here is what are the relative magnitudes
of damages awarded when litigation succeeds.

Also, no doubt, one needs to take account that in some specialities
there is a natural propensity for things to go wrong, and
childbirth tends to spring to mind. So we would also need data
on the relative frequencies of unexpected crises.

> To what extent the litigation risk influences clinical practices
> is, of course, still a matter for speculation.

Indeed, and I suspect it can cut both ways. An experienced
obstetrician might tend to trim his practices so as to reduce
the risk of exposing himself to outcomes more likely to provoke
litigation, even at the risk of inducing other outcomes, perhaps
more regrettable, but less attributable. At the same time, data
like the figures above must surely have a negative effect on
recruitment to the speciality, perhaps leading to a greater
proportion of less sure-footed (oops, sure-handed) recruits who
in turn may be more likely to mess things up, incur litigation,
and push up the premiums for all. But this is, indeed, just
speculation!

Best wishes to all,
Ted.


--------------------------------------------------------------------
E-Mail: (Ted Harding) <[log in to unmask]>
Fax-to-email: +44 (0)870 094 0861
Date: 21-Jun-05                                       Time: 15:17:01
------------------------------ XFMail ------------------------------

******************************************************
Please note that if you press the 'Reply' button your
message will go only to the sender of this message.
If you want to reply to the whole list, use your mailer's
'Reply-to-All' button to send your message automatically
to [log in to unmask]
*******************************************************