Higher Physician Spending Tied to Lower Risk for Malpractice Claims


Yes, you read the title right. It turns out that when researchers compared the spending of 25,000 Florida physicians in 2000–2009 to their malpractice claims, higher resource use was associated with lower rates of malpractice claims in the following year.  This occurred in all specialties.

The authors concluded:

“Without evidence on rates of errors associated with greater resource use, we cannot definitively conclude that defensive medicine … reduces the number of malpractice claims. However, our findings still suggest that greater resource use is associated with fewer claims, which is consistent with physician beliefs that higher resource use, more generally, is associated with reduced liability of malpractice.”

Yes, they were afraid to straight out say it but the truth of the matter is that defensive medicine defends the doctors from lawsuits.  Get some tort reform and this stops.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “Higher Physician Spending Tied to Lower Risk for Malpractice Claims

  1. tad hominem
    November 11, 2015 at 2:44 pm

    Just so long as you define what u mean by “tort reform”. from my occasional posts some will know that I am an attorney and high end consumer of medical services. 23 years since ms diagnosis. most of my carer spent in Family Law and now estates and trusts working in court system. I agree with estimate of 25 inquiries per month and 1 valid case out of 20-25.
    So what do u do for my co-worker whose healthy 70 year old mother went in for surgery to repair hernia 4 months ago and died on table when she bled out when someone nicked the artery (abdominal, aortic ??) when closing. Death certificate lists cause of death as medical error. How much does family get and how long does it take ?
    worst scenarios are the birth error cases where kid will spend life mentally and physically disabled. victims in bona fide cases need just compensation within a reasonable time. 1 or 2 years, tops.

    • Pat
      November 11, 2015 at 4:04 pm

      Tad, why the presumption that anything should be paid for an error? “Error” does not automatically equate to “negligence”… unless one is a plaintiff attorney, I guess.

      Birth errors? Your colleagues have so badly poisoned the system that myself and every other Florida physician pays $250 per year to a mandatory compensation fund, even if they don’t deliver babies. How in hell is that just?

      • Bill Ameen MD
        November 11, 2015 at 5:04 pm

        As Dr. Doug knows, in Virginia (where I’m licensed also) it’s $300 per non-obstetrical physician per year and a whopping $6,200/year for doctors who deliver babies. I guess this is socialism at its purist…Everybody pays even when it’s not his/her fault (or nobody’s).

  2. Seneca
    November 11, 2015 at 1:54 pm

    It follows that more lawsuits will be generated by acronymal abominations such as ACO’s who pursue cost reduction through a centralized, top-down bureacracy. Unfortunately, the corporate guys never get named and only care to the extent that their institution is liable. There is a well known case at Kaiser where a spine MRI was repeatedly denied to a teenage girl who had a spinal cord tumor. The settlement was $4 million, but one of the Kaiser administrators said nothing will change because it is cheaper to pay out the occasional lawsuit than order expensive tests which are deemed unnecessary, as long as it is not one of the administrators or their families who needs the MRI!

  3. Pat
    November 11, 2015 at 12:00 pm

    Damn, what a cowardly sidestep by the authors. I practice defensive medicine every single shift, and I don’t care who knows it. Practicing only according to what I thought was right and providing only what I thought was good care was so long ago I don’t even remember what it felt like. It is corrosive to the soul to see every patient as a potential threat, but it’s reality.

  4. Dave Mittman, PA, DFAAPA
    November 11, 2015 at 11:53 am

    Seriously, how did “Midlevels” which is a crappy term BTW, get in here? If I am a midlevel, Bill, you forever are a provider. Then we can be even.|
    I am a PA and I order no more tests than any other physician I have worked with.
    I agree that when you order more tests two things happen. People feel more taken care of and you will have a second by product. You will find incidental findings, some of which will lead to finding other diseases. Treating those diseases well will lead to less malpractice. People will also feel better and more secure with you and less litigation will occur.
    IT’s just not good medicine.
    Yes, we need malpractice reform!!

    • Bill Ameen MD
      November 11, 2015 at 12:39 pm

      Dave, since Doug brought up tort reform (yes, more work needs to be done), I commented that a lot of lawsuits appear, at least in my state, to be generated by physician extenders. All of us need to police ourselves better. With all due respect, unlike Sermo website full of PA/NP bashing, I trained PAs/NPS and hired them for over 30 years and treated them as equals. As part of the equation, patients need to be informed not to expect every test under the sun (not to mention Z-paks). A doctor once had a sign in his office that said, “Here we give you what you need, not what you want.” Oh, and none of the PAs whose suits I am familiar with were sued for doing too many tests, but for errors of omission and/or judgment usually without good physician consultation.

  5. Bill Ameen MD
    November 11, 2015 at 9:13 am

    This is one of those “Well, duh!” surveys. Yes, higher medical costs are associated with defensive medicine. Some tort reform has occurred state-by-state by tightening up the legal requirements for medical malpractice. One of the top plaintiff attorneys in our state told me that his office gets about one inquiry a day but only about one case a month has any merit to it…and the majority are settled. Having been asked to be an expert witness for both sides through the years, what I’ve found that no one seems to be commenting about is the logarithmic rise of cases involving midlevels who are poorly trained, experienced, or afraid to ask questions of their sponsoring physicians (who’ll also get into trouble). There again, midlevels save insurance companies money but cost more in the long run when they generate lawsuits.

  6. Steve O'
    November 11, 2015 at 8:39 am

    I note that the variable is “money spent” not “better care.” In many ways, our “quality indicators” document how well we are practicing defensive medicine – ordinary, cookbook medicine with extensive annotation of trivia – which is only there for lawyer repellent. I still give about two years before video cameras are installed in the examination rooms, with or without patient consent. In the push to “eliminate errors” rather than to reduce harm, a tremendous amount of time, energy and effort is spent in areas that are tangential to patient care.

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