Malpractice occurrence in emergency medicine: Does residency training makea difference?

We evaluated the effects of Emergency Medicine (EM) residency training, EM board certification, and physician experience on the occurrence of malpract ice claims and indemnity payments. This was a retrospective review of close d malpractice claims from a single insurer. Outcome measures included the o ccurrence of claims resulting in indemnity, indemnity amounts, and defense costs. Differences in the outcome measures were compared based on: EM resid ency training, EM board certification, EM residency training versus other r esidency training, and physician experience using both univariate and multi variate analyses. There were 428 closed EM claims with indemnity paid in 81 (18.9%), Indemnity was paid in 22.4% of closed claims against non-EM resid ency-trained physicians, and in only 13.3% against EM residency-trained phy sicians (p = 0.04). The total indemnity was $6,214,475. Non-EM trained phys icians accounted for $4,340,951 (71.5%), EM residency-trained physicians ac counted for $1,773,524 (28.5%), The average indemnity was $76,721 and the a verage defense cost was $17,775. There were no significant differences in t he mean indemnity paid per closed claim or the mean cost to defend a closed claim when comparing EM-trained and non-EM residency-trained physicians. T he total cost (indemnity + defense costs) per physician-year of malpractice coverage was $4,905 for non-EM residency-trained physicians and $2,212 for EM residency-trained physicians. EM residency-trained physicians account f or significantly less malpractice indemnity than non-EM residency-trained p hysicians. This difference is not due to differences in the average indemni ty but is due to significantly fewer closed claims against EM residency-tra ined physicians with indemnity paid. This results in a cost per physician-y ear of malpractice coverage for non-EM residency-trained physicians that is over twice that of EM residency-rained physicians. (C) 2000 Elsevier Scien ce Inc.