"Neurosurgeons in Illinois are more likely to believe that there is an ongoing medical liability crisis and more likely to practice defensively than neurosurgeons in Texas."

World Neurosurg. 2016 Feb 4. pii: S1878-8750(16)00168-6. doi: 10.1016/j.wneu.2016.01.080. [Epub ahead of print]

Neurosurgical Defensive Medicine in Texas and Illinois: A Tale of Two States.

Cote DJ1, Karhade AV2, Larsen AM2, Castlen JP2, Smith TR2.

Author information

• 1Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, USA 02115. Electronic address: david_cote@hms.harvard.edu.
• 2Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, USA 02115.

Abstract

OBJECT:

In this study, we compare the self-reported liability characteristics and defensive medicine practices of neurosurgeons in Texas with those of neurosurgeons in Illinois, in an effort to describe the effect of medico-legal environment on defensive behavior.

METHODS:

An online survey was sent to 3,344 members of the American Board of Neurological Surgery (ABNS). Respondents were asked questions in eight domains, and responses were compared between Illinois, the state with the highest reported average malpractice insurance premium, and Texas, a state with a relatively low average malpractice insurance premium.

RESULTS:

Of 146 neurosurgeons surveyed in Illinois, 85 (58.2%) responded to the survey. In Texas, 65 of 265 (24.5%) neurosurgeons surveyed responded. In Illinois, neurosurgeons were more likely to rate the overall burden of liability insurance premiums to be an extreme/major burden (OR=7.398, p<0.001) and to have greater than $2 million in total coverage (OR=9.814, p<0.001) than neurosurgeons from Texas. Annual malpracticeinsurance premiums in Illinois were more likely to be higher than $50,000 than in Texas (OR=9.936, p<0.001), and survey respondents from Illinois were more likely to believe that there is an ongoing medical liability crisis in the U.S. (OR=9.505, p<0.001). Neurosurgeons from Illinois were more likely to report that they very often/always order addition imaging (OR=2.514, p=0.011) or very often/always request additional consults (OR=2.385, p=0.014) compared with neurosurgeons in Texas.

CONCLUSIONS:

Neurosurgeons in Illinois are more likely to believe that there is an ongoing medical liability crisis and more likely to practice defensively than neurosurgeons in Texas.