Table 1.
Unadjusted ORs and 95% CIs for the Associations Between Pathologist Demographics, Training, and Clinical Experience and Influence Toward a More Severe MSL Diagnosis Due to Concerns About Medical Malpractice (n = 207)a
| Pathologist Characteristic | All Pathologists, No. (%) | Influence Toward a More Severe Diagnosis, No. (%) | No Influence on Diagnosis, No. (%) | OR (95% CI)b | P Value |
|---|---|---|---|---|---|
| Total | 207 (100.0) | 57 (27.5) | 150 (72.5) | ||
| Demographics | |||||
| Age, y | .007 | ||||
| <50 | 95 (45.9) | 35 (36.8) | 60 (63.2) | Reference | |
| ≥50 | 112 (54.1) | 22 (19.6) | 90 (80.4) | 0.42 (0.23-0.79) | |
| Sex | .13 | ||||
| Male | 123 (59.4) | 29 (23.6) | 94 (76.4) | Reference | |
| Female | 84 (40.6) | 28 (33.3) | 56 (66.7) | 1.62 (0.87-2.99) | |
| Training and clinical experience | |||||
| Residency training | .10 | ||||
| Anatomic/clinical pathology | 186 (89.9) | 48 (25.8) | 138 (74.2) | Reference | |
| Dermatology | 21 (10.1) | 9 (42.9) | 12 (57.1) | 2.17 (0.86-5.47) | |
| Fellowship training/board certification | .81 | ||||
| Otherc | 126 (60.9) | 34 (27.0) | 92 (73.0) | Reference | |
| Dermatopathologyd | 81 (39.1) | 23 (28.4) | 58 (71.6) | 1.08 (0.58-2.00) | |
| Years interpreting MSLs | <.001 | ||||
| <20 | 143 (69.1) | 50 (35.0) | 93 (65.0) | Reference | |
| ≥20 | 64 (30.9) | 7 (10.9) | 57 (89.1) | 0.24 (0.10-0.56) | |
| MSL volumee | .32 | ||||
| <35 | 76 (36.7) | 24 (31.6) | 52 (68.4) | Reference | |
| ≥35 | 131 (63.3) | 33 (25.2) | 98 (74.8) | 0.73 (0.39-1.36) | |
| Total number of MSLs (per month)e | |||||
| Mean (SD) | 125 (178.0) | 111 (131.5) | 131 (192.9) | 1.00 (0.99-1.01)f | .58 |
| For what percentage of MSLs is your final assessment that the diagnosis is borderline or uncertain? | .28 | ||||
| None | 21 (10.1) | 3 (14.3) | 18 (85.7) | Reference | |
| 1%-4% | 93 (44.9) | 24 (25.8) | 69 (74.2) | 1.86 (0.53-6.55) | |
| ≥5% | 93 (44.9) | 30 (32.3) | 63 (67.7) | 2.54 (0.73-8.84) | |
| Have you ever been named in a medical malpractice suit | .70 | ||||
| Never been sued | 139 (67.1) | 41 (29.5) | 98 (70.5) | Reference | |
| Yes, related to MSL | 12 (5.8) | 3 (25.0) | 9 (75.0) | 0.87 (0.23-3.30) | |
| Yes, not related to MSL | 56 (27.1) | 13 (23.2) | 43 (76.8) | 0.74 (0.36-1.51) | |
CI, confidence interval; MSL, melanocytic skin lesion; OR, odds ratio; SD, standard deviation.
aPercentages may not total 100 due to rounding.
bFirth’s bias reduction method based on penalized likelihood (addresses issues of separability, small sample sizes, and bias of the parameter estimates). Wald χ2 statistics were used to test the effect each independent coefficient had on the direction of influence.
cIncludes fellowships or board certifications in surgical pathology, cytopathology, or hematopathology.
dPathologists in this category have single or multiple certifications/fellowship training, including dermatopathology.
eSum of number of melanomas + benign MSLs interpreted per month.
fOdds ratio for every 5-unit increment in number of MSLs per month.