While numerous recent US studies indicate a decline in medical malpractice suits across many medical specialties in the past decade, medicolegal concerns facing radiologists have conversely increased.1–4 A 2013 report on diagnostic radiologists indicated that 30.9% (2600 of 8401) of all US radiologists have been sued.4 A subsequent 2014 study of neuroradiologists found that 449/904 (49.7%) American Society of Neuroradiology members had been sued, and of these, nearly 50% were sued multiple times.3 The level of concern over malpractice suits was reported as moderate in severity by practicing neuroradiologists in the United States, and most respondents, despite substantial contradictory evidence on the outcomes of malpractice trials favoring defendants, thought that the medicolegal system was weighted against them.3 We are scared.
Have we exported malpractice suits as readily as we have exported Kentucky Fried Chicken and Subway outlets across the globe? With the exception of the European Union, few countries outside the United States report malpractice lawsuit rates. We, therefore, created an informal survey, which was sent via e-mail to 96 neuroradiologists worldwide, representing 49 countries, to gain a sense of whether the American experience and anxiety over being sued are unique or universal. The survey results were sent to 60 officers of those national radiology society boards to confirm the data.
The data from this informal survey are presented in the Table. The following are the 8 countries with the highest rates of radiologic malpractice suits, shown with average radiologist salaries and annual malpractice premium rates (presented respectively in parentheses):
United States, government and private (46%, $340,000, $21,000)3
Italy, government (50%, $300,000, $3000)
Ireland, government (35%, $235,000, $8000)
Germany, government and private (30%, $300,000, $1670)
Spain, government (10%, $65,000, $550)
Sweden, government (10%, $130,000, $550)
Saudi Arabia, government (10%, $300,000, $8500)
Chile, government (10%, $120,000, $1000).
Survey research data collected
| Country | Average Radiologist Salary | Radiologist/Practice Pays for Insurance | Average Insurance Premium | Radiology Malpractice Rate | Representative Radiologist Sued for Malpractice | Fear of Being Sueda | Practices Defensive Medicinea | Malpractice Affects Practicea |
|---|---|---|---|---|---|---|---|---|
| Africa | ||||||||
| Egypt | $50,000 | No | Null | 5% | No | 3 | 4 | 2 |
| Americas | ||||||||
| Argentina | $37,000 | Yes | $1200 | 5% | Yes | 1 | 2 | 2 |
| Brazil | $130,000 | Yes | $560 | 1% | No | 1 | 1 | 2 |
| Canada | $300,000 | No | $3000 | 5% | Yes | 2 | 2 | 2 |
| Chile | $120,000 | Yes | $1000 | 10% | Yes | 3 | 3 | 4 |
| Guatemala | $35,000 | No | Null | 1% | No | 1 | 1 | 1 |
| United States | $340,000 | Yes | $21,000 | 46% | No | 4 | 4 | Null |
| Asia | ||||||||
| Indonesia | $60,000 | Yes | $300 | 0% | Yes | 5 | 5 | 4 |
| Japan | $100,000 | Yes | $70 | 1% | Yes | 2 | 4 | 4 |
| Malaysia | $190,000 | Yes | $8400 | 0% | No | 2 | 2 | 2 |
| Philippines | $21,000 | No | Null | 2% | No | 2 | 1 | 2 |
| Singapore | $200,000 | Yes | $1750 | 5% | Yes | 3 | 3 | 3 |
| South Korea | $200,000 | Yes | $5000 | 3% | Yes | 2 | 1 | 2 |
| Sri Lanka | $12,000 | No | Null | 0% | No | 2 | 3 | 2 |
| Taiwan | $120,000 | Yes | $600 | 3% | Yes | 4 | 4 | 4 |
| Australia/Oceania | ||||||||
| Australia | $450,000 | Yes | $5000 | 5% | No | 2 | 2 | 2 |
| New Zealand | $240,000 | Yes | $1300 | 0.1% | No | 2 | 2 | 2 |
| Europe | ||||||||
| Belgium | $300,000 | No | Null | 1% | No | 3 | 3 | 3 |
| Bosnia/Herzegovina | $17,000 | No | Null | 2% | No | 3 | 2 | 2 |
| Croatia | $25,000 | No | Null | 2% | Null | 2 | 3 | 2 |
| Cyprus | $84,000 | Yes | Null | 5% | Yes | 2 | 2 | 3 |
| Denmark | $100,000 | No | Null | 10% | Yes | 2 | 2 | 1 |
| Finland | $100,000 | No | Null | 1% | No | 1 | 2 | 2 |
| France | $180,000 | Yes | $1360 | 5% | Yes | 3 | 5 | 4 |
| Germany | $300,000 | Yes | $1670 | 30% | Yes | 2 | 3 | 2 |
| Greece | $30,000 | No | $750 | 1% | No | 2 | 3 | 2 |
| Ireland | $235,000 | Yes | $8000 | 35% | No | 4 | 3 | 4 |
| Italy | $300,000 | Yes | $3000 | 50% | Yes | 3 | 3 | 4 |
| Lithuania | $14,000 | No | Null | 3% | No | 3 | 4 | 4 |
| The Netherlands | $165,000 | No | Null | 1% | No | 2 | 1 | 2 |
| Norway | $200,000 | Yes | $70 | 1% | Yes | 1 | 1 | 1 |
| Portugal | $150,000 | Yes | $2000 | 1% | Yes | 2 | 3 | 3 |
| Spain | $65,000 | Yes | $550 | 10% | Yes | 2 | 2 | 3 |
| Sweden | $130,000 | No | $550 | 10% | Yes | 2 | 2 | 1 |
| Turkey | $40,000 | Yes | $300 | 3% | No | 3 | 3.2 | 3.4 |
| United Kingdom | $175,000 | Yes | $1700 | 2% | No | 2 | 2 | 2 |
| Middle East | ||||||||
| Iran | $36,000 | Yes | $400 | 4% | Yes | 4 | 4 | 3 |
| Iraq | $19,200 | No | Null | 0% | Yes | 3 | 4 | 5 |
| Israel | $12,000 | Yes | $330 | 2% | No | 2 | 2 | 2 |
| Lebanon | $120,000 | Yes | $200 | 1% | Yes | 4 | 4 | 3 |
| Saudi Arabia | $300,000 | Yes | $8500 | 10% | Yes | 5 | 4 | 3 |
Note:—Null indicates no response/not applicable.
1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = always.
The responses generally revealed a moderate level of concern about malpractice that is a global phenomenon. The impact on our collective practice of medicine varies from mild to moderate across countries. As to Americans' fear of malpractice lawyers, WE ARE NOT ALONE.
REFERENCES
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