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Study: Practice of defensive orthopedic medicine costs United States $2 billion annually
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 Manish Sethi |
Researchers have estimated that U.S. orthopedic surgeons create approximately $2 billion per year in unnecessary orthopedic health care costs through the practice of defensive medicine.
The study suggests unnecessary costs associated with the practice of defensive medicine play a role in the increasing costs of health care, according to a Vanderbilt University Medical Center news release.
According to the study abstract, the researchers sent an online survey to 2,000 orthopedic surgeons selected randomly from a list provided by the American Academy of Orthopaedic Surgeons. With 1,214 respondents (61%), the researchers reported 1,168 (96%) said they had practiced defensive medicine through ordering “imaging, laboratory tests, specialist referrals or hospital admissions mainly to avoid possible malpractice liability.”
The results mean that 24% of all ordered tests, according to the abstract, were ordered for defensive reasons. “Currently, our nation’s expenditure on health care is 20% of GDP,” study author Manish Sethi, MD, stated in the release. “If defensive medicine can be curbed, we will see a dramatic reduction in health care costs, and our research makes this case.”
Cost of defensive medicine per respondent was calculated through mean national Medicare payment information, the authors noted in the abstract, determining the total to be approximately $100,000 per respondent per year. Extrapolated out to cover the 20,400 practicing orthopedic surgeons in the United States, the authors estimated defensive medicine cost the orthopedic field a total of more than $2 billion per year.
Reference:
- Sethi MK, Obremskey WT, Natividad H, et al. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: A national survey study. Am J Orthop. 2012;41(2):69-73.
- Disclosures: The authors have no relevant financial disclosures.
This study is yet another step in the right direction, albeit with an inherent flaw related to bias in answering a survey containing self-serving questions. Most physicians would obviously like to see the incidence of medical malpractice litigation reduced, or eliminated entirely. As scientists, physicians also naturally want to quantify the true incidence and cost of procedures and tests done solely to avoid litigation, with no benefit to the patient. Those data would identify the true incidence of so-called defensive medicine.
Instead, the term “defensive medicine” has been bandied around to built support for legislative reforms aimed at conferring physician immunity for allegedly tortious acts that can constitute professional negligence. The truth is that a precise definition of what constitutes defensive medicine remains elusive. To the extent that tort law contributes to a healthy fear that the system will hold an individual accountable, what the survey identified as defensive medicine may be just what the doctor ordered, so to speak, in order to ensure quality and safety. Study authors are to be applauded for tackling, as other authors have done in the past, one of the most difficult and vexing subjects at the intersection of the law and medical practice.
— B. Sonny Bal, MD, JD, MBA
University of Missouri School of Medicine
Columbia, Mo.
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