Week 9 Discussion: APRNs and Malpractice
- My courses
- Week 9: Legal Perspective: Malpractice
- Week 9 Discussion: APRNs and Malpractice
To do:Make forum posts: 2
Value: 100 points
Due: In an effort to facilitate scholarly discourse, create your initial post by Day 3, and reply to two of your classmates by Day 7.
Grading Category: Discussions
Review Tables 29.1 and 29.2 in the Joel textbook (2022) and compare APRN adverse events and malpractice claims to MDs in your state of practice. Identify the differences, explain why you think there is a difference, and discuss how malpractice suits affect patient access.
Reply to at least two of your classmatesâ€”from different states if possibleâ€”after reviewing the information provided in the initial post and comparing your state stats. Address some of the problems, if any, with the current malpractice legal system related to malpractice.
Please refer to the Grading Rubric for details on how this activity will be graded and incorporate these guidelines in your discussion. The grading for the number of reply posts is based on individual Discussion Board instructions. If the rubric indicates a different number for reply posts, you will not be graded down as long as you have followed the reply post instructions.
For this assignment to be considered complete, you must address all the promptsâ€”including how malpractice suits affect patient access to care, comparing APRN to MD adverse events in your state, noting what differences there are, and discussing why there may be differencesâ€”by Day 3 and reply to two classmates, addressing some of the problems with the current malpractice legal system by Day 7
This is my peer’s post
Re: Week 9 Discussion: APRNs and Malpractice
by Cara O’Connor – Monday, 23 October 2023, 11:34 PM
This post aims to first compare adverse actions and malpractice claims made on APRNs and physicians, then to better understand the reasons for these statistics and ultimately how they affect patient care. In table 29.1, Joel (2022) listed the number of reports of malpractice suits and settlements and adverse actions made on various provider types from 2010 to 2019 (p. 501). Physicians, including both MDs and DOs, had 91,111 reports of malpractice and 68,949 reports of adverse actions against them compared to just 3,179 reports of malpractice and 2,898 reports of adverse actions made against APRNs (Joel, 2022). During this time period in Vermont, these same trends were reflected. In the state of Vermont from 2010 to 2019 there were 263 reports filed against physicians and only 18 reports filed against APRNs (NPDB, 2023).
In table 29.2, Joel (2022) lists the percentage of closed claims per APRN specialty, with adult medical/ primary care (41.2%), behavioral health (15.3%), family practice (12.5%), and gerontology (11.9%) accounting for the highest frequencies (p. 502). The physician specialties that have the highest rates of claims include surgery, specifically neurosurgery (19.1%), cardiothoracic surgery (18.9%), and general surgery (15.3%), followed by lower risk specialties such as primary care (5.2%), pediatrics (3.1%), and psychiatry (2.6%) (Jena et al., 2011). Nevertheless, experts estimate that 75% of physicians in the lower risk specialties face a malpractice claim at some point in their careers (Jena et al., 2011). The most common reasons for malpractice allegations among all providers are diagnosis related, surgery related, and treatment/ medication related (Brock et al., 2017).
There are multiple possible reasons for the difference in the number of claims made against physicians versus APRNs. One is that there are simply more physicians compared to APRNs. There are about 1 million active physicians in the United States (AAMC, 2020) compared to about 350,000 licensed nurse practitioners (AANP, 2022). Additionally, physicians are more likely to be performing surgical procedures and treating high risk patients which draws a higher risk for malpractice claims. The higher frequency of malpractice claims against physicians versus APRNs may also be able to be explained by relative incidence of communication failure. According to Joel (2022), communication failure plays a factor in more than 30% of malpractice cases (p. 503). Compared to physicians, APRNs spend a longer time with patients during each encounter, have better communication, and, in turn, more satisfied patients who are less likely to sue (Joel, 2022, p. 504).
Malpractice suits can impair patient access to healthcare. Some have argued that malpractice suits lead to the increasing costs of healthcare related to the need for providers to have malpractice insurance with consistently rising premiums some of which patients end up paying in the form of doctorâ€™s fees (TAMUCC, 2022). Moreover, afraid of being sued, many physicians practice â€œdefensive medicineâ€ where they order potentially unnecessary tests to avoid accusations of malpractice and negligence, also leading to increased healthcare costs (TAMUCC, 2022). From the perspective of the patient, stories of negligence and malpractice can cause fear and trust issues, perhaps preventing some from seeking care at all.
American Association of Medical Colleges (AAMC). (2020). Active Physicians with a U.S. Doctor of Medicine Degree by Specialty. Retrieved from https://www.aamc.org/data-reports/workforce/data/active-physicians-us-doctor-medicine-us-md-degree-specialty-2019American Association of Nurse Practitioners (AANP). (2022). NP Fact Sheet. Retrieved from https://www.aanp.org/about/all-about-nps/np-fact-sheet#:~:text=There%20are%20more%20than%20355%2C000,NPs)%20licensed%20in%20the%20U.S.&text=More%20than%2036%2C000%20new%20NPs,academic%20programs%20in%202020%2D2021.Brock, D.M., Nicholson, J.G., & Hooker, R.S. (2017). Physician Assistant and Nurse Practitioner Malpractice trends. Medical care research and review: MCRR, 74(5), p. 613-624. https://doi.org/10.1177/1077558716659022Jena, A.B., Seabury, S., Lakdawalla, D., & Chandra, A. (2011). Malpractice risk according to physician specialty. The New England journal of medicine, 365(7), p. 629-636. https://doi.org/10.1056/NEJMsa1012370Joel, L.A. (2022). Advanced practice nursing: Essentials for role development (5th ed.). F.A. Davis Company.National Practitioner Data Bank (NPDB). (2023). Data Analysis Tool. U.S. Department of Health & Human Services. Retrieved from https://www.npdb.hrsa.gov/analysistool/Texas A&M University Corpus Christi (TAMUCC). (2022). Malpractice and Its Effects on the Healthcare Industry. Retrieved from https://online.tamucc.edu/degrees/business/mba/healthcare-administration/malpractice-and-its-effects-on-the-healthcare-industry/