Ophthalmologist Malpractice Insurance

During the past two decades, there have been major changes in the risk management environment for ophthalmologists in America. Sub-specialization has become much more common; today, more than half of ophthalmologists continue their education into a sub-specialty. Sub-specialties of ophthalmology include glaucoma, neuron-ophthalmology and refractive surgery. Also, 63 percent of ophthalmologists are now practicing as part of a physician group, whereas 20 years ago, most ophthalmologists were solo practitioners. With the arrival of managed care, ophthalmologists have begun working more efficiently and more collaboratively. Reimbursement rates have fallen dramatically-in 2007, ophthalmologists received about a quarter to a third of what they got for a cataract operation in 1987, even though the procedure is now more technically difficult to perform. Lastly, new technologies and drugs have increased exposure to lawsuits for ophthalmic medical malpractice.

In the past, ophthalmology was classified by medical malpractice insurers as a low-risk specialty, but still carried relatively high premiums. Today, the specialty is usually considered high-risk, and premiums for medical malpractice insurance have risen steadily. Premiums vary depending on the physician’s location and specific exposure to risk. Premiums are highest in more litigious, urban states like Florida and Illinois, but are generally lower in more rural states.

The most common source of malpractice claims against ophthalmologists is cataract surgery. Another common cause of lawsuits is refractive surgery, which are elective and paid for out of patients’ own pockets. As a result of this, patients often have very high expectations and more likely to sue if these inflated expectations are not met.

A particularly high-risk sub-specialty of ophthalmology is pediatric ophthalmology. As patients are at the beginning of their lives, the indemnity judgment when a physician is found liable for a permanent injury to a child’s eyes can be quite large. Pediatric ophthalmologists should be especially scrupulous in their risk management practices.

The frequency of malpractice claims against ophthalmologists spiked in 2003 and has fallen to a rate of about one-in-12 ophthalmologists receiving a claim during the course of their career. This downward trend has been accompanied by an opposite, upward movement in the dollar value of the average claim paid out. According to a study of malpractice suits resulting from Lasik and PRK surgeries, the most effective predictor of whether an ophthalmologist will face a malpractice claim is his or her surgical volume.Physicians who perform more surgeries have a greater risk of being sued. Previous claims were also an indicator for future claims. Another factor that may have an effect is time spent with patients before surgery. More preoperative time translated to a somewhat lower risk of a lawsuit.

Ophthalmologists should be familiar with these common causes and risk factors for malpractice lawsuits, and should also employ effective risk management techniques to minimize the likelihood of a claim. These include thorough documentation and effective communication with patients. If ophthalmologists are concerned about rising liability insurance premiums, they should support the efforts of their specialty organizations and of state politicians to effect tort reform in courts across the United States.

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Important Resources for Ophthalmologist

American Academy of Ophthalmology
American Board of Ophthalmology
Ophthalmology – Medscape
Digital Journal of Ophthalmology
Optometrist Vs. Ophthalmologist (patient info)
International Council of Ophthalmology
Practice Management Resources
Atlas of Ophthalmology
The Association for Research in Vision and Ophthalmology