Academic Urological Surgeons have Greater Exposure to Risk Management Activity than Community Urological Surgeons: An Empirical Analysis of Patient Complaint Data

Introduction: Previous research reveals associations between patient complaints and urological subspecialty, but relationships between complaints and practice environments have gone untested. In this study we explored whether associations exist between the types and rates of patient complaints filed against urological surgeons and their practice environments, defined as academic (medical school faculty) or community (independent medical group members). Complaints are a surrogate for malpractice litigation risk, so understanding the variables that drive complaints may suggest risk reduction interventions. Methods: In this retrospective, exploratory study we examined 2,883 unsolicited patient complaints about 357 urologists affiliated with organizations partnering with the Vanderbilt Center for Patient and Professional Advocacy. Overall 222 (62%) urologists were practicing in 16 academic medical center systems and 135 (38%) in 11 community systems that recorded complaints from January 1, 2011 through December 31, 2014. Specific concerns about urologists were counted. Complaint type profiles were generated using a standardized coding system. Statistical analyses tested associations among practice environment (academic vs community), complaint counts and distribution of complaints by type. Results: Academic urologists had more complaints per physician than their community colleagues (Z = 2.53, p <0.05). They also had more complaints about care/treatment, communication (p <0.05) and access issues (p <0.001). Conclusions: Academic urologists are associated with more patient complaints than community urologists, suggesting greater exposure to medical malpractice claims. Concerns regarding access, communication and the care that patients received appear to drive this discrepancy. Personal practice and clinical management solutions designed to improve these elements of patient experiences, especially access, may help reduce medical malpractice claims related activity.