What is an acceptable annual increase in malpractice premiums? The physician perspective

• Objective: To determine what annual increase in malpractice premiums would be acceptable to academic physicians at a large institution. • Methods: All 270 full-time physician faculty in the department of medicine at Johns Hopkins University School of Medicine in 2004 were invited to participate in this study. A contingent valuation approach was used to assess willingness to accept a specified increase in annual premiums. The median acceptable malpractice rate increase was calculated using logistic regression and assessed the influence of faculty characteristics using multivariable regression. • Results: 197 (73%) faculty responded. Thirty percent were female and two thirds were clinician-investigators. The median acceptable annual increase in malpractice premiums was 6.4%. Clinician-educators were more likely than clinician-investigators to accept any of the proposed annual increase in premiums (odds ratio [OR], 3.23 [95% confidence interval {CI}, 1.18-8.87]). Compared with their younger counterparts, older male faculty were more willing to accept any of the assigned rates (OR, 30.3 [95% CI, 2.53-361.22]). Older female faculty were 90% less likely to accept any suggested rate increase compared with older male faculty (OR, 0.10 [95% CI, 0.02-0.59]). • Conclusion: Academic physicians believe that small annual increases in malpractice rates are acceptable. Knowing what physicians judge to be acceptable is relevant for understanding the frustration associated with recent rate increases and may be pertinent to efforts aimed at moving toward a resolution of the malpractice crisis.