For physicians, quality of care is regulated through the medical malpractice and professional licensing/disciplinary systems. The medical malpractice (med mal) system acts through ex post private litigation; the licensing system acts through ex ante permission to practice (i.e., licensure), coupled with ex post disciplinary action against physicians who engage in “bad” behavior. How often do these separate mechanisms for ensuring quality control take action against the same doctors? With what result? We study these questions using 41 years of data (1975–2015) from Indiana, covering almost 30,000 physicians. Disciplinary sanctions are much less common than med mal claims—whether paid or unpaid. Only a small number of physicians are “tagged” by both systems. Disciplinary risk increases with the number of past med mal claims. Paid claims have a greater impact than unpaid claims, and large payouts (≥100 k, 2015$) have a slightly greater impact than small payouts on disciplinary risk. The risk of a paid claim increases with more severe disciplinary sanctions (i.e., revocation and suspension). Our findings suggest an obvious model for the interaction of these two systems.

中文翻译：

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针对不良医生：1975-2015年印第安纳州的教训

对于医生来说，医疗质量是通过医疗事故和专业许可/学科系统进行管理的。医疗事故（医疗事故）制度是通过事后私人诉讼进行的；执照制度通过事前许可（即执照）行事，并针对从事“不良”行为的医生事后采取纪律处分。这些确保质量控制的独立机制多久对同一位医生采取行动？结果如何？我们使用来自印第安纳州的41年数据（1975-2015年）研究了这些问题，涵盖了近30,000位医生。无论是有偿还是无偿，纪律处分都没有医疗索赔那么普遍。这两个系统仅对少数医师进行“标记”。学科风险随着过去的医学索赔数量的增加而增加。支付的索赔比未支付的索赔具有更大的影响，大额支出（≥100k，2015 $）对纪律风险的影响比小支出更大。随着更严厉的纪律制裁（即撤销和中止），有偿索赔的风险增加。我们的发现为这两个系统的相互作用提出了一个明显的模型。