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Stuck in a Moment: An Ex Ante Analysis of Unsolicited Patient Complaints in Plastic Surgery, Dermatology, and Surgery, to Predict Malpractice Risk Profile, in a National Cohort of Physicians from the Patient Advocacy Reporting System (PARS)
Charles S. Hultman, MD, MBA1, Thomas F. Catron, PhD2, Gerald B. Hickson, MD2, Gwyther Robert, MD, MBA1.
1University of North Carolina, Chapel Hill, NC, USA, 2Vanderbilt, Nashville, TN, USA.

Introduction: Unsolicited patient complaints (UPCs) serve as a powerful predictor of increased malpractice risk, and reductions in UPCs, through targeted physician interventions, lower incidence of lawsuits and decrease the cost of overall risk management. Ex ante studies to predict malpractice risk, based on UPCs, have been performed and validated for some surgical subspecialties, but not plastic surgery. We conducted an analysis of UPCs, reported to and verified by patient relations, to determine the malpractice risk of plastic surgeons, compared to dermatologists, all surgeons, and all physicians, from a national patient complaint registry.
Methods: We examined the patient complaint profiles and risk scores of 31,077 physicians (3,935 surgeons, 338 plastic & reconstructive surgeons, and 519 dermatologists), who participated in the Patient Advocacy Reporting System (PARS), a national registry of UPCs. Patient complaint data were collected from 70 community and academic hospitals across 29 states, from 2009-2012. In addition to determining the specific complaint mix for plastic surgery compared to all physicians, each physician was assigned a patient complaint risk score, based on a weighted sum algorithm. Scores above 50 are considered to be at moderate risk for medical malpractice claims, whereas scores above 70 are at high risk. Plastic and reconstructive surgeons (PRS) were further divided into “plastic surgery” (PS, n=245) and “reconstructive plastic surgery” (RS, n=93) cohorts, based on self-identification by the physician. Patient complaint profiles and risk scores were compared between all groups, using Wilcoxon rank and chi-square analysis. P values <0.05 were assigned statistical significance.
Results: Over this 4-year period, the majority of plastic surgeons (50.8%) did not generate any patient complaints, but those who did received an average of 9.8 complaints from 4.8 patients. RS generated an average of 17.0 complaints from 7.5 patients, whereas PS generated an average of 8.7 complaints from 4.3 patients. Overall mix of patient complaints for PRS was nearly the same as the national cohort of all physicians: care and treatment, 49%; communication, 19%; accessibility and availability 14%; money or payment issues, 9%, and concern for patient/family, 9%. While PRS had lower risk scores than all surgeons, dermatologists had substantially lower risk scores than PRS (p<0.02). PRS who identified themselves as RS had significantly higher risk scores than PS (p<0.005).
Conclusions: PRS are at increased risk for UPCs, compared to most physicians, especially dermatologists. PRS who self-identify as RS have the highest risk profile for the cohorts in this analysis; however, the risk profile of PS approaches that of dermatologists. Because UPCs are a robust proxy for malpractice risk, targeted interventions to decrease patient complaints concerning RS may improve patient satisfaction and reduce malpractice claims. Monitoring UPCs may permit early identification of and intervention in high risk PRS, before malpractice claims accumulate.
Comparison of Physician Groups, Based on Index Score of Patient Complaints
All physiciansAll surgeonsPlastic & recon surgeons (PRS)DermatologistsPlastic surgeons (PS)Recon surgeons (RS)
N=31,077N=3,935N=338N=519N=245N=93
Index score > 50 (moderate risk)5.5%9.2%6.9%3.2%5.3%15.0%
Index score > 70 (high risk)2.0%4.1%2.4%1.4%1.4%7.5%


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