243 Medico-Legal Liability and Defensive Medicine in Neurosurgery: Results From a National Survey

INTRODUCTION: Defensive medicine is the practice of providing (or withholding) care as a safeguard from litigation, instead of following true medical indications. Neurosurgeons have the highest medico-legal liability of any specialty and are at high, but understudied, risk for practicing defensive medicine. METHODS: We surveyed US neurosurgeons on the AANS listserv using a previously validated survey about liability burden, defensive medicine practices, and burnout. Of the 450 people who opened the link, 279 (62%) people completed the survey. RESULTS: 279 attending neurosurgeons completed our survey, representing diverse sub-specialties, practice settings, and geographies. Defensive medicine was prevalent among surveyed surgeons with 86% ordering imaging, 68% referring patients to other consultants, 66% ordering lab tests, 30% prescribing medication, and 28% suggesting a procedure due primarily to medicolegal risk. While a majority (53%) reported they would still choose neurosurgery if the current liability situation was present when they initially chose the specialty, 62% stated that medico-legal liability affects their decision on how long to practice neurosurgery, 60% believe there to be a medical liability crisis, and 60% potentially see every patient as a lawsuit. Similarly, 29% stopped offering procedures/services that they deemed “high-risk”, 40% avoided caring for 'high malpractice/lawsuit risk' patients for liability reasons alone, and 50% experienced symptoms of burnout. CONCLUSIONS: A national neurosurgery-specific survey on medico-legal liability and defensive medicine revealed significant, widespread use of defensive medicine tactics, avoidance of certain operations, and an impact on early retirement. The current medico-legal environment for neurosurgeons appears likely to simultaneously lead to inefficient care and artificial neurosurgical shortages.