The frequency and size of compensation related to medical negligence claims has significantly increased globally over the last decade. In South Africa, The Gauteng Department of Health alone saw an increase in claims from R573-million in the 2009/2010 to R1.28-billion in the 2012/2013 financial year.1 As a result of this, the cost of medical indemnity for doctors has spiraled. In the eight years between 2005 and 2013, the cost of indemnity insurance for private specialists in obstetrics had increased by 382%.2 Obviously, this is one of the higher paying specialties, as an injury incurred during childbirth can have lifelong implications and costs. The actual amount that some obstetricians are paying on an annual basis can be up to R850, 000. There are a number of hypothesis to explain this increasing trend. Firstly, that overall standard of practice has declined over the years and that doctors are not as competent as previously; secondly, patients have more rights and are better informed of their rights and ability to lay claims and lastly that litigating lawyers have taken an increased interest in medical claims and are advertising their services to a greater extent. For each of these hypotheses, one could argue for and against their validity, however regardless of the reasons, the outcome is negatively impacting the way doctors are practicing and their decisions to practice. Unsurprisingly, clinical practice is shifting to a “defensive” strategy rather than an appropriate patient centered approach.

What exactly is medical indemnity insurance?

It is a type of insurance cover for any “actual or alleged” medical negligence by a healthcare professional, including complaints lodged with the professions Councils. The cover indemnifies you against your legal liabilities for damages for any bodily injury, mental injury, mental anguish or shock, illness, disease or death of any patient caused by your alleged negligence, including legal costs and expenses.

Who should have medical indemnity insurance?

Anyone who is practicing or offering traditional or non-traditional medical healthcare.

Do I need insurance if I work for the state?

The state has its own indemnity which will protect doctors from any negligence claims whilst under their employment. However, this does not include assistance for internal disciplinary committees or HPCSA investigations. Thus as a result the majority of doctors have insurance with a third party provider e.g. MPS.

Which insurance provider should I use?

There are a number of insurance providers including the 2 biggest and most popular providers, Medical Protection Society (MPS) and newer player Aon, as well as smaller private insurance providers. It is important to note that MPS is not an insurance provider but rather a not-for-profit professional organisation, owned and accountable to its members. They have been offering services in South Africa for 50 years and has 31,000 members in the country. In order to claim from MPS however, you need to be a current member at the time of the event. This means that post retirement if a claim is laid against you, you will not be covered. One can purchase an additional five years of post-retirement protection at a special rate however beyond this, doctors are open to civil action. There have been claims up to 40 years after the event in some circumstances.3 Thus for peace of mind one should consider Aon who does offer tail cover, or coverage for future suits against incidents that occurred while the doctor was insured, even after he has retired or left for private practice. When it comes to pricing, this can greatly vary depending on your position level and specialty, therefore for each provider you would need to request a personalised quote.

Conclusion

As with any form of insurance, it is expensive when you don’t need it, but very cheap if you ever do. In the current landscape of increasing medical negligence claims, it is an indispensable part of practicing healthcare and you shouldn’t be caught without it.

Reference:

  1. PIENAAR, Letitia.Investigating the reasons behind the increase in medical negligence claims. PER [online]. 2016, vol.19, n.1 [cited  2018-03-26], pp.1-22. Available from: <http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1727-37812016000100005&lng=en&nrm=iso>. ISSN 1727-3781.  http://dx.doi.org/10.17159/1727-3781/2016/v19i0a1101.
  2. https://www.fin24.com/Economy/r1m-bill-no-one-left-to-deliver-our-babies-20170406
  3. https://www.themdu.com/guidance-and-advice/journals/mdu-journal-november-2013/indemnity-for-claims-many-years-after-an-incident

Exams booked and 4 months to prepare for the first step in reaching my dream of becoming a specialist. More than enough time but sufficiently short enough to apply some pressure to start studying. Or so I thought. The demands of work and ensuring that I spent the remainder of my spare time avoiding anything medically related meant that the first 2 months were not very productive.

I spent most of my time attempting to study sections in between work and calls and searching my network for any and all past papers. The second part I was more successful at and managed to get hold of and spend a small fortune photocopying a whole stack of past paper questions. Time seemed to disappear and with 1 month left I focused entirely on past papers. This was a fantastic way to learn what to expect and how to perform well in the actual exam. The most time-consuming part of this however, was having to refer to textbooks to substantiate the answers and gain a clearer understanding of why I was right or wrong.

In the end, it was all worth it just to see my name on the pass list and know that I’m one step closer to my dream. If Passmed had been available at the time, this would have made life 100x easier.

According to WHO, there is currently a global shortage of more than 7 million health workers and this could rise to nearly 13 million by 2035. Growing populations and access to medical educational are just two factors creating the global shortage of health care workers which is compounded by natural disasters and health crises.

Health workers are inequitably distributed throughout the world, with severe imbalances between developed and developing countries. Even within countries, there is a lack of adequate staff in rural areas compared to urban areas. Sub-Saharan Africa faces the greatest challenges. While it has 11 percent of the world’s population and 24 percent of the global burden of disease, it has only 3 percent of the world’s health workers.

Sudden catastrophic events can quickly overwhelm local and national health systems already suffering from staff shortages or lack of funds. When the Ebola epidemic struck West Africa in 2014, the outbreak led to the death of 221 health care workers in Sierra Leone, further complicating already challenging health problems for women and children. With the current COVID 19 pandemic, healthcare workers on the front lines have been exposed and many have lost their lives. At least 90,000 health-care workers worldwide are believed to have been infected with COVID-191.

Distribution of health workers by level of health expenditure and burden of diseases, for WHO regions. (The size of dots is proportional to health expenditure)

Add to this the rising incidence of non-communicable diseases (NCDs) and the growing geriatric population – will generate a demand for 40 million additional health workers globally by 2030. This would require doubling our current global health workforce.

Health systems designed around hospitals and clinics need to shift focus towards preventive care and encourage a holistic health approach encompassing all socio-economic determinants of health.  This will not just help avoid unnecessary in-patient and emergency room visits but will also result in better health outcomes for the community at large.

Other challenges facing the healthcare workforce include gender inequality, poor distribution of skills and inadequate training and recruitment. According to the WHO, globally only 30% of doctors are females and more than 70% of nurses are females2.  A balanced healthcare workforce that addresses the issue of gender inequity and ensures equal pay for work of equal value, a favorable working environment, and targets investments towards training the female workforce is needed now more than ever.

As per an OECD global survey, 79% of nurses and 76% of doctors were found to be performing tasks for which they were over-qualified3. Given the global evidence for the poor distribution of skills, we must rationally re-organize our workforce for effective management of high-burden diseases.

Development of strong frameworks to oversee medical education, health employment and migration of health workers can bridge this global shortage of healthcare workers. Concrete efforts are required in sectors such as recruitment, development, training and retention of the health workforce in developing countries so as to make sure that the workforce is directly proportional to the population.

 

References

  1. Reuters. Over 90,000 health workers infected with COVID-19 worldwide: nurses group 2020 [updated 6 May, 2020. Available from: https://www.reuters.com/article/us-health-coronavirus-nurses/over-90000-health-workers-infected-with-covid-19-worldwide-nurses-group-idUSKBN22I1XH2020.
  2. Organization WH. Global strategy on human resources for health: workforce 2030. 2016
  3. Britnell M. Human: solving the global workforce crisis in healthcare: Oxford University Press 2019.

1. Study, Sleep, Repeat.

Sleep is almost as important as study time. It’s during this downtime that the brain strengthens new memories which means that there is a good chance we’ll remember whatever we review right before we sleep. Don’t bring your books to bed though, as this encourages bad study habits and subconsciously takes your bed from a sleeping haven to a study den. We have all attempted an all-nighter before but these have been linked to impaired cognitive performance and greater sensitivity to stress. So tuck in and get yourself some slumber time.

2. Space it out.

“Cramming” is often the weapon of choice and is actually a very effective way of passing exams. However much of what is learnt is forgotten in an equally short period of time. “Spaced repetition,” first described in the 1880s by German psychologist Hermann Ebbinghaus is a far more effective way of retaining those golden nuggets of information. So instead of spending a week or two, dosed up on your energy supplement of choice, rather spend an hour a day going over smaller chunks of information and review them consistently over a longer period of time.

3. Be creative.

A lot of medical learning is didactic and the easiest way to remember those long lists of complications, signs etc, is to create your own memorable mnemonics. Passmed have added a few here and there to spark your imagination, however your own are often the best.

4. Change it around.

Change topics, location, or even the music you listen to whilst studying as this forces the brain to make new and stringer associations.

5. Test yourself

Testing yourself is one of the best ways to assess how prepared you really are. This is why Passmed has an exam mode which recreated time test like conditions.