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.

There is a global shortage of healthcare workers estimated by the WHO to reach a deficit of 12.9 million by 2035. This is more than the population of Cyprus, Denmark and Finland combined. Many countries are struggling to reach the basic threshold of 23 skilled health professionals per 10 000 people, and there are still 83 countries below this basic threshold. Unfortunately, the rate of training of new health professionals is falling well below current and projected demand.

The largest shortages in numerical terms are expected to be in parts of Asia, and sub-Saharan Africa. For example, in the 47 countries of sub-Saharan Africa, 11 have no medical schools, and 24 countries have only one medical school with 2 doctors and 11 nursing/midwifery personnel per 10,000 population

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.