Medical liability insurers adding personality tests to application process

Are physicians risk takers? Are they influenced by what others think of their behavior?

Some medical liability insurers want to know and are quizzing doctors on their bedside manner in hopes of reducing medical liability claims.

Iowa-based United Medical Liability Insurance Co. is among the latest to require physicians to take a communication skills assessment -- akin to a personality test -- before issuing a policy.

In a 15-minute online test, doctors must respond to statements that gauge how they view themselves and how they believe others view them.

"The idea is not to become invasive, but to create awareness of what might be seen as an issue and reduce the probability of a malpractice claim," said James E. Krist, president and CEO of United Medical.

Doctors who fare "poorly" on the assessment have to go through a coaching session, at no cost to them, on how to improve their communication skills if they want coverage. The coaching also is available to any physician already insured with the company. United Medical has been using the test for at least a year in Iowa and hopes to further refine it to account for physicians' roles in different specialties, Krist said.

"We can't change personality, but we can change behaviors," he said.

Insurers point to a host of studies over the past decade linking physicians' communication skills -- or lack thereof -- to the potential for getting sued. They see the test as one way to predict and possibly curb that risk.

Michigan-based American Physicians Assurance Corp. has used a similar evaluation since 2003 in three of the seven states it covers -- Illinois, Kentucky and Ohio. Executives chose those states because they saw a higher number of liability claims and payouts there.

APAC also requires the three-page written test as a condition of receiving a new policy.

APAC spokeswoman Cathy Burke said doctors who do "well" on the test tend to have fewer claims filed against them, according to an internal survey of 1,200 policyholders. That, combined with independent research showing physicians' rapport with patients can indicate their odds of being sued, is what motivated the company to turn to the assessment.

"We want them to not only meet underwriting criteria, but have good communication skills," Burke said.

But some doctors question how insurance companies can fairly and accurately evaluate physicians. They also wonder whether the results could lead to higher premiums or even disqualify them for coverage.

Norman Jensen, MD, president-elect of the American Academy on Communication in Healthcare, is suspicious "because I don't know of any personality test or communications skills test that has been validated for the purpose of estimating physicians' risk for malpractice claims."

He said an assessment could be a good vehicle for insurers to promote communications training for doctors or contribute to further research. But until a sound test is developed, the practice "could encourage discrimination," warned Dr. Jensen, a professor of internal medicine at the University of Wisconsin School of Medicine and Public Health.

Iowa pediatrician James R. Hubbard, MD, agrees. "It's difficult enough [for doctors] to get malpractice insurance, and to have one more barrier in the way doesn't help." His liability coverage is not through United Medical.

But Angela Voos, CEO of Surgical Associates LLP of Grinnell, in Iowa, which is insured by United Medical, said many of the practice's surgeons saw the test as an opportunity to learn something about themselves.

No doctors "failed" the assessment, she said. Nevertheless, they opted to undergo a group coaching session.

"Our approach was not about passing or failing," Voos said. "We took it as, this is really a tool for a group of doctors to learn what is the best way we can work together, and where might we learn about communication such that in the malpractice world, we can eliminate risk."

United Medical's Krist said none of its insured doctors have been penalized as a result of their test scores. Instead, doctors may receive a discount for doing well. However, when determining premiums, the assessment is just one factor, along with a doctor's specialty and claims history, he said.

APAC's Burke also said the insurer's evaluation is just one piece of the underwriting process and said no doctors were turned away based solely on the communications test. If doctors "pass" the assessment, it also can factor into a premium credit.

Krist acknowledged that United Medical is asking doctors to "jump through a hoop" by taking the personality profile.

But, he said, it's about more than just saving money.

"[Physicians] are continually under pressure," Krist said. "Maintaining that communication with patients should not get lost in the activity."