Purpose: In this study perceived discipline risks are compared with the actual discipline risk together with an identification of variables that may explain variations in such risk perceptions. Finally, we investigate if risk perceptions have an effect on clinical decsion making.
Method: Postal questionnaire to a panel of 1649 Norwegian medical doctors of which 1072 responded, to all or some questions, after a reminder (65%). The questions relevant for this study were answered by between 891 to 964 respondents (54% to 58.5%). Ordinary Least Squares and Probit models, allowing for endogenous regressors, were estimated.
Results: In average physicians overestimate the risk by 50% for the most punitive disciplines (warnings, revoke of license and/or authorization), while they underestimate the risk for the less severe one (reprimands). Discipline risk perceptions are found to be highest among physicians in private practice. No significant effect from the perceived liability risk on the self-assessed propensity to adhere to clinical guidelines was identified, however, private practice physicians were found to be less likely to adhere to clinical guidelines than those outside of private practice.
Conclusion: This study shows that the discipline risk is higher in a no-fault systems than in the US malpractice system. Furthermore, the degree of risk-bias is less if compared with liability risk biases in malpractice systems suggesting that physicians in no-fault systems are well informed about actual risks. Our findings also confirm that physicians in private practice differ from those outside of private practice both when it comes to risk estimation and the degree of adherence to clinical guidelines.
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