Both avoidant and assurance defensive medical practices tend to predominate in high-risk specialties such as Neurosurgery. Various states in the US have diverse medical-legal environments which present different liability risks to practioners. It has not been shown, however, that a state’s medical-legal risk environment correlates with defensive medicine.

     This is the first nationwide survey of neurosurgical defensive practices.

     3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons; which represents 76% of neurosurgeons in academic and private practices.

     A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons; which represents 76% of neurosurgeons in academic and private practices. The responses regarding defensive medicine were then correlated to state-by-state medical-legal risk environments using multivariate regression models.

     A total of 1028 surveys were completed, yielding a 31% response rate. More than two thirds of those surveyed reported engaging in both assurance and avoidant behaviors out of liability concerns. State medical-legal risk environment was a significant predictor of response rate, the number of neurosurgeons per population, perceptions of patient as a potential lawsuit, perception of liability burden, insurance premiums, the adoption of asset protection strategies, assurance and avoidant behaviors in multivariate logistic regression models (p<.05).

     This is survey-based data.

     US Neurosurgeons correctly perceive the medical-legal environment in which they practice. These perceptions have led to decreased neurosurgical services, decreased number of neurosurgeons, increased suspicion of patients, increased insurance premiums, and higher levels of defensive behaviors in high-risk states.

     States with high liability risk profiles are associated with more waste, less service, and likely higher costs of health care delivery.