title: Neurosurgical Defensive Medicine in Texas and Illinois: A Tale of 2 States.
abstract: OBJECTIVE
  To compare the self-reported liability characteristics and defensive medicine practices of neurosurgeons in Texas with neurosurgeons in Illinois in an effort to describe the effect of medicolegal environment on defensive behavior.
  
  
  METHODS
  An online survey was sent to 3344 members of the American Board of Neurological Surgery. Respondents were asked questions in 8 domains, and responses were compared between Illinois, the state with the highest reported average malpractice insurance premium, and Texas, a state with a relatively low average malpractice insurance premium.
  
  
  RESULTS
  In Illinois, 85 of 146 (58.2%) neurosurgeons surveyed responded to the survey. In Texas, 65 of 265 (24.5%) neurosurgeons surveyed responded. In Illinois, neurosurgeons were more likely to rate the overall burden of liability insurance premiums to be an extreme/major burden (odds ratio [OR] = 7.398, P < 0.001) and to have >$2 million in total coverage (OR = 9.814, P < 0.001) than neurosurgeons from Texas. Annual malpractice insurance premiums in Illinois were more likely to be higher than $50,000 than in Texas (OR = 9.936, P < 0.001), and survey respondents from Illinois were more likely to believe that there is an ongoing medical liability crisis in the United States (OR = 9.505, P < 0.001). Neurosurgeons from Illinois were more likely to report that they very often/always order additional imaging (OR = 2.514, P = 0.011) or very often/always request additional consultations (OR = 2.385, P = 0.014) compared with neurosurgeons in Texas.
  
  
  CONCLUSIONS
  Neurosurgeons in Illinois are more likely to believe that there is an ongoing medical liability crisis and more likely to practice defensively than neurosurgeons in Texas.
authors: Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: david_cote@hms.harvard.edu.
authors: David J
authors: DJ
authors: Cote
authors: Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors: Aditya V
authors: AV
authors: Karhade
authors: Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors: Alexandra M G
authors: AM
authors: Larsen
authors: Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors: Joseph P
authors: JP
authors: Castlen
authors: Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors: Timothy R
authors: TR
authors: Smith
mesh_terms: D001291:Attitude of Health Personnel; D003675:Defensive Medicine / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007087:Illinois; D007351:Insurance, Liability; D020407:Internet; D008297:Male; D000069471:Neurosurgeons / Q000523:psychology; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D057566:Self Report; D011795:Surveys and Questionnaires; D013781:Texas
keywords: Defensive medicine; Malpractice; Medicolegal environment; Neurosurgery