Medical malpractice occupies a unique place in American healthcare.

It is discussed in debates about physician burnout, healthcare spending, administrative burden, and defensive medicine. Physicians frequently cite malpractice concerns as a factor influencing clinical decision-making, particularly around testing, documentation, and referrals. Patients, meanwhile, often view malpractice litigation as one of the few accountability mechanisms available when care goes wrong.

But despite how often malpractice is discussed, relatively few people look closely at the underlying numbers.

A recent analysis from Kitchel Law examined malpractice report data from 2021 through 2025 and ranked states by malpractice incidence per 1,000 practitioners. The findings offer an interesting snapshot of how malpractice exposure varies across the country.

States With The Highest Malpractice Rates

According to the study, the states with the highest malpractice report rates per 1,000 practitioners were:

  1. New Mexico — 130.98 reports per 1,000 practitioners
  2. New York — 108.99
  3. Pennsylvania — 100.80
  4. Florida — 96.86
  5. Hawaii — 85.85

The study also looked at total report volume. By total number of reports, the highest-volume states were:

  1. New York — 5,932 reports
  2. Florida — 5,875
  3. California — 5,100
  4. Pennsylvania — 3,922
  5. New Jersey — 2,768

The distinction between total volume and rate matters. Large states with many physicians naturally generate more total malpractice reports, but their rates per practitioner may be lower than expected.

California is a notable example. Although it ranked third nationally in total reports, its malpractice rate per 1,000 practitioners was 50.48, placing it #24 overall.

Texas showed a similar pattern, ranking sixth in total reports but only #30 in malpractice rate at 33.34 per 1,000 practitioners.

States With The Lowest Rates

At the other end of the spectrum, the states with the lowest malpractice report rates per 1,000 practitioners were:

  • North Dakota — 14.04
  • Minnesota — 17.42
  • Wyoming — 21.20
  • Alabama — 24.51
  • Colorado — 24.92

The variation between states is substantial. New Mexico’s rate was more than nine times higher than North Dakota’s.

That geographic variation likely reflects multiple factors, including differences in state tort law, physician workforce composition, insurance environments, practice patterns, reporting standards, and patient demographics.

Why Malpractice Still Shapes Physician Behavior

Even though malpractice report rates vary widely across the country, the issue remains deeply influential in clinical practice.

Malpractice concerns are frequently cited as a contributor to “defensive medicine,” a term used to describe tests, referrals, procedures, or documentation undertaken in part to reduce legal exposure.

Research on the true financial impact of defensive medicine has produced varying estimates over the years, but there is broad agreement that litigation concerns influence physician psychology and organizational culture.

This is especially true in high-risk specialties such as obstetrics, neurosurgery, emergency medicine, and surgery, where adverse outcomes can occur despite appropriate care.

The impact is not purely financial. Physicians who experience malpractice litigation often describe significant emotional and professional strain, regardless of case outcome.

Living in Los Angeles, it is easy to assume malpractice litigation is extraordinarily common.

The visibility is hard to miss. Personal injury attorney advertising is everywhere—on freeways, buses, billboards, television, and social media.

But the California data illustrates the difference between visibility and incidence.

California’s large healthcare system produces a high absolute number of malpractice reports, but its rate per practitioner is lower than many states that receive far less public attention in malpractice discussions.

Part of that may reflect California’s longstanding MICRA framework, which has historically shaped malpractice litigation in the state. But it also highlights how difficult it can be to compare malpractice environments across states without looking at both raw totals and practitioner-adjusted rates.

A Window Into The Complexity Of American Healthcare

The broader lesson from the Kitchel Law analysis is not that malpractice is overblown or underappreciated.

It is that the malpractice landscape in the United States is highly uneven.

Some states experience substantially higher litigation rates than others. Large states do not necessarily have the highest per-physician exposure. And the public perception of malpractice environments may not always align neatly with the underlying numbers.

At a time when healthcare leaders are debating physician burnout, administrative burden, healthcare spending, and patient safety, these kinds of data points are useful reminders that malpractice is not just a legal issue.

It is also an operational, cultural, and psychological feature of modern American medicine.