Mere 1% of physicians accounted for one-third of all paid malpractice claims over a decade, according to a 2016 study published in the New England Journal of Medicine. The common risk factors among physicians with any paid claims included being male, older age, having a previous claim, and practicing as part of several subspecialties, such as surgical subspecialties and obstetrics and gynecology. Lead author David Studdert, from Stanford Medical School and Stanford School of Law in California, said, "The most important implications of these findings is that frequent flyers are a significant problem, and identifying and remediating them early may help improve the quality of the healthcare system. It suggests that there is some underlying factor that is predisposing certain physicians to malpractice claims. Provision of substandard care is the obvious culprit. Poor communication skills is likely to be another factor in this mix."