Introduction: Healthcare systems in many countries struggle with recruiting general practitioners (GPs) for clinics among others in rural areas leading to less GPs required to each serve an increasing number of patients. As a result, fewer resources are available for individual patients potentially influencing patient satisfaction and the likelihood of malpractice litigation.

Aims: To investigate the association between malpractice litigation and local setting characteristics in a Danish national sample of GPs considering rurality, number of patients listed with the GP, as well as local unemployment,- education,- income,- and  healthcare expenditure levels.

Materials and methods: Register study on Danish complaint files and administrative register data using multivariate logistic regression.

Results: No statistical significant association could be established between litigation figures and rurality, occupation respectively education figures, and municipality level of healthcare expenditures. However, larger patient list size was associated with higher rates of malpractice litigation (OR 1.05 per 100 patients). Litigation was less frequent in settings with higher income patient populations (OR 0.65), though seemed much more likely to be concluded justified (OR 6.03).

Conclusions: Higher workload in terms of greater patient lists is a premise for a substantial number of GPs. This can cause drawbacks in terms of patient dissatisfaction and malpractice litigation even though local factors like population economic wealth apparently interfere. Further research is needed about the role of geographic variations, workload, and socio-economic inequality in malpractice litigation.