Malpractice insurance and medicine

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    How does the increased cost of malpractice insurance affect you? Doctors-to-be, are you concerned about the rising rates of malpractice insurance? What affect is it having upon the delivery of medicine?


    As an ob/gyn in practice for 13 years, this is a hot topic and a sore one. My current malpractice carrier is a secondary market carrier, because I practice in a high liability field and area, and have the misfortune of having partners covered by other companies, a previous company who is dropping everyone but still charging tail insurance and a history of settlements (2 small, 1 large) which were advised at the time by my attorneys. So now, I am in a position of trying to decide if I can afford to keep practicing my chosen field, need to switch to gyn only or retire early (not an option with three schoolage kids and a househusband).
    E.g. my initial premium when I joined my current practice 4 years ago as an “experienced” OB/GYN
    (read, more possible suits pending) was$ 37,000 a year. Now, I am paying $22,000 a year for 3 years for “tail insurance” for prior events, and $97,000 for my regular insurance. I had one suit pending last year which was dismissed by the judge after a request for a summary judgement, but because that was pending, my rates were higher and will stay that way for a couple of years, at best. This is for a “nuisance” suit, accoring to attorneys, with no chance of her winning in court, but it heavily impacted my ability to get insurance. So, in our HMO-dense area, I am paying over three times more for insurance, but cannot charge or collect more for my expenses. That means I get to pay over half of my gross pay to insurance companies, another 35% in taxes, and struggle to support my family on the remaining 15%!!! And doctors are supposed to be making a good living. I wouldn’t be able to do it at all except for my husband’s father’s recent death and using his inheritance to pay insurance! Many obstetricians are giving up practice, and this is why!
    Oh, yeah, and this is in California, as state that has tort reform, and is supposed to be a model for the rest of the country!


    (Sorry but my log-in name is not working so I am typing unregstered.)

    Just what the above poster said is one of the reasons I am scared to become a physician 🙁

    I think it is absolutly disgusting to see malpractice insurance go so high that MDs are having to quit there jobs. Here in the paper I have read about MDs quitting and going into another career’s because of malpractice insurance!

    I mean you have to make money to live so what is the point of going through med school with a sh*tload of debt to barely get by in the end?

    I’m really surprised I don’t hear more of the pre-meds and med students discussing this more. For me it makes me re-think busting my butt to get into med school.

    Great post topic IMO. I really am interested in reading others replies on this topic.



    Before you consider hanging up your scrubs. You might want to check out alternate locations as insurance rates vary greatly around the nation. Some of the bigger metro areas also are host to some of the fastest growing insurance premiums. It maybe lame to live out of the way but it can mean a lower cost of living and a bigger paycheck in the end.



    A couple summers ago my boyfriend worked for an OB/GYN in Washington state who ended up quitting his practice because of the obscene cost of insurance. It’s so sad to see that happen to someone who has given his life to his career. I believe he ended up looking into becoming a military doc?

    I think we need some serious legal reform in the States (I’m in Canada now, but am American).


    Increased malpracice costs don’t affect me directly ( primary care, rural areas, lower premiums , and I am always covered by the ins the employer buys…) but INDIRECTLY I am sure it is not helping me to get a raise !


    My malpractice carrier left my state this year, officially because of 9/11 payouts, and to get new coverage with a new company my premium doubled to $4000/yr (outpatient psychiatry). Nothing compared to OB/Gyn, obviously, but a big impact on my overhead. I was tempted to drop out of Medicare until the law got passed which should mean my reimbursements at least hold and not go down like they did last year. Ugh …


    I’d like to add in a Canadian perspective. I practice in Southwestern Ontario (about 60 miles from both Detroit and Point Edward). I have been in practice as an OBGYN for 7 years, and have my Canadian fellowship and am Board Certified in the US. In the past 3 years, my malpractice has tripled. In Ontario, the malpractice insurance for OB has risen to approx. $90,000 CDN. The fee schedule is set by the provincial government, and presently the average fee for delivery is $350 CDN. To pay for the “privilege” of providing obstetrical services, I would have to do 260 deliveries per year. That is only to cover malpractice, not the cost of running and office, and a secretary to do the billing. For my colleague Lynne in California, assuming an average fee per delivery of $2000 USD (I apologize if this is an over-estimation – my Michigan colleague tells me fees in rural Michigan range from $1500-$3000), she would need to do 49 deliveries (97000/2000) to solely cover the cost of malpractice insurance.
    Fortunately, we are not in the position of losing our insurance provider (although the midwives have lost their provider). Ours is available through the Canadian Medical Protective Association, which is run solely by and for Canadian MDs. The current malpractice environment was predicted, based on what had occurred in the US 5-10 years previously. With pervasive cross-border TV signals, US attorneys tell everyone they can sue for undesired outcomes. Presently, 1:4 OBs are sued each year in Ontario, so we have caught up to our colleagues south of the border. :guilty:


    What can we do? It’s up to *us.* Ultimately *we* as physicians hold the trump card!! We can quit, we can complain, we can try to spread the word about the horrific tales of being an OB (or any doctor for that matter), but until something changes…it’s all for naught.

    Maybe doctors should unionize…like pilots, like most workers in america. Maybe it should be a bit more difficult to sue doctors (such as in the military), or maybe doctors should start coutersueing lawyers and patients who file frivious lawsuits, or “umbrella” claims. WE have to implement change…not run from our chosen profession.

    Ladies…what are *we* gonna do? :grouphug:


    I’ve heard of docs sueing patients, and recouping some of the money lost defending themselves (time away from work, lawyers, stress, increase in insurance premiums, etc). If more of us did this, maybe people would think twice before sueing.

    I think that a readily available legal recourse should exist, just not to the point where people sue “just for the hell of it.” I think people should be forced to “think twice” about sueing someone, and if they are found not guilty, the person who initiated to lawsuit shouldn’t just be able to walk away like “oh well, maybe next time,” while the poor doctor is left dealing with increased malpractice insurance, family stress, time off work, etc. There should be some responsibility in filing a lawsuit, and by countersueing, we force people to be more responsible.


    I totally agree with the union idea. The system stops entirely without you guys, and yet you’re the ones getting the shaft from all sides. And at this point, the only wiggle room you seem to have is with the patient — shorter visits, extra fees, etc. But of course that makes us poor & surly, & more inclined to sue when something goes wrong.

    I’m not starry-eyed about unions; I grew up in a steel town. But I think at some point you have to do like TR did about Somoza: “He’s a bast@rd, but he’s our bast@rd.” Unions are not generally nice, but they’re often on your side.



    There should be some responsibility in filing a lawsuit, and by countersueing, we force people to be more responsible.

    I think the problem is less lack of responsibility than lack of reasoning skills, lack of ethics, and an overwhelming need to be right. We still live in a country where half the people think the sun goes around the earth, and most people are incapable of telling a story in some coherent, chronological order. An awful lot of people cannot distinguish between prejudice and reasoned opinion.

    So you get someone who’s upset about a bad outcome, a lawyer or family friend who convinces them you’ll pay for it, and your culpability isn’t going to be rigidly examined. Even if they’re squeamish about it at first, they’ll quickly convince themselves they’re completely in the right and you’re a dangerous incompetent. With people like that, the word “responsibility” is meaningless. They don’t see themselves as having any — it’s all your fault, remember? The best you can hope to do, I think, is scare them out of filing suit.



    I recently read a story where a woman filed a frivolous lawsuit, lost, and then couldn’t believe it when her doctor refused to see her anymore. She was like, “but he was so nice, how will I find another doctor I like?”. :rolleyes: It’s as if some people are so self-centered that they can not understand the consequences of their own actions. :boggled:

    I am going into family med, and I love to do OB, but almost no family docs do it anymore, because it costs so much you can’t afford the insurance because you don’t do as many deliveries as a full-time OB/Gyn does. Maybe in a rural area I still could, but with a surgeon-to-be husband, that is not really an option.

    Lots of docs talk about refusing to treat lawyers until they turn their act around, but I don’t think that is really a reasonable solution. I also think part of the problem is that regular people don’t have a good grasp on what is really going on. Like my mom, who is well educated, keeps up with the news, etc: the other day I was telling her about the problems with malpractice reform, and she did not realize that lawyers are the ones fighting it tooth and nail. She also did not know that they get nearly half of all the settlements.

    I don’t know what the solution is, but I hope someone thinks of something soon! :ouch:


    There was a recent article in the Baltimore Sun about a local doc who sent a letter asking his patients to contribut $10 each to cover his higher malpractice bill and allow him to stay in practice. It worked!

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