Malpractice Question

[Messerschmitts]

I can never get a straight answer from anyone. We all know malpractise insurance for OB/GYNs is astronomical, but I am very curious what the actual numeric range is? Also, is it possible for you to work for a hospital, and have the hospital pay for your malpractise? Or are OB/GYNs too expensive for hospitals to cover? Thanks!

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[smq123]

I can never get a straight answer from anyone. We all know malpractise insurance for OB/GYNs is astronomical, but I am very curious what the actual numeric range is?

I believe it depends on region, scope of practice, etc. So I guess your best bet would be to talk to OB/gyns in the area of the country that you see yourself practicing in.

 

[Global Disrobal]

Just so you have an idea:

For private practitioners in mid-atlantic, range is 70-150 with contingency that OB remains part of obstetrics. In most group private practices, its included as part of your overhead. In hospital/academic settings, the hospital covers malpractice which is why there is a movement toward hospital based practices.

Now my answer is very broad in nature as I am not touching the issue of "tails" and so forth... And to answer your question, no, OB's are not too expensive for hospitals.

Hope this answers your question.

 

[chrisisinnocent]

It's extremely variable based on geographical location. It even matters in what county you live in. It can be as low as 20k in the midwest or so expensive that many OBs go uncovered (Florida).

 

[Messerschmitts]

Thanks for the responses! Ha ha I definitely want to work from a hospital then! My dream is to return to California and work there, but I'm guessing it's going to be like Florida.

 

[pruritis_ani]

malpractice is a big concern. however, i think that people overestimate the financial burden when the are choosing a specialty...

most salary estimates put ob/gyn right up there with general surgery...avg around 250k for those in practice over 5 years. remember, these numbers are AFTER malpractice insurance is factored in...

so, you will make a good living, as things are now. if the malpractice crisis is resolved or improved, and reimbursements stay the same, ob/gyns stand to improve in take home pay. if reimbursements decrease and things improve, we can likely stay the same....

now, the emotional burden of being constantly scared of lawsuits, of going through more lawsuits than your colleagues in other specialties and the difficulty of constantly practicing defensive medicine are real burdens to consider.

best of luck

btw, CA is generally considered an OB freindly state, with tort reform and award limits. it is the cost of living there that really makes your take home pay worth less. and FLA is a very malpractice unfreindly state! do your homework, do not make assumptions...

 

[minime]

From what I hear from my future partners:
mine will start out around 20K and increase to appx. 50K after a few years of practicing(ie gaining liability). This is for KY, which is a reasonably high risk state for malpractice.

 

[drlexygoat]

there's no place that's worse than Florida. I'm an Ob/G resident in Orlando and from what I hear, for those than can afford it, it's going to cost you 75k-80k for just 250k of coverage. That's really expensive for just a little bit of coverage. A lot of people here in Orlando are going bare now, which started over the past few years. In Miami, the vast majority of those who are still delivering are bare. In Tampa, the other metropolitan area, it's about the same story as Orlando.

Not all states are as bleak as Florida, but I hear we have it the worst.

 

[Messerschmitts]

there's no place that's worse than Florida. I'm an Ob/G resident in Orlando and from what I hear, for those than can afford it, it's going to cost you 75k-80k for just 250k of coverage. That's really expensive for just a little bit of coverage. A lot of people here in Orlando are going bare now, which started over the past few years. In Miami, the vast majority of those who are still delivering are bare. In Tampa, the other metropolitan area, it's about the same story as Orlando.

Not all states are as bleak as Florida, but I hear we have it the worst.

Wow that sounds terrible. I have no interest in ever practising or residing in Florida though, so I guess it doesn't concern me. I wonder why Florida in particular is so bad though.

 

[shamrock13]

The interesting thing is that the state of malpractice in each area of the country should interest everyone going into this specialty. If it is considered acceptable in Florida then what will stop other states to start to think that this kind of coverage for physicians is okay?

No matter where you are in this country the state of health care is totally despicable. Doctors often have their hands tied due to fear of retaliation and lawsuits and patients often can't get the tests/care that they need because there is no insurance for them or because someone with less than an MD who isn't familiar with the case decides what they do or do not need.

We all need to start getting more involved in why we are at this crisis point and what we can do about it.

 

[badasshairday]

I just don't understand how the premiums can be in the 200k range... It is totally ridiculous. And if those doctors in Miami are going bare, they are totally screwed when they do get sued. Why do they even continue practicing there?!? Can they make patients sign a waiver that states they will not sue or something?

 

[Kateb4]

I just don't understand how the premiums can be in the 200k range... It is totally ridiculous. And if those doctors in Miami are going bare, they are totally screwed when they do get sued. Why do they even continue practicing there?!? Can they make patients sign a waiver that states they will not sue or something?

This is a scary issue. I'm from the Chicago area and over the last 10 years OB's have been flocking to Wisconsin from IL to get away from the horrible costs of malpractice, it jumped $100,000 from 2003-2004. Check out this article for more info...

http://www.med.umich.edu/opm/newspage/2005/obgyn.htm

I know my doctors have been working with the state medical societies to get some legislature passed to control these costs, but I don't know if any good has come from it. Hope nobody went into this field for the money!

 

[dejerine]

Get legistlation passed for malpractice trials to be heard by judges with expertise (just like they do in all patent cases now) and for the judge to require experts from the state in question to testify for free. This keeps costs down and rationality up.

 

[TheJayBee]

Thanks for the responses! Ha ha I definitely want to work from a hospital then! My dream is to return to California and work there, but I'm guessing it's going to be like Florida.

Actually, CA OB/Gyns currently have some of the lowest malpractice rates in the USA. Tort reform works and CA has had that in place for 20+ years.

 

[edmadison]

Forgive the response in the OB forum by a pediatrician, but I'm also a lawyer and can shed a light on some things.

One poster commented on the riskiness of "going bare". If you are very careful in how you structure you assets, going bare can offer some advantages. In Florida, a provider without insurance must, in effect, post a $250,000 surety bond to provide against malpractice suits. That's not a whole lot to go after if you are a plaintiff's attorney. If all you your assets are in your spouses name or tied up in trusts and what not, you become relatively judgment proof (beyond the 250K). I'm not saying it's a good thing to do, but there are some good financial arguments in its favor.

Second, someone suggested modifying the rules for malpractice suits the way they are for patent law (requiring experts and what not). Some (not here) have even suggested that malpractice claims be heard by a special court and adjudicated by a panel of experts. This becomes a constitutional issue. Federal constitution law guarantees a right to a jury trial in civil cases -- this rule is present in many states as well. New causes of action created by statute (like patent cases) do not follow these rules. There has been some success in a few jurisdictions requiring expert certification prior to filing a lawsuit. Whether this has any impact on the system, remains to be seen

Ed

 

[dejerine]

edmadison
It seems many cases going to judges. And it seems judges could call local obgyns as witnesses, rather than making the process money driven.

 

[edmadison]

edmadison

I understand the majority of all civil suits are tried by judges, not juries. Why is that do you think? Even if before a jury, all judges in all states that I know about have the right to summon doctors to testify about standard of care. I think they should do this to keep the "****** of court" away from the juries. I am not opposed to legitimate testimony but the big bucks being paid make it unlikely unbiased testimony will ever be given. If you are an attorney, I am guessing you also testify in malpractice actions, so I don't want to offend you, but my experience with "expert" witnesses is that they are aware of who signs the paycheck.

The most recent data I could find was from a report looking a lawsuits in the largest 75 counties in the US in 2001 (Source: DOJ. Bureau of Justice Statistics 2004). 96% of cases going to trial were adjudicated by juries rather than judges. There are some other interesting statistics:

• Plaintiffs in all tort cases succeed approximately 50% of the time while malpractice plaintiffs succeeded less that 33% of the time.
  
• Tort cases (not just malpractice) before judges, rather than juries, resulted in plaintiff victory in more than 60% of the cases.
  
• The median malpractice award was $422,000 which is approximately 16 times greater than median awards for winning tort cases in general. One third of successful malpractice cases resulted in verdicts of greater than $1 million (this is likely skewed by the extent of the damages claimed in the suit).
  
• The median award for successful malpractice claims almost doubled between 1992 and 2001.

Regarding expert witnesses, they are typically not called by the judge, but rather, by the parties. You are never going to eliminate the right of the parties to call witnesses to support their case. Herein lies the problem. If I'm the plaintiff and can find three wackos with good credentials, my case looks strong even if they hold very small minority of opinions. The defendant can't really call 1000 docs to testify as to true standard of care. Thus, the jury ends up with the "battle of the experts". My solution would be to do what they do in France (I can't believe I like something French). The court appoints a neutral expert. The parties are free to present their own hired guns, but it's clear to the jury (or court) that there is a neutral expert.

Don't worry about offending me, I don't practice law anymore and never did any malpractice work.

Ed

 

[dejerine]

edmadison

Nice to see support from the peds end of things.

 

[JMK2005]

Flipping through the Sept 09 issue of TIME, they have a one page thing on malpractice reform. In it, it has a graphic on estimated 2008 premiums for obstetricians:

Los Angeles - $80,000
Minneapolis - $20,000
Miami - $200,000

I can't imagine malpractice costing that much. Didn't think doctors would dare practice without malpractice, but learned something new.

edmadison - can you explain more about surety bonds and other potential liabilities of 'going bare'? Doesn't a medical practice have assets that patients can go after (medical office, equipment .... stuff like that)?