Malpractice insurance - just how bad is it?

I’ve been reading a number of posts about how bad malpractice insurance costs are, but I haven’t seen many concrete numbers and google hasn’t been as helpful as it usually is.
Just how bad are things for the various specialties? I realize it varies by state and doctor, but are there any general figures available?

Hi there,
The going premium for a Vascular Surgeon in Cleveland, OH is $150,000 - $160,000 per year for the miniumum $3,000,000 coverage. My faculty advisor (a superb vascular surgeon) had to mortgage his house in order to pay his office staff when his premiums rose over the course of a year. Since two carriers have dropped out of Ohio, I expect that this number will go up. The premiums are higher for Orthopedic and Neurosurgery especially if you take Trauma call. Ohio is one of the endangered states along with Wyoming, Pennsylvania and West Virginia. As an example, there are two neurosurgeons in the entire state of West Virginia (both are in Charleston). Neither of these folks do Trauma so wear a crash helmet if you drive in West Virginia. Fortunately for me, Virginia has not gone endangered but every physician is potentially at risk unless something done. When you look around, that Trauma surgeon may not be there for you or your family member.

So, do doctors employed by hospitals pay their own premiums, or do hospitals help out? And do you have to start paying any of the cost of premiums in residency? I can’t imagine how anyone could afford to pay that out-of-pocket. I feel like I hear a lot of statistics on this issue but I don’t really know how it works…

$150,000. Wow.
Natalie, when you become a lawyer please fix this situation!!!
Seriously… I wonder how many doctor-lawyers are there in the world? I’m thinking we’re going to need some pretty strong advocates out there pushing tort reforms to curb some of the excesses of the current system, elsewise those of us hoping to get into the medical field will find the system to be completely broken by the time we are out of the box.

I’m not sure it’s all about tort reform. There’s insurance industry reform as well. Wisconsin has one big risk pool for awards over a certain amount. Doctors pay into this fund (which is constantly in danger of being raided by the state legislature) and buy insurance for suits below that minimum. I don’t know how much lower this makes premiums, but I know the state is not undergoing a mass exodus of physicians.

In fact, the premiums are so good in Wisconsin as compared to other states that Wisconsin is actually getting an influx of doctors.

Academic physicians generally have their premiums paid by their institution. This varies in private practice but often when you are in a group private practice, the group is the legal entity that solicits liability insurance on behalf of their docs. So while the premium may not come directly out of the pockets of each doc, it is an expense that the group must pay and therefore comes out of the pot that must pay the doc’s salaries, as well as other expenses. So when considering salaries in a private practice setting, one needs to ask how the group handles their liability premiums. Solo providers (not in a group practice) I presume, are on their own. Don’t sweat the liability issue too much however. Although its not a hard and fast rule, specialities where premiums are high generally pay well (more risk, more pay). Concentrate on picking a speciality that excites you. The liability and salary issues will work themselves out.


So, do doctors employed by hospitals pay their own premiums, or do hospitals help out? And do you have to start paying any of the cost of premiums in residency? I can’t imagine how anyone could afford to pay that out-of-pocket. I feel like I hear a lot of statistics on this issue but I don’t really know how it works…

Hi there,
As a resident, I am covered by my institution and the physicians that practice there thus I do not pay malpractice at this point.

Only thing I’ve heard is not to get into OB/GYN in WV…everything else is just as good or just as bad as your salary dictates.
Please don’t get into medicine for the money and please don’t let the money deter you.

Hey great to see some discussion on the money/insurance questions with some real numbers…
A couple questions though
Natalie, your doc with the 150k insurance premium, do you know what his salary is?
Anyone have any other kind of numbers for the other specialties? It’d be interesting to learn what say a general family doc or a pediatrician has to pay for insurance versus what they make etc…
I agree with the post above tho, it seems like it’s definitely going to take more than just “tort reform” to fix the insurance problem…Anyone have any thoughts on the argument that the insurance premiums went up more because of bad insurance co investments rather than some raging legal storm?
back to lurking,

Some states have caps like Louisiana is 500,000 per incident and i think Cali is the lowest at 250,000 cap, there is some info on the web, some states there is no cap and thats where you will pay the highest premiums. Check it out with google.
As a resident you will be covered by the hospital,
there are even deals where practices set up as clinics cover the Docs in the practice.

The premium for an FP doing OB in Southern Illinois is around 80-100K (what my mom paid). Crazy. Then again, illinios is really bad for malpractice lawsuits.

I’d like to know if any of the insurance rates for those practicing in states with caps has gone down.
I lean towards not, but do eagerly await confirmation.

Hi there,

The insurance rates in states with caps have not gone down. The rates have not risen exponentially. It is not just a matter of caps on non-punitive damages but tort reform and rising costs of office practice. The legislation that I lobbied for on Capitol Hill last week would have also imposed penalties for lawsuits without merit that seem to be clogging our courts. We also lobbied for more debt relief for medical students since the average debt for the average medical graduate is $120K with that figure rising.

There is also the issue of reimbursements for physicians which were slated to be cut. Our reimbursment formula is tied to gross national product which has NOTHING to do with rising costs. The bottom line is that while your costs of opening an office, paying office staff etc. are rising, your income is actually going doing. This means that you will not be able to afford to pay off your loans, pay your malpractice insurance and then take much of anything home.

When you see those wonderful six-figure salaries for physicians, look again because many folks coming out of medical school even today are not going to make that much money especially if you go into primary care. In fact, you won’t even be close to taking home six figures by the time you pay for practicing.

If you want to stem the tide, go to the AMA political action site, get informed and get politically active. There were 400 of us (medical students, residents and fellows) that flooded the offices of the US Senate and US House of Representatives lobbying for our future practices last week. I really could have used my vacation time to lie on the beach somewhere but there is a huge crisis and the lay public just doesn’t get it. The good thing is that all of those first and second year medical students that were with me DO understand the situation and were quite effective. I was especially impressed by my University of Virginia delegation.


Yes, it’s horrible. I spoke with a surgeon who gave me an example. He may get $1200 for an apendectomy for a cash patient. A patient with insurance means he’ll only get about $600 for it and that continually decreases. Factor that in with wages going up as well as the light bill. Call me selfish, but I’d rather have a happy doctor who doesn’t feel rushed to fit two or three patients in what used to be the same block of time for one patient slicing me open.

If nothing is done, the government will have to step in and we’ll have socialized medicine. Politicians can make it sound dreamy, but in reality, it means someone in need of a gall bladder surgery will wait three months on medication for their symptoms, instead of scheduling it the next week and getting it taken care of.

As much as I hate to diagree with Natalie, Caps in Texas (combined with our other reforms including a constitutional ammendment solidifying our caps) have indeed resulted in lower premiums. Take a look at this timeline for the Texas Medical Association:
Speaking of the TMA (the best state medical association around, in my admittedly biased opinion), here is a page with many articles on this topic:
Take care,