Attendings! Did you ever pay a "tail" when you left a group?

[DreamMachine]

How much did you pay?

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[mcgreen]

Yes,

$27000 before tort reform

$7000 after tort reform same state.

 

[pgg]

Yes,

$27000 before tort reform

$7000 after tort reform same state.

Tort reform is a beautiful thing.

My initial reaction when I got my first quote for insurance in CA was irritation because I thought they'd screwed it up. It comes to a couple days' work for my first year out of residency, and a whole week's work at maturity.

A guy at the group I'll be moonlighting with (the military's my day job) said his malpractice premiums dropped by more than 2/3 after tort reform.

 

[jetproppilot]

How much did you pay?

$27.000 in the year 2004.

 

[Noyac]

I paid 19,000 for La. Patient Compensation fund and then another 19,000 for tail in La. back in 2004.

 

[mcgreen]

How much did you pay?

Most insurance companies seem to calculate tail cost at about 1.5 to 2 times your last year’s annual malpractice cost in a state where the plaintiff has a two year window to sue. Unfortunately you need to pay the full tail cost within 30 day of canceling your policy, since the insurance company would gladly dump the liability on you. Many hospitals and groups will require you to prove you bought tail coverage to get credentialed at your next job.

 

[QofQuimica]

Would one of you mind explaining what a tail is for those of us not so well informed? I gather it has something to do with malpractice insurance, but what purpose does it serve, exactly?

 

[Arch Guillotti]

Would one of you mind explaining what a tail is for those of us not so well informed? I gather it has something to do with malpractice insurance, but what purpose does it serve, exactly?

Tail refers to the period of time after you have left a group and are no longer covered by the groups malpractice insurance. Unfortunately once you have left the group you are still liable to be sued for whatever reason for some event that happened while you were employed with this particular group. So if you leave a group and are sued 6 months later you had better have tail coverage or you are really putting yourself on the line. I am not sure how long someone is able to sue us, from a previous posters comment it sounds like it may be based on state law.

Hope this makes sense. Tail is essentially insurance coverage after you have left a job.

 

[QofQuimica]

Tail refers to the period of time after you have left a group and are no longer covered by the groups malpractice insurance. Unfortunately once you have left the group you are still liable to be sued for whatever reason for some event that happened while you were employed with this particular group. So if you leave a group and are sued 6 months later you had better have tail coverage or you are really putting yourself on the line. I am not sure how long someone is able to sue us, from a previous posters comment it sounds like it may be based on state law.

Hope this makes sense. Tail is essentially insurance coverage after you have left a job.

Yes, thank you. I hadn't ever thought about this problem. But it makes sense that you'd need to continue malpractice coverage for as long as it took the statute of limitations to run out on all of the cases you did while you were with the previous practice.

Does anyone know if it works the same way in academia when someone switches universities?

 

[Arch Guillotti]

Does anyone know if it works the same way in academia when someone switches universities?

My university provides tail coverage for free when you leave. This includes residents, fellows and attendings. Not sure what other places do.

 

[mcgreen]

Thanks for the replies!

I met with my malpractice representative last week. He said the cost of a tail for me would be about $45,000.

Even though I don't plan on leaving my group...in the event things don't work out, that SUCKS!

Nobody takes a job planning to leave but the vast majority of former residents are not working at their first practice location two years later.

$45000 seems high. What is the yearly medical practice premium?

Many jobs will cover the tail, are there any other red flags that this many not be the best job? Have you taken the time to talk the all the people who have left the group in the last couple to get the full story about what kind of situation You are stepping into?

 

[urge]

45k seems too high for someone just starting. Especially if you will be doing "healthier" patients and/or small procedures. You can shop around for quotes. Although, there are not too many companies around.

The statistics are like ~80% of new grads will change jobs within 2 yrs. That's something to keep in mind.

 

[Pilot Doc]

45k seems too high for someone just starting.
.

Varies widely by state. In some cases it can push 100K. Also depends on how long a tail you buy. A permanent tail (including peds cases, etc) will be more expensive than a 2-3 year tail.

Getting back to the question about university coverage above, there are two types malpractice insurance.

Occurence basis: You buy a policy to cover any claim for care tha occurred in a time period. It's good forever, no tail is needed. Very expensive and hard to obtain. Most universities are self-insured and provide occurrence basis. (Memory tool: an O is round - 360 degree coverage)

Claims made: You buy a policy to cover claims made in a given year. You can buy a policy with a "nose" if you have prior experience that needs coverage. For someone just starting out a claims made policy will be relatively cheap the first year and rise in price substantially each year until year 5 or so as you accumulate claimable case volume. At that point it levels off because your'e losing exposure to the statute of limitations at the same rate you accumulate it. If you leave this policy, as noted above, you lose coverage unless a tail is purcha$ed. (Memory tool: a C is missing a segment, compared to an O - it's incomplete coverage)

 

[gobears!!]

I spoke with a recruiter from an AMC recently. I asked about the malpractice coverage. She stated that it was claims made but that a tail wasnt needed for some reason which I did not fully understand. She said something about how they would give you a letter that you don't need coverage if you were to leave. I have to admit I stopped listening to her explanation because it wasn't making complete sense to me and figured I'd ask elsewhere and read up to see if this is possible or if she is making something up. Is this true? It's possible to not need tail coverage despite the AMC having claims made coverage depending on how they buy their insurance?

 

[aneftp]

I spoke with a recruiter from an AMC recently. I asked about the malpractice coverage. She stated that it was claims made but that a tail wasnt needed for some reason which I did not fully understand. She said something about how they would give you a letter that you don't need coverage if you were to leave. I have to admit I stopped listening to her explanation because it wasn't making complete sense to me and figured I'd ask elsewhere and read up to see if this is possible or if she is making something up. Is this true? It's possible to not need tail coverage despite the AMC having claims made coverage depending on how they buy their insurance?

The big AMCs team health, Mednax American anesthesiology, Sheridan/amsurg are all self
Insured.

Many hospital employed positions are also self insured.

It gets confusing. But self insured practices in a nut shell will cover your "tail".

But the language needs to be built into the contract.

I have seen the team health and American anesthesiology language and it's very clear cut.

My previous private practice paid my tail when I left in June. Because I had language in the contract that "if they terminated me without clause" they pay my tail. Which they did. Group was taken over AMC in July. Lot of bickering over the language.

 

[gobears!!]

The big AMCs team health, Mednax American anesthesiology, Sheridan/amsurg are all self
Insured.

Many hospital employed positions are also self insured.

It gets confusing. But self insured practices in a nut shell will cover your "tail".

But the language needs to be built into the contract.

I have seen the team health and American anesthesiology language and it's very clear cut.

My previous private practice paid my tail when I left in June. Because I had language in the contract that "if they terminated me without clause" they pay my tail. Which they did. Group was taken over AMC in July. Lot of bickering over the language.

gotcha thanks!

 

[BLADEMDA]

A tail coverage could cost as much as $30-$40,000 for a mature policy. You must be aware of this fact when signing any contract.

 

[vendtex]

A tail coverage could cost as much as $30-$40,000 for a mature policy. You must be aware of this fact when signing any contract.

It may be possible to get the new employer to pay the tail of the previous job in lieu of a signing bonus or in addition to if they are anxious to sign you.


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[aneftp]

It may be possible to get the new employer to pay the tail of the previous job in lieu of a signing bonus or in addition to if they are anxious to sign you.


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Good luck with that. Not many will do that. Maybe a desperate (or small town hospital employed position) will do that.

 

[pgg]

I was quoted 240% of my last year premium to cover the tail for the claims-made individual policy I pay for.

Is nose coverage from a new policy commonly available? Is it generally less expensive than a tail?

 

[aneftp]

I was quoted 240% of my last year premium to cover the tail for the claims-made individual policy I pay for.

Is nose coverage from a new policy commonly available? Is it generally less expensive than a tail?

Nose is generally 1/3 of a tail.

 

[ssmallz]

Nose coverage is actually pretty cheap. Assuming you've got no prior or pending suits they basically just agree to cover you at the current rate for any prior acts just like if you had been with them for that period of time and were in good standing. I had to do this when I went into fellowship and the again when I switched malpractice insurers. It didn't really cost much of anything


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[aneftp]

Nose coverage is actually pretty cheap. Assuming you've got no prior or pending suits they basically just agree to cover you at the current rate for any prior acts just like if you had been with them for that period of time and were in good standing. I had to do this when I went into fellowship and the again when I switched malpractice insurers. It didn't really cost much of anything


Sent from my iPhone using SDN mobile

It depends on tie liability exposure. My sister tail was $40k matured policy. She ended up paying around 10k.