bad medical-legal states to practice

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EMgig

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Just wondering- why would anyone in EM want to practice in a state that has bad medical-legal climate (i.e. illinois, nyc, Fl, etc?). Those who have experience, please speak up and share! It sounds as though it would be a game of russian roulette, unless there are ways of protecting personal assets (if anyone has ideas on this please share!). The reason I ask is that I want to live in a state that is horrendous for litigation, I don't want to practice there only for that reason (with no caps, long statue of limitations, etc.), so either I do locums or move to a better state. Thoughts anyone?
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They have family there, love the city etc. Also, while Florida has a terrible malpractice climate (especially Dade County) it also has great asset protection laws.

The additional cost of malpractice insurance pales in comparison to the higher cost of living in many locations. And it is almost always the insurance company footing the entire bill if you're sued.
 
Personally I wouldn't work a single shift in a D or F rated state. Washington, Oregon, illinois, kentucky, Florida, pennsylvania...what others?
 
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New Jersey


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Thank you so much for your replies! I was hoping to hear that people just don't get sued that often so they're not worried about it, or whatever the reason may be to practice EM in those high-risk states, but for lower-risk specialties taking the risk makes more sense for lifestyle reasons (not having to travel for work), but for EM....it's not a matter IF you will be sued, it's a matter of WHEN just because of sheer volume and time pressures....and when it happens you want to make sure there at least there are caps/limitations/some protections in place for practitioners and not a free-for-all. I happen to want to live in one of those states, but not sure if i'm willing to take the risk of practicing there and am surprised people still do.
 
Last edited:
EMgig said:
Thank you so much for your replies! I was hoping to hear that people just don't get sued that often so they're not worried about it, or whatever the reason may be to practice EM in those high-risk states, but for lower-risk specialties taking the risk makes more sense for lifestyle reasons (not having to travel for work), but for EM....it's not a matter IF you will be sued, it's a matter of WHEN just because of sheer volume and time pressures....and when it happens you want to make sure there at least there are caps/limitations/some protections in place for practitioners and not a free-for-all. I happen to want to live in one of those states, but not sure if i'm willing to take the risk of practicing there and am surprised people still do.
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Keep in mind that you don't necessarily have to work in the state that you live in. It's more doable than you might think.
 
Old_Mil said:
Personally I wouldn't work a single shift in a D or F rated state. Washington, Oregon, illinois, kentucky, Florida, pennsylvania...what others?
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Where can I find those ratings?
 
What's interesting is that there appear to be some significant differences between the EM Report Card and the state-by-state guide in the ranking of certain states' medical liability environments. Different ranking methodology can have huge effects.
 
Cinclus said:
What's interesting is that there appear to be some significant differences between the EM Report Card and the state-by-state guide in the ranking of certain states' medical liability environments. Different ranking methodology can have huge effects.
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True, but lipstick never turns a pig into a swimsuit model.

By the way, don't totally disregard these rankings when looking at residency programs either. While it is less likely to get sued as a resident than as an attending (more supervision, fewer pph), sovereign immunity in some cases, it does happen.
 
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One point to keep in mind: Even though the laws are the same in a given state, how judges and juries apply them can vary greatly.

In the rural, pretty conservative, part of my state, it is incredibly tough for a plaintiff to win a case that goes to jury trial. That definitely affects the cases the lawyers will take and their settlement offers for the ones they do. On the other hand, in urban areas in the state, it is a plaintiff's paradise. Same state, very different environments. (It also isn't strictly a rural/urban thing. I have heard in the deep south it is reversed.)

So don't be surprised if you hear some physician say "X is a great state (with respect to malpractice)" and others say "X is a horrible state." They are both right, they just work in different areas of that state.
 
Vandalia said:
One point to keep in mind: Even though the laws are the same in a given state, how judges and juries apply them can vary greatly.

In the rural, pretty conservative, part of my state, it is incredibly tough for a plaintiff to win a case that goes to jury trial. That definitely affects the cases the lawyers will take and their settlement offers for the ones they do. On the other hand, in urban areas in the state, it is a plaintiff's paradise. Same state, very different environments. (It also isn't strictly a rural/urban thing. I have heard in the deep south it is reversed.)

So don't be surprised if you hear some physician say "X is a great state (with respect to malpractice)" and others say "X is a horrible state." They are both right, they just work in different areas of that state.
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Wow, I had no idea, good point! Thank you so much for sharing this!
 
Isn't EM middle-of-the-road in terms of specialty malpractice risk? And aren't almost all doctors, regardless of specialty bound to be sued eventually? What I don't understand how some of these states have a single neurosurgeon. I wonder if they have to be paid significantly more.


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Old_Mil said:
True, but lipstick never turns a pig into a swimsuit model.

By the way, don't totally disregard these rankings when looking at residency programs either. While it is less likely to get sued as a resident than as an attending (more supervision, fewer pph), sovereign immunity in some cases, it does happen.
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I'm going to (mostly) disagree with you on this. The likelihood of loosing a lawsuit as a resident is quite low, and there are many other factors to consider in selecting a residency, so I think med-mal climate should not be a consideration for most people. However, I will grant that it could be a factor in 2 ways:

1 - The student for whom all else is equal when trying to pick between 2 programs - 1 in a great environment, the other in a terrible environment. Sure, consider med-mal.
2 - You're more likely to get a job close to where you train. So training in a terrible med-mal state makes you more likely to work in a terrible med-mal state. (But it by no means obligates you to do so.)
 
doctalaughs said:
Isn't EM middle-of-the-road in terms of specialty malpractice risk? And aren't almost all doctors, regardless of specialty bound to be sued eventually? What I don't understand how some of these states have a single neurosurgeon. I wonder if they have to be paid significantly more.


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Click to expand...

EM was almost exactly at the median in terms of risk of a lawsuit by specialty. There was a really interesting article in NEJM about this about 5 yrs ago.

http://www.nejm.org/doi/full/10.1056/nejmsa1012370#t=article
 
Vandalia said:
One point to keep in mind: Even though the laws are the same in a given state, how judges and juries apply them can vary greatly.

In the rural, pretty conservative, part of my state, it is incredibly tough for a plaintiff to win a case that goes to jury trial. That definitely affects the cases the lawyers will take and their settlement offers for the ones they do. On the other hand, in urban areas in the state, it is a plaintiff's paradise. Same state, very different environments. (It also isn't strictly a rural/urban thing. I have heard in the deep south it is reversed.)

So don't be surprised if you hear some physician say "X is a great state (with respect to malpractice)" and others say "X is a horrible state." They are both right, they just work in different areas of that state.
Click to expand...

This is 100% true and shouldn't be under-appreciated. I know a few med mal lawyers and spoke with them when job hunting. They will almost never take a case in a jurisdiction where there's only 1 hospital. In addition to those places tending to be more conservative/rural, the people who sit on the local juries are more likely to know the doc(s) involved and don't want to do things that could damage relationships and risk pushing away a doctor from working in their area.
 
EMgig said:
Just wondering- why would anyone in EM want to practice in a state that has bad medical-legal climate (i.e. illinois, nyc, Fl, etc?). Those who have experience, please speak up and share! It sounds as though it would be a game of russian roulette, unless there are ways of protecting personal assets (if anyone has ideas on this please share!). The reason I ask is that I want to live in a state that is horrendous for litigation, I don't want to practice there only for that reason (with no caps, long statue of limitations, etc.), so either I do locums or move to a better state. Thoughts anyone?
Click to expand...
I guess some people stay in those places due to family issues, weather, etc....
 
wait, does bad medical legal environment affect your malpractice insurance cost or something?
 
Are you being sarcastic?


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