Insurance

[GAdoc]

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I guess posts about insurance (the bad news of practicing as an ob/gyn) are inevitable from time to time.

I'm starting medical school this year. I've been accepted to one Georgia school and am waiting to hear back from three others. I'm not entering medical school with my mind set on anything, but currently ob/gyn is very appealing to me. It gives one the opportunity to be a primary care physician AND a surgeon. We'll see if I still feel this way during my 3rd year clerkships! But what would I be getting myself into as far as insurance? Are there any georgia ob/gyn residents or practicing physicians who would care to comment? I saw an article talking about how many Georgia ob/gyns are dropping all obstetrics. Some of them can't even get insurance. The average reported by ACOG is that ob/gyns get sued 2.5 times during their career! Georgia is one of those crisis states. What do yall think?

I spoke to an ob/gyn just last night who told me he was quiting practice here in Georgia and moving to Virginia. He said he wasn't in medicine for the money but that he commonly works 100 hours per week and pays way more to malpractice insurance than he feels like he should.

 

[bubblegumbezoar]

Well, you seem to be very well informed about malpractice issues in ob/gyn. The whole issue of malpractice and insurance is highly regional. For instance, as you mentioned, GA is a very crisis-ridden state. Many ob/gyns are of the opinion that this malpractice extravaganza within the field will swing back the other way because otherwise, who will deliver our grandchildren? In fact, there's a JAMA article about 4-6 months back with that title. Other states, such as TX, are considering putting a cap on malpractice lawsuits.

I think that as long as you head West, the malpractice and insurance issues become less of a headache. For instance, in NM, malpractice insurance is 70,000 annually, but drops to 40,000 if you no longer do any labor and delivery (i.e. you are a glorified CNP, but able to perform surgery). But there are always ways to circumvent the problem. Let's say that you are very skilled at surgery, and the ob portion of residency is just something you tolerate, then you can do a one year laparoscopic fellowship, and then do no ob, but just pre-op, operate, and do post-op care for gyn patients sent to you by older docs who aren't comfortable doing laparoscopic surgery.

I'm not sure if this is helpful to you, but you can get around these issues by moving to a friendlier area to ob/gyns or doing a certain fellowship.

 

[coolbabe76]

if an ob is earning 200 k average , how much of this goes into malpractice ? just thought that would get a better idea with absolute figures.

 

[gyngirl06]

I'm a fourth-year med student in Pennsylvania, which is also a crisis state in terms of malpractice insurance for ob/gyns. Next to certain cities in Florida, Philadelphia has the highest rates in the country. I've definitely spoken to docs who have had to leave the state. The good news is that physicians in the university setting are relatively sheltered. Obviously they don't have quite the earning potential of docs in private practice, but in states like Georgia you'll probably be happiest staying in academics. I made the choice to go into ob/gyn long before med school, and was happy to find that the obs at my school were incredibly positive about the future of the field and were obviously happy with their career choices. But when I started meeting people in private practice, I saw a completely different picture - they kept telling me to choose anything besides ob/gyn! I've heard of some people dropping the obstetrics part of their practices, but several docs in private practice have told me that deliveries are very lucrative and they just have to do a ton of them in order to make make up for the insurance rates. So they work long hours and are unhappy.

That being said, if you love the specialty then you'll go into it. More than any other field, ob/gyn is a passion - not something that people choose because of lifestyle or money. An advisor once told me, if there's something you like almost as much as ob/gyn, go into that other field. Ob/Gyn is hard for a lot of reasons, but it's also the most rewarding specialty there is, in my opinion.

I guess posts about insurance (the bad news of practicing as an ob/gyn) are inevitable from time to time.

I'm starting medical school this year. I've been accepted to one Georgia school and am waiting to hear back from three others. I'm not entering medical school with my mind set on anything, but currently ob/gyn is very appealing to me. It gives one the opportunity to be a primary care physician AND a surgeon. We'll see if I still feel this way during my 3rd year clerkships! But what would I be getting myself into as far as insurance? Are there any georgia ob/gyn residents or practicing physicians who would care to comment? I saw an article talking about how many Georgia ob/gyns are dropping all obstetrics. Some of them can't even get insurance. The average reported by ACOG is that ob/gyns get sued 2.5 times during their career! Georgia is one of those crisis states. What do yall think?

I spoke to an ob/gyn just last night who told me he was quiting practice here in Georgia and moving to Virginia. He said he wasn't in medicine for the money but that he commonly works 100 hours per week and pays way more to malpractice insurance than he feels like he should.

 

[GAdoc]

Well, you seem to be very well informed about malpractice issues in ob/gyn. The whole issue of malpractice and insurance is highly regional. For instance, as you mentioned, GA is a very crisis-ridden state. Many ob/gyns are of the opinion that this malpractice extravaganza within the field will swing back the other way because otherwise, who will deliver our grandchildren? In fact, there's a JAMA article about 4-6 months back with that title. Other states, such as TX, are considering putting a cap on malpractice lawsuits.

I think that as long as you head West, the malpractice and insurance issues become less of a headache. For instance, in NM, malpractice insurance is 70,000 annually, but drops to 40,000 if you no longer do any labor and delivery (i.e. you are a glorified CNP, but able to perform surgery). But there are always ways to circumvent the problem. Let's say that you are very skilled at surgery, and the ob portion of residency is just something you tolerate, then you can do a one year laparoscopic fellowship, and then do no ob, but just pre-op, operate, and do post-op care for gyn patients sent to you by older docs who aren't comfortable doing laparoscopic surgery.

I'm not sure if this is helpful to you, but you can get around these issues by moving to a friendlier area to ob/gyns or doing a certain fellowship.

That was very helpful. Thanks for the info. Med students and residents are notorious (in my limited experience) for discouraging people in my situation from entering med school with a made up mind as to specialty. I understand the importance of not limiting oneself; however the same students/residents complain about not having enough time to make a good decision about career choice. Therefore, I think its important to study any field of medicine I might consider. I had not considered post-residency fellowships. I may look into that and ask around to see how insurance rates compare.

Thank you for the valuable info though.

 

[bubblegumbezoar]

If an ob/gyn earns $200,000, it usually factors in the malpractice insurance into that figure. That's why a laborist only earns $110,00 to 150,00 because working one 24-hour shift every 7 days with $70,000 to pay out in malpractice lowers your pay scale quite a bit.

One more thing to remember with ob/gyn vs. say, general surgery, is that ob/gyn is a surgical field in which you can work part-time (2/3 or 3/4 time), and still earn around $80,000 or so a year, which is about as much as a full-time pediatrician. General surgeons cannot afford the luxury of working part-time and keep up with their malpractice nearly as well as ob/gyns can.

 

[lilycat]

If an ob/gyn earns $200,000, it usually factors in the malpractice insurance into that figure. That's why a laborist only earns $110,00 to 150,00 because working one 24-hour shift every 7 days with $70,000 to pay out in malpractice lowers your pay scale quite a bit.

One more thing to remember with ob/gyn vs. say, general surgery, is that ob/gyn is a surgical field in which you can work part-time (2/3 or 3/4 time), and still earn around $80,000 or so a year, which is about as much as a full-time pediatrician. General surgeons cannot afford the luxury of working part-time and keep up with their malpractice nearly as well as ob/gyns can.

The part-time you mention is quite interesting because I was told by a couple of different physicians that part-time in OB doesn't really exist because of the malpractice. One physician used the following explanation (assuming private practice and more or less a 5-day work week): 2 days/week = malpractice insurance, 1 day/week = office costs (equipment, MA/RN/NP salaries, office supplies, etc.), 2 days/week = YOUR salary. So, going by his example, if you work a 4-day week, you essentially cut your take-home in half. I have no idea if this is really accurate or not, but I thought it was interesting.

 

[bubblegumbezoar]

The part-time you mention is quite interesting because I was told by a couple of different physicians that part-time in OB doesn't really exist because of the malpractice. One physician used the following explanation (assuming private practice and more or less a 5-day work week): 2 days/week = malpractice insurance, 1 day/week = office costs (equipment, MA/RN/NP salaries, office supplies, etc.), 2 days/week = YOUR salary. So, going by his example, if you work a 4-day week, you essentially cut your take-home in half. I have no idea if this is really accurate or not, but I thought it was interesting.

Lilycat-That is very interesting. I think that sound accurate, though. Where I am located, ob/gyn's in private practice earn $200,000-$250,000 for Monday-Friday, call q. 10 days, and no weekends. Of course, if you want to take call q. 21 days, they will cut your salary down. And for a laborist, who only works one 24-hour shift q. 7 days, the salary cuts down to $100,000-$110,000, so that is a 50% to possibly a 60% paycut for working part-time. Of course, that is the salary of a full-time pediatrician in some locations near to where I live, so still a great living for only working 24 hours per week from my point of view.

I also know of an ob/gyn resident who was married to a general surgery resident who both took jobs in a different state. She is contracted for 24 hours of work per week, with 24-hour call q. 7 days, and she made the same salary as her husband, who was contracted to work 70 hours per week.

What are your thoughts? I know that one of the general surgeons who recently left an academic setting in my area considered going into private practice, but said that there is just no way to work part-time and make any money after the fact of paying for insurance.

 

[lilycat]

Bubblegum -- Where I am (Texas), there doesn't seem to be a good part-time model yet. I think starting salaries for most private groups are in the 160-180K range, and then you get up to the 200K range within a few years. However, that's assuming a 5-day work week with overnight call anywhere from q7 to q15 (really large groups). This could be in part due to the unfavorable malpractice situation here until recently. However, I've heard that in the Boston area, a lot of positions are advertised as 3 1/2 or 4 days/week positions with call as q7 or q10, starting around 150-160K, and usually maxing out at 200K. The California Kaiser model is known for offering very lifestyle-friendly schedules with lots of part-time options, but I'm not sure what the salaries are for OB. I know that for an ortho surgeon (I had a friend who was looking at a Kaiser job) the salary was significantly less, but he would also be working far less hours than traditional private practice.

It seems like maybe the idea of part-time OB/gyn work is closely tied in to the malpractice environment of that particular state??? 😕

 

[bubblegumbezoar]

Lilycat-

These issues may be very tied into the state where I live (a neighbor to you). However, the residents I spoke of above moved to a southern state, where she earned a pretty good living for far less hours than her husband.

Here, in private practice, you can sort of bargain with people. For instance, if you want 12 weeks of vacation per year rather than 7, then if you still wanted to maintain your partnership, you would give up a good chunk of salary. On the other hand, if the normal call is q. 21 days for a partner, and you agree to q. 14 days or q. 10 days with 12 weeks vacation, then they may accept this offer without changing your salary, but then again, they may revoke your partnership.

 

[tiredmom]

Other states, such as TX, are considering putting a cap on malpractice lawsuits.

Thought you might like more info on the tort reform that passed 2 years ago in Texas.

http://www.texmed.org/Template.aspx?id=780

 

[abmd2006]

Hi tiredmom!
How are you hanging in there?
Thursday is like 4 Christmases in one. I can't wait. I haven't counted down days like this since I was a kid! I am very nervous and stand to be elated or very disappointed!
Anyway. The article on the Texas Tort reform says it all.
Hello! Pass tort reform = lower premiums and more docs in high need areas. Why can't we spell this out to the country for national reform?
Hmmm...maybe because 9/10 of Congress are lawyers. I still have hope though.

 

[Diane L. Evans]

bubblegumbezoar I beg to differ on your salary numbers.Judging from your posts you are a medical student/ MS4. Please correct me if I am wrong.

OB/Gyn starting salaries after finishing residency vary depending on which part of the state you are in from $300-180K. Peds make signifantly more than 80K. Malpractice is not usually figured into salaries it is usually paid for by the group or hospital services you enter if you enter into solo practice then you must make the amount overhead to cover malpractice i.e FL malpractice $170K most solo make $400K- office staf- sx expense avg salary $160K

 

[bubblegumbezoar]

Error.

 

[amfrank]

I am a 2nd year and we had a meeting with different OBGYNs in the area. We were told that OBGYNS can be sued until the child is 19 and 1 day. Because of this, the physician has to pay malpractice insurance for this time or else they can do a one time buyout (usually 2-3 years of malpractice insurance). Is this true? If I was to take some time off to have a family, would I still be required to pay 70k a year even when I am not working. I am confused and have been kindda turned off of OB when I heard this!