Practicing without Malpractice or Liability Insurance

[ballerdoc]

Was wondering what people's thoughts are on starting a private practice without malpractice or liability insurance. I've never heard of any of my colleagues being sued in close to 100 combined years of private practice. If you consider yourself a responsible dermatologist who is extremely vigilant, careful, and alert with every patient, is there really a need for medical malpractice insurance?

We had a medical malpractice law firm visit our derm practice and tell us the ins and outs of physicians getting sued for malpractice. It is extremely difficult to be sued, and 97% of the calls that medical malpractice law firms receive are just complaints from unhappy customers. The conditions that must me met in order to be sued are as follows:

1) Displaying gross negligence. Doing something that no competent physician in your field would do.

2) The doctor's negligence caused an injury.

3) The injury lead to specific damages, physical, mental, or monetary.

Additionally, the attorney who visited our practice told us that she is able to come after a physician's personal assets even if he/she has malpractice insurance. This attorney said the best way to not get sued is to be a competent physician, and if you make a mistake, take ownership, apologize sincerely, and empathize with your patient. This is usually enough to ward off a complaint to a law firm.

Additionally, I've met with plastic surgeons (a field that is probably a higher risk than dermatology for medical malpractice) who have stopped their medical malpractice insurance and actually saw a decrease in contact from law firms (law firms tend to target physicians with malpractice insurance since they know they can go after an easy settlement).

After all these points considered, it seems to me that medical malpractice insurance is unnecessary if you are a competent dermatologist. The best way to avoid a lawsuit is to be a competent physician and to be nice to your patients.

Knowing this, would anybody go into private practice without medical malpractice insurance? Thanks in advance!

---

Members don't see this ad.

 

[TMP-SMX]

This sounds like a very bad idea. You are human and if you haven't made mistakes you aren't paying enough attention. Not meeting the three conditions for a successful suit doesn't mean you won't get sued it just means you are not likely to lose a suit if you can afford representation. You are still responsible for court costs which are not cheap. How do law firms know what physicians have malpractice insurance? Also many states have requirements for insurance and hospitals certainly will for hospital privileges. As for this lawyer unless it is your lawyer make sure you know your state law. There are varying laws across different states with admitting fault.

 

[asmallchild]

Was wondering what people's thoughts are on starting a private practice without malpractice or liability insurance. I've never heard of any of my colleagues being sued in close to 100 combined years of private practice. If you consider yourself a responsible dermatologist who is extremely vigilant, careful, and alert with every patient, is there really a need for medical malpractice insurance?

We had a medical malpractice law firm visit our derm practice and tell us the ins and outs of physicians getting sued for malpractice. It is extremely difficult to be sued, and 97% of the calls that medical malpractice law firms receive are just complaints from unhappy customers. The conditions that must me met in order to be sued are as follows:

1) Displaying gross negligence. Doing something that no competent physician in your field would do.

2) The doctor's negligence caused an injury.

3) The injury lead to specific damages, physical, mental, or monetary.

Additionally, the attorney who visited our practice told us that she is able to come after a physician's personal assets even if he/she has malpractice insurance. This attorney said the best way to not get sued is to be a competent physician, and if you make a mistake, take ownership, apologize sincerely, and empathize with your patient. This is usually enough to ward off a complaint to a law firm.

Additionally, I've met with plastic surgeons (a field that is probably a higher risk than dermatology for medical malpractice) who have stopped their medical malpractice insurance and actually saw a decrease in contact from law firms (law firms tend to target physicians with malpractice insurance since they know they can go after an easy settlement).

After all these points considered, it seems to me that medical malpractice insurance is unnecessary if you are a competent dermatologist. The best way to avoid a lawsuit is to be a competent physician and to be nice to your patients.

Knowing this, would anybody go into private practice without medical malpractice insurance? Thanks in advance!

I personally wouldn't do this.

I do agree lawsuits are less common in dermatology but I wouldn't take the risk of going naked. As rare as it is, I've had a co-resident get sued while he was a resident.

The attorney who came to your practice seems like a fearmonger. While they CAN come after your personal assets, it is highly unlikely. She already noted it is difficult to be sued and 97% of the calls are just unhappy patients. Now she's saying she can take the remaining 3% and claim they have damages that exceed your malpractice policy limits?

If you've attended any medical malpractice talk, you'll know never to conflate a medical malpractice lawsuit with competence.

I'm an employed physician so my malpractice is covered by my company but if I were to start one on my own, I would definitely not go without malpractice coverage. (And while I would listen, I'd be very wary about taking advice from a medical malpractice law firm)

 

[ballerdoc]

This sounds like a very bad idea. You are human and if you haven't made mistakes you aren't paying enough attention. Not meeting the three conditions for a successful suit doesn't mean you won't get sued it just means you are not likely to lose a suit if you can afford representation. You are still responsible for court costs which are not cheap. How do law firms know what physicians have malpractice insurance? Also many states have requirements for insurance and hospitals certainly will for hospital privileges. As for this lawyer unless it is your lawyer make sure you know your state law. There are varying laws across different states with admitting fault.

Thank you for your reply. Of course I make mistakes and so do my colleagues, but in my experience its rare that these mistakes cause patient harm because we have sound standard operating procedures that catch significant mistakes before they happen. I agree that getting sued may lead to expensive court costs, but malpractice insurance premiums are also expensive, and if saved, could be used for court costs should that need arise. In the state that I practice, you are required to display in the reception area that you do not carry malpractice insurance, and I think this is how lawyers figure out which physicians are not worth targeting for a settlement.

I will definitely be giving more due diligence before making a decision, but it is not unheard of to go without malpractice insurance. There are other strategies for protecting your assets and asset protection lawyers can come up with good strategies for limiting your losses and protecting your accounts receivable in case of a lost case. It makes sense to have malpractice insurance to cover representation and court costs, but not having to pay malpractice premiums may be more economical even with having paying for representation and court costs in the rare event that you must do so.

 

[ballerdoc]

I personally wouldn't do this.

I do agree lawsuits are less common in dermatology but I wouldn't take the risk of going naked. As rare as it is, I've had a co-resident get sued while he was a resident.

The attorney who came to your practice seems like a fearmonger. While they CAN come after your personal assets, it is highly unlikely. She already noted it is difficult to be sued and 97% of the calls are just unhappy patients. Now she's saying she can take the remaining 3% and claim they have damages that exceed your malpractice policy limits?

If you've attended any medical malpractice talk, you'll know never to conflate a medical malpractice lawsuit with competence.

I'm an employed physician so my malpractice is covered by my company but if I were to start one on my own, I would definitely not go without malpractice coverage. (And while I would listen, I'd be very wary about taking advice from a medical malpractice law firm)

I was using the notion of lawyers coming after your personal assets as an argument against having medical malpractice insurance since it may not even protect you, while there are asset protection strategies that can protect you and your accounts receivable and cost significantly less (mainly just initiation costs).

The lawyer that spoke to our group was making the point that just because you have malpractice insurance, you shouldn't rest assured that you will be entirely covered. The main thesis of her talk was be a good physician, be empathetic with your patients, and that is the best way to protect yourself.

 

[asmallchild]

I was using the notion of lawyers coming after your personal assets as an argument against having medical malpractice insurance since it may not even protect you, while there are asset protection strategies that can protect you and your accounts receivable and cost significantly less (mainly just initiation costs).

The lawyer that spoke to our group was making the point that just because you have malpractice insurance, you shouldn't rest assured that you will be entirely covered. The main thesis of her talk was be a good physician, be empathetic with your patients, and that is the best way to protect yourself.

That I do agree with

 

[doctalaughs]

I was using the notion of lawyers coming after your personal assets as an argument against having medical malpractice insurance since it may not even protect you, while there are asset protection strategies that can protect you and your accounts receivable and cost significantly less (mainly just initiation costs).

The lawyer that spoke to our group was making the point that just because you have malpractice insurance, you shouldn't rest assured that you will be entirely covered. The main thesis of her talk was be a good physician, be empathetic with your patients, and that is the best way to protect yourself.

I’m not sure I agree. Obviously it’s smart to be careful and empathetic and it’s been shown to reduce your risk. However the key word is REDUCE. Look at the NEJM article from a few years back about physician liability data. Sure, Derm is lower risk than most specialties but still over a career about 50% of dermatologists get sued (where there is either a settlement or go to trial, not dismissed).

So your risk even as a diligent conscientious doctor is 50/50 over a career. If you are ok with the massive stress of going through this with zero coverage then do it. I personally could not bear the stress.

 

[ShadowDoc]

As rare as it is, I've had a co-resident get sued while he was a resident.

Mind if I ask what the circumstances were in that case? Just curious (pending if you are allowed to talk about it of course), thanks!

 

[asmallchild]

Mind if I ask what the circumstances were in that case? Just curious (pending if you are allowed to talk about it of course), thanks!

Case PMed to you.

 

[reno911]

For all of the reasons you point out, derm malpractice insurance is really quite inexpensive. I suppose this is regional, but have you priced it out? To avoid the risk of ruin, purchasing it is completely worth it.

 

[Merely]

Case PMed to you.

Why PM the case we would all like to learn from it

 

[siliso]

Miss one melanoma dx or staging in time and lose everything you have and will have going forward. Not worth it given what you will likely have to lose. Insure.

 

[asmallchild]

Why PM the case we would all like to learn from it

Not my case to widely disseminate

I PMed you as well

For everyone else who is interested, it is rare to be sued as a resident

But the same concepts apply as a resident and an attending:

- as a resident, don't go anything your attending explicitly tells you not to do (this should be obvious)
- try to establish a good rapport with patients

 

[werd]

I thought many (most?) states had required minimum malpractice coverages or they won't let you practice. even if you are very good and thorough and cautious, that does not protect you from being sued. some people equate bad outcomes with bad practice and will come after you even if nothing was done wrong. while being cautious and thorough should protect you from being sued successfully, it does not always do this either. no matter how good you are, I think it would be a mistake to practice without insurance.

 

[MOHS_01]

Dumb AF - especially given how cheap derm medmal is.