State regulations on tort reform/malpractice caps when considering where to practice?

[izchief360]

I'm a rising CA3 currently on the job hunt, and casting a relatively large geographic net while looking. There is certainly a lot to consider when searching for the "right" place to practice, and no doubt the definition changes based on economic and non-economic factors.

That being said, one area I'd appreciate input on is tort reform as it relates to our work - economic and noneconomic damages. My understanding is that States like Texas are on one end of the tort reform spectrum (more physician-protective?) with more conservative caps on damages, whereas NE States are more liberal with their caps. Then I'm coming across States like Nevada which historically may have had stricter caps similar to TX, but as of very recently it seems like that is changing and quickly

I'm training in a State with "physician friendly" regulations, and the attendings at my academic institution have, on more than one occasion, mentioned how this State is a "good" place to practice for that reason.

It seems that the regulations surrounding this can change, and sometimes rather quickly. I'm wondering how heavily did you - or would you - recommend weighing these regulations when selecting a practice location, and do the laws in your State change or significantly affect your day-to-day operations (eg. "defensively" charting)?

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[aneftp]

Don’t worry about malpractice in ur state of practice.

That’s my take on it

 

[amyl]

Love you aneftp but will disagree on this one. When I practiced on the edge of Indiana and Illinois there was a huge difference. Indiana was way more dr friendly and the malpractice rates proved it. The group ended up dumping the Illinois business bc of the difference

 

[nimbus]

How much of a difference is there between states? I’ve always practiced in a tort reform state so even never considered the malpractice environment.

 

[nimbus]

How much of a difference is there between states? I’ve always practiced in a tort reform state so never even considered the malpractice environment

 

[IDGARA]

I'm a rising CA3 currently on the job hunt, and casting a relatively large geographic net while looking. There is certainly a lot to consider when searching for the "right" place to practice, and no doubt the definition changes based on economic and non-economic factors.

That being said, one area I'd appreciate input on is tort reform as it relates to our work - economic and noneconomic damages. My understanding is that States like Texas are on one end of the tort reform spectrum (more physician-protective?) with more conservative caps on damages, whereas NE States are more liberal with their caps. Then I'm coming across States like Nevada which historically may have had stricter caps similar to TX, but as of very recently it seems like that is changing and quickly

I'm training in a State with "physician friendly" regulations, and the attendings at my academic institution have, on more than one occasion, mentioned how this State is a "good" place to practice for that reason.

It seems that the regulations surrounding this can change, and sometimes rather quickly. I'm wondering how heavily did you - or would you - recommend weighing these regulations when selecting a practice location, and do the laws in your State change or significantly affect your day-to-day operations (eg. "defensively" charting)?

I've never considered this a day in my life.

Just don't be a d!ck to your patient's. Don't do anything that you can't justify to your peers.

 

[dannyboy1]

This is why you have insurance. Let them worry about it.

 

[amyl]

In theory I agree - when doing solo cases…. But care team is a different story. I have oodles of stories about crnas that have royally f—-d up

 

[Airway]

I think it does matter. I started my career doing high risk anesthesia and icu in Wisconsin. Until I left I didn't realize how great working in wi was in terms of malpractice and medicolegal risk.

Wisconsin Supreme Court Upholds Non-Economic Malpractice Damage Cap

The state Supreme Court upheld limits Wednesday on how much injured patients can receive for non-economic medical malpractice damages — or pain and suffering. The 5-2 ruling upholding the $750,000 […]

www.wpr.org

A decent comparison of states here

Medical Malpractice Lawsuits: 50-State Survey

A patient pursuing a claim against a health care provider should understand issues such as statutes of limitations, affidavits of merit, and damages caps.

www.justia.com

 

[Dr. Rude]

The risk of having personal assets attached as a result of a medmal event is very very low….but not zero.

 

[Ronin786]

Lifehack- working for a state hospital protects you from being named in a suit (your state may vary).

 

[abolt18]

Lifehack- working for a state hospital protects you from being named in a suit (your state may vary).

Not where I trained. I definitely heard about a few malpractice suits at my state university while I was in training.

 

[Ronin786]

Not where I trained. I definitely heard about a few malpractice suits at my state university while I was in training.

You can be sued, but often times the state is named and not you individually as a result of being a state employee.

 

[centdoc]

I've never considered this a day in my life.

Just don't be a d!ck to your patient's. Don't do anything that you can't justify to your peers.

It absolutely matters… malpractice insurance rates are much less in tort reform states. You would only know that if you’re in private practice (ie, “run the show”) and pay your own policy. If you’re employed, you’ll never know the difference.

 

[IDGARA]

It absolutely matters… malpractice insurance rates are much less in tort reform states. You would only know that if you’re in private practice (ie, “run the show”) and pay your own policy. If you’re employed, you’ll never know the difference.

I've got my own policy. Again, there are so many more important things that we deal with than, "Oh golly, what kind of tort reforms has my state undertaken?!"

If one of your biggest concerns is how much money a patient can get from you in a lawsuit, you're probably a **** doctor who has no respect for the people you're taking care of. They're your patients, not the enemy.

 

[deleted1183938]

I've got my own policy. Again, there are so many more important things that we deal with than, "Oh golly, what kind of tort reforms has my state undertaken?!"

If one of your biggest concerns is how much money a patient can get from you in a lawsuit, you're probably a **** doctor who has no respect for the people you're taking care of. They're your patients, not the enemy.

Yeah, this is bull****. Tell that to the OBs who can be sued for a little patch of white hair where it shouldn’t be until the kid turns 21 and who have run away from places like Florida.
You don’t have to be a ****ty doctor to have a bad outcome or two.

 

[Gern Blansten]

I've got my own policy. Again, there are so many more important things that we deal with than, "Oh golly, what kind of tort reforms has my state undertaken?!"

If one of your biggest concerns is how much money a patient can get from you in a lawsuit, you're probably a **** doctor who has no respect for the people you're taking care of. They're your patients, not the enemy.

I think that approach is being overly naive. It’s not an important issue until it is. And really good doctors get sued too. I wouldn’t project those accusations onto someone just for asking the question. Tort reform is an issue important to many.

 

[anonperson]

I've got my own policy. Again, there are so many more important things that we deal with than, "Oh golly, what kind of tort reforms has my state undertaken?!"

If one of your biggest concerns is how much money a patient can get from you in a lawsuit, you're probably a **** doctor who has no respect for the people you're taking care of. They're your patients, not the enemy.

It's not about respect or not being nice or not being a good physician.

If you have a bad outcome, there is a reasonable chance you will be sued if there is a chance a lawyer can make a dollar. Even if you do everything correctly. Lawyers will find a "expert witness" who will write a bogus opinion in order to push a case to trial.

The patient may have a great relationship with you but all it takes is one family member or friend to put the malpractice bug in their ear...

 

[slabb]

The malpractice climate and cost for anesthesia in a particular state, should not be a major factor in where you want to practice.
I'm not saying don't consider it, as there is a good chance any physician will be involved in a lawsuit during their career, but it shouldn't be in the top ten issues about a practice in a particular state. It's definitely in the second tier of things to consider when moving somewhere to practice anesthesia.
I might not say the same thing about some other speciaties though.

 

[abolt18]

The malpractice climate and cost for anesthesia in a particular state, should not be a major factor in where you want to practice.
I'm not saying don't consider it, as there is a good chance any physician will be involved in a lawsuit during their career, but it shouldn't be in the top ten issues about a practice in a particular state. It's definitely in the second tier of things to consider when moving somewhere to practice anesthesia.
I might not say the same thing about some other speciaties though.

I disagree, to an extent. I think that it's pretty easy to look at statistics with regards to medical malpractice and avoiding the top five to ten states (most litigious, largest payouts, etc) likely reduces your risk dramatically. Outside of those top offenders, the differences get dramatically smaller and are likely not worth worrying about.

 

[UscGhost]

I am in no way an expert on this.

However I think the general assumption is that patients will sue for whatever the maximum cap is. 1 million, 2 million, etc. The rest of the lawsuits are minor ones.

A barometer for how bad the state is regarding liability probably correlates with the cost of malpractice insurance. So try a few different states you are interested in and check their rates.

California, for example, is around 5-10k per year for standard claims made coverage.

I don't think anesthesia malpractice costs varies from state to state as much as other specialists

 

[Dr. Rude]

I am in no way an expert on this.

However I think the general assumption is that patients will sue for whatever the maximum cap is. 1 million, 2 million, etc. The rest of the lawsuits are minor ones.

Lots of states have caps for non-economic damages, e.g., pain and suffering. Few, if any have caps for economic damages, e.g., lost wages. So the same screw up that ends a neurosurgeon's career will potentially cost you lots more than one that ends an Uber Driver's career.

 

[<(^_^)>]

The malpractice climate and cost for anesthesia in a particular state, should not be a major factor in where you want to practice.
I'm not saying don't consider it, as there is a good chance any physician will be involved in a lawsuit during their career, but it shouldn't be in the top ten issues about a practice in a particular state. It's definitely in the second tier of things to consider when moving somewhere to practice anesthesia.
I might not say the same thing about some other speciaties though.

What would your top 10 be? Since in my mind it does belong maybe #8-10, but curious what you think.

 

[sevoflurane]

Indiana is an exceptionally great place to practice as a physician. But it is also an exceptionally terrible place to live.

 

[UscGhost]

Lots of states have caps for non-economic damages, e.g., pain and suffering. Few, if any have caps for economic damages, e.g., lost wages. So the same screw up that ends a neurosurgeon's career will potentially cost you lots more than one that ends an Uber Driver's career.

Yup. But are there any safeguards against that in any state? I honestly don't know.

The OP was asking to compare states.

 

[Dr. Rude]

Yup. But are there any safeguards against that in any state? I honestly don't know.

The OP was asking to compare states.

For economic damages...IANAL, but other than working under the benefit of sovereign immunity...Probably not.
Things that help...not working in a pro plaintiff community...Spousal ownership, (do you feel lucky?), If your state allows Joint Tenancy by the Entirety. More exotic things that are unlikely to be worth the cost but might help like LLCs, equity stripping ARs, Cash value life insurance, Irrevocable trusts, etc.

 

[<(^_^)>]

Also worth noting a 401k is not subject to judgments while in some states an IRA is. You can also roll cash balance plans into a 401k. Between the two of them you can protect a heck of a lot of $.

 

[anonanes]

Do you think the amount of malpractice matters?

I had someone to say getting the minimum is fine since if you're involved in a lawsuit - other lawyers will only try to go after whatever liability coverage you have - and if they see you have minimum coverage - it may not even be worth their time?

Additionally - I've mostly seen only the standard 1/3million policy - on occasion I have seen much lower numbers offered by groups and they have responded to my inquiries regarding this by stating: "we're in a tort reform state - it doesn't matter"

What do you guys think ?

 

[UscGhost]

Do you think the amount of malpractice matters?

I had someone to say getting the minimum is fine since if you're involved in a lawsuit - other lawyers will only try to go after whatever liability coverage you have - and if they see you have minimum coverage - it may not even be worth their time?

Additionally - I've mostly seen only the standard 1/3million policy - on occasion I have seen much lower numbers offered by groups and they have responded to my inquiries regarding this by stating: "we're in a tort reform state - it doesn't matter"

What do you guys think ?

It's extraordinarily rare unless you are doing very high risk procedures and/or grossly negligent. And in that case, a slightly higher or lower policy won't really matter as they might sure for 20 million for economic and related damages.

So maybe if you are working on professional athletes, high risk OB, neurosurgeon, etc