tail insurance

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iso

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like many ca3's I have been looking at different job opportunities to find one I like. One thing I noticed is that the private practice groups I have interviewed with do not offer tail insurance. Is not providing tail coverge a common thing for those in private practice?

If I had to buy it myself, does anyone know how much it would cost (ball park estimate)? This will be my first job out of residency so I am unfamiliar with the ins and out of malpractice tail coverage.

thanks.
 
iso said:
like many ca3's I have been looking at different job opportunities to find one I like. One thing I noticed is that the private practice groups I have interviewed with do not offer tail insurance. Is not providing tail coverge a common thing for those in private practice?

If I had to buy it myself, does anyone know how much it would cost (ball park estimate)? This will be my first job out of residency so I am unfamiliar with the ins and out of malpractice tail coverage.

thanks.
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A friend of mine paid 25k after working for 3 years doing general.
 
Any idea if the amount changes based on case mix, e.g. OB or cardiac?
 
Occurance based insurance is the way to go for your first job IMO... unless the group/hospital pays tail. OB/GYN friend just retired... tail was over 100k.
 
What I've been quoted is that most companies charge 200% of your most recent annual premium for tail.
 
To extend my current occurrence based policy to cover a locums gig would cost me about $130 per day. I looked into this about 3 months ago and this is what I was quoted by MedPro.
 
sevoflurane said:
To extend my current occurrence based policy to cover a locums gig would cost me about $130 per day. I looked into this about 3 months ago and this is what I was quoted by MedPro.
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That's weird.

I have medpro and I know they will cover up to 6 weeks vacation coverage for me at no extra cost. I am in Florida and pay for my own occurrence coverage.

They do have to underwrite whoever is covering me so that could potentially affect my policy. But if it's a clean MD without any records or hits it shouldn't cost me any money. Up to 6 weeks coverage.
 
narcusprince said:
So how is tail coverage work when you work locums?
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Depends. If it's a short stint you're probably going to be more interested in having malpractice covered by the agency or the employer. For something longer term, assuming you have benefits elsewhere (as we .mil moonlighters do), you might be better off getting your own policy and negotiating a higher cash 1099 arrangement. Maybe.

When I was looking at a 3-5 year period of "locums" at one hospital a few miles from my Navy day job, I considered all of that. Eventually I settled on getting my own policy. It's a claims made 1/3 million policy. CA is a tort reform state with capped punitive damages so the premiums are low, but tail will be my problem. I've just been setting aside about 1/2 of every premium I pay to cover tail, if that day comes and my first non-.mil full time employer won't.

A tail doesn't have to be a big deal if you do the math and plan ahead for it.
 
aneftp said:
That's weird.

I have medpro and I know they will cover up to 6 weeks vacation coverage for me at no extra cost. I am in Florida and pay for my own occurrence coverage.

They do have to underwrite whoever is covering me so that could potentially affect my policy. But if it's a clean MD without any records or hits it shouldn't cost me any money. Up to 6 weeks coverage.
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Hmmm. Interesting aneftp. I feel like I remember you posting this info in the past. I wonder if the difference is related to the fact that I was looking into doing locums in another state. I acually never ended up doing the locums gig, but I did spend some time talking on the phone to medpro. $130 per day was their phone estimate. This was before I filled out all the paperwork... which was like starting a new policy all together. Have you done locums outside of Florida? If so, did you pay any extra for malpractice (doesn't sound like you did) ? It seems that $130 p/d conincides with what locums companies charge groups/hospitals for malpractice.

As a side note, if my memory serves me right... you are at $12,000 a year in Florida. My latest premium jumped to $12,100 in Indiana (tort reform/physician friendly state/clean record). I found that odd as Florida is suppossed to be a physician not so friendly state- more so in south Florida. Maybe central Florida rates are very diff. than south Florida.
 
Sevo.

Currently I am at $13500 or so for occurrence 250k/750k coverage. It's Florida and you want to only go with the lowest required. If surgeons carry 250/750 u carry the same. OB and some neuro docs are another end to itself in Florida.

I did risk management with med pro online course so they knocked off 5% from the $14k plus premium.

Yeah definitely depends on where you are doing locums. Of its out state locums you will have to pay extra.

If you are in state it doesn't cost you an extra.

Florida malpractice is really based on high risk counties (Palm beach, Broward, Miami-Dade) and the other counties. So if I were planning on doing locums down there I would need to pay extra.

The Florida panhandle is the lowest premiums.

But anyways. Medpro said if I needed anyone to cover me while I am on vacation they would cover up to 6 weeks locums at no extra charge provided the MD can meet underwriting standards (cough cough no previous claims I assume).
 
aneftp said:
Sevo.

Currently I am at $13500 or so for occurrence 250k/750k coverage. It's Florida and you want to only go with the lowest required. If surgeons carry 250/750 u carry the same. OB and some neuro docs are another end to itself in Florida.

I did risk management with med pro online course so they knocked off 5% from the $14k plus premium.

Yeah definitely depends on where you are doing locums. Of its out state locums you will have to pay extra.

If you are in state it doesn't cost you an extra.

Florida malpractice is really based on high risk counties (Palm beach, Broward, Miami-Dade) and the other counties. So if I were planning on doing locums down there I would need to pay extra.

The Florida panhandle is the lowest premiums.

But anyways. Medpro said if I needed anyone to cover me while I am on vacation they would cover up to 6 weeks locums at no extra charge provided the MD can meet underwriting standards (cough cough no previous claims I assume).
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How did you secure occurrence based insurance? That is a feat in itself. I ask because I am looking at a job in central FL and they are claims based (250/750) with no tail coverage. I am worried as to how much tail would cost if I didn't like it after a couple of years.
 
foxtrot said:
How did you secure occurrence based insurance? That is a feat in itself. I ask because I am looking at a job in central FL and they are claims based (250/750) with no tail coverage. I am worried as to how much tail would cost if I didn't like it after a couple of years.
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If you join a group you may not have much of a choice. A lot of groups in Florida use a very specific Florida based malpractice company. And that coverage is mainly claims made and not occurrence.

I always advise young MDs before joining a group partnership track. They mist ask how the malpractice is paid. Not only are you getting screwed for 2-3 years. But if they don't pay your tail if you don't become a partner. Watch out. These are red flags. Or at least they need to be fair. Like if you leave before a year you owe your own tail coverage.

Like I said. I have medpro occurrence coverage. I originally had a 3/5 million dollar policy in Tennessee. Than I transferred it down to Florida 250/750k occurrence coverage.

PM me if you need further answers. Central Florida is a very cut throat market. Especially with Sheridan buying out one of the three major players

That group only had 2-3 "super partners". Let's just say they got a kings random to turn the practice over to Sheridan.
 
Ok , so I am new and I am a 3rd year med student who is debating b/w anesthesiology and a few other residencies. I don't know any anesthesiologists personally to ask such an inappropriate question but nonetheless important. What is the average anesthesiologist salary after liability and insurance is taken out???

I believe it is important when thinking about the opportunity costs before choosing a specific specialty 🙁

I would appreciate any feedback!!!
 
Average income can vary greatly.

You can make anywhere between $200-700k.

It's impossible to compare apples to apples when it comes to income, W2 employee vs 1099, group benefits vs hospital employee benefits (which are usually better)

Factor in work hours,calls vs. no calls.

That's why average salary is very misleading.

What is a fact is average salary did go down for the first time in 13-14 years.

Anesthesia has relatively low malpractice premiums compared to other specialities.

And it depends on claims vs occurrence policy and how mature the claims policy is. Factor in location you are practicing.

I've seen claims malpractice premiums as low as $4k. I've seen claims mature policy as high as $17k/year.

I've seen occurrence policies as high as $36k a year.

Tail is usually 2.5x the claims made policy. So if your claims policy is maturer say $15x. You tail will be close to $40k. That's what my sisters tail was in Maryland after getting screwed out of a 5 year partnership track when they didn't make her a partner.
 
As a general rule.

I advise people who have claims insurance to prepare for the following
1. Leave group after one year (cost will be around $10-15k for tail)
2. Leave group after two years (cost of tail will be $14-19k)
3. Leave group after three years (cost of tail 20-25k)
4. Leave group after four years (cost of tail $25-30k)
5. Leave group after five years and longer ( cost of tail $35-40k)

My buddy's tail in Central Florida after 7 years was $35k. Since he was partner it was paid out of groups funds

My sisters tail in Maryland (suburban DC) was $40k after 6 years. She didn't make partner after 5 years.

If you retire or leave your speciality all together you will not have to pay a tail

If you use a national carrier like MedPro that has policy coverage in other states you may continue using their claims made policy in new state.

To all the rookies out there. If a group does not offer tail coverage in a partnership track. You need to than factor in the tail cost when evaluating contracts.

You could always pay a "head or nose" coverage which is usually 1/3 the cost
 
aneftp said:
As a general rule.

I advise people who have claims insurance to prepare for the following
1. Leave group after one year (cost will be around $10-15k for tail)
2. Leave group after two years (cost of tail will be $14-19k)
3. Leave group after three years (cost of tail 20-25k)
4. Leave group after four years (cost of tail $25-30k)
5. Leave group after five years and longer ( cost of tail $35-40k)

My buddy's tail in Central Florida after 7 years was $35k. Since he was partner it was paid out of groups funds

My sisters tail in Maryland (suburban DC) was $40k after 6 years. She didn't make partner after 5 years.

If you retire or leave your speciality all together you will not have to pay a tail

If you use a national carrier like MedPro that has policy coverage in other states you may continue using their claims made policy in new state.

To all the rookies out there. If a group does not offer tail coverage in a partnership track. You need to than factor in the tail cost when evaluating contracts.

You could always pay a "head or nose" coverage which is usually 1/3 the cost
Click to expand...

I've been told if you are stuck paying a tail when leaving, you should ask for the previous year's rate as the rate does go up each year and also ask to make the premium pretax. These things could save a few bucks. Unfortunately we are at a time where it is impossible to find a group that offers partnership or an occurance policy. I recommend finding a group where you are happy with the location. Because you could be in the highest paying place that offers partnership and an occurance policy, but if you are not happy with the location you will end up making your self miserable. Money doesn't buy happiness. And truth be told, starting salaries where I am are between 300-350k. So what you don't like the place after a year and pay 10 or 15k, it is not like you will be eating dog food.
 
cincincyreds said:
I've been told if you are stuck paying a tail when leaving, you should ask for the previous year's rate as the rate does go up each year and also ask to make the premium pretax. These things could save a few bucks. Unfortunately we are at a time where it is impossible to find a group that offers partnership or an occurance policy. I recommend finding a group where you are happy with the location. Because you could be in the highest paying place that offers partnership and an occurance policy, but if you are not happy with the location you will end up making your self miserable. Money doesn't buy happiness. And truth be told, starting salaries where I am are between 300-350k. So what you don't like the place after a year and pay 10 or 15k, it is not like you will be eating dog food.
Click to expand...

True, most of us (anesthesiologists) will not starve having to pay the $15K-40K malpractice tail.

However, some people will get "sticker shock" at a 40K malpractice tail like my sister was. People live in the now and don't think about the actual tail amount in the future. Believe it or not, but some of my friends still spend like crazy. My buddy in Texas says he's "struggling" at $500K a year after making $700-800K/yeare before the recession.

And it's a kick me while I am down thinking if the group doesn't offer you partnership PLUS you get that $40K tail when you exit the group like my sister had. This is a 5 year partnership some people go through. While partners were making 450-500K they were paying the younger MD's on the partnership track 120K, 140K,160K,180K, 200K. So your "buyin" money was already close to 1 million dollars over 5 years and at the end of 5 years, you still get stuck with this 40K tail.

Makes you think doesn't it?

That's why it always important to think about tail costs BEFORE you sign on the dotted line.

15-20K malpractice tail doesn't mean that much to me after being out 8 years in practice. I have no student loans, no car payments, no debt other than a small $2400 mortgage payment. It's still a lot of money but I have funds to cover it.

However, 10-15K may matter to young MDs just starting out. Many have young families to support, mortgage payments, car payments, student loans. If young MD makes say 220-250K (that's what some of the pay is in big cities). After taxes, expenses, they may not have much left after a 1-2 years to pay that malpractice tail.
 
aneftp said:
True, most of us (anesthesiologists) will not starve having to pay the $15K-40K malpractice tail.

However, some people will get "sticker shock" at a 40K malpractice tail like my sister was. People live in the now and don't think about the actual tail amount in the future. Believe it or not, but some of my friends still spend like crazy. My buddy in Texas says he's "struggling" at $500K a year after making $700-800K/yeare before the recession.

And it's a kick me while I am down thinking if the group doesn't offer you partnership PLUS you get that $40K tail when you exit the group like my sister had. This is a 5 year partnership some people go through. While partners were making 450-500K they were paying the younger MD's on the partnership track 120K, 140K,160K,180K, 200K. So your "buyin" money was already close to 1 million dollars over 5 years and at the end of 5 years, you still get stuck with this 40K tail.

Makes you think doesn't it?

That's why it always important to think about tail costs BEFORE you sign on the dotted line.

15-20K malpractice tail doesn't mean that much to me after being out 8 years in practice. I have no student loans, no car payments, no debt other than a small $2400 mortgage payment. It's still a lot of money but I have funds to cover it.

However, 10-15K may matter to young MDs just starting out. Many have young families to support, mortgage payments, car payments, student loans. If young MD makes say 220-250K (that's what some of the pay is in big cities). After taxes, expenses, they may not have much left after a 1-2 years to pay that malpractice tail.
Click to expand...

This is very true. The reality of the situation is that salaries are going down and partnership tracks are getting longer. The bottom line is to save as much money as possible because you don't know what the future holds. I am not trying to be a doom and gloom person, but it is important to be a realist and prepare for worst case scenarios so that you come out ahead.
 
foxtrot said:
This is very true. The reality of the situation is that salaries are going down and partnership tracks are getting longer. The bottom line is to save as much money as possible because you don't know what the future holds. I am not trying to be a doom and gloom person, but it is important to be a realist and prepare for worst case scenarios so that you come out ahead.
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Foxtrot... you should call medpro and see if they will extend you an occurence based policy... 🙂
 
I was contacted by a group that I have never worked with before to do some short term locums work with the surgery center in town. Their malpractice is claims made. I thought that was strange. I have done locums with locumtenens before and it was all occurrence based for short term gigs. What do folks think about this?
 
foxtrot said:
I was contacted by a group that I have never worked with before to do some short term locums work with the surgery center in town. Their malpractice is claims made. I thought that was strange. I have done locums with locumtenens before and it was all occurrence based for short term gigs. What do folks think about this?
Click to expand...


Unless it was an occurance policy, I would just tell them to suck it.
 
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