Dr. Marcus E. Tower remembers a time when it was nearly impossible for ob.gyns. to secure and retain medical malpractice insurance in his home state of Ohio.
Skyrocketing lawsuits had forced most physicians to shutter their practices, while insurers were dropping ob.gyns. from coverage and doctors were looking to escape the litigious state. Today, the legal landscape is vastly different, said Dr. Tower, director of ob.gyn. at Hillcrest Hospital, a Cleveland Clinic hospital in Mayfield Heights, Ohio. Malpractice reforms have helped stabilize the environment, he said, reducing frivolous lawsuits and making insurance more affordable.
Dr. Tower now pays $32,000 a year in malpractice premiums, the same rate he paid 30 years ago as a new physician.
“It’s improved quite dramatically,” Dr. Tower said. “Fifteen years ago, we were seeing a physician exodus from the state. Why would someone who just started a career in medicine want to practice in a state where you have to worry constantly about being sued? Now things have improved where you can take care of the patients as opposed to worrying about what you’re going to be facing in the courtroom.”
Dr. Tower’s experience is becoming more common across the country, legal experts say. Although historically obstetrics and gynecology had one of the most challenging legal landscapes, data show that more ob.gyns. are getting some relief. The number of lawsuits against ob.gyns. is on the decline nationwide, and the majority of malpractice premiums are decreasing or holding steady.
“On the whole, obstetricians have benefited from the overall improvement in the medical malpractice climate in the United States, particularly in the last 10 years,” said Paul A. Greve Jr., executive vice president and senior consultant for the Willis Health Care Practice, a global risk management consultant firm. “The number of suits being filed are at an all-time low.”
National medical liability insurer the Doctors Co. reports that ob.gyn. claim frequency has dropped by 50% from 2005 to 2014, according to its claims database.
As for malpractice premiums across specialties, after significant hikes in the early 2000s, rates started to fall across the board in 2006 and 2007. In 2008, 43% of premiums decreased for internists, general surgeons, and ob.gyns. And another 50% of rates did not change, according to 2008 data from the Medical Liability Monitor (MLM), which surveys rates from major liability insurers for internists, general surgeons, and ob.gyns. Steady premiums have continued for the past several years, with 71% of rates remaining unchanged in 2015, according to the latest MLM survey.
But not all ob.gyns. can attest to these improvements, said Dr. Thad L. Anderson, an ob.gyn. in private practice in Dubuque, Iowa, and chair of the American College of Obstetricians and Gynecologists’ Committee on Professional Liability.
Results from the 2015 American Congress of Obstetricians and Gynecologists’ Survey on Professional Liability show that about 40% of ob.gyns. made changes to their practice as a result of affordability and/or availability of liability insurance from 2012 to 2014. But that’s down from the 2012 survey, when 51% of ob.gyns. reported making changes based on insurance affordability and availability. The latest ACOG survey also found that nearly half of ob.gyns. made changes to their practice as a result of fear of litigation, a decrease from the 58% who responded similarly in the 2012 survey.
“Things may be stable, but if you go state by state, it’s very dependent on the litigation environment in that state,” Dr. Anderson said. “There are always hotbed states of litigation.”
Dr. Karen Harris, a gynecologist in Gainesville, Fla., has practiced in one of these hotbeds for the last 26 years.
In 2015, ob.gyns. in the Sunshine State paid between $80,000 and $190,000 in insurance premiums, according to the 2015 MLM survey, among the highest rates in the country. The excessive costs have forced Dr. Harris and her colleagues in a 10-physician practice to forgo insurance coverage. Instead, they have a prepaid malpractice defense policy with a law firm. The practice pays a monthly charge, and the firm defends them against all claims.
Dr. Harris said she’s paid less in settling claims than she would have paid in insurance premiums. She noted that the decision to skip coverage was driven by a 2005 case in which the settlement exceeded the practice’s insurance coverage.