# Why can't some Doctors AFFORD their own insurance??? **URL:** \ **Category:** Factual Questions\ **Created:** [January 11, 2003, 3:41pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962 "2003-01-11T15:41:46Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Birefringence](https://avatars.discourse-cdn.com/v4/letter/b/7cd45c/32.png) [@Birefringence](https://boards.straightdope.com/u/Birefringence)\ **Post date:** [January 11, 2003, 3:41pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/1 "2003-01-11T15:41:46Z")
Listening to NPR last night I heard that there are some doctors who can not afford their own malpractice insurance. How can this be? Case in point there are some docs in the U.S. who actually refuse to conduct some surgeries because they are too risky. One woman in West Virginia had to be _Driven_ 200 miles to be seen by a doc who had the right insurance for himself. Maybe I have been disillusioned as to how much Docs really make - I was thinking over a mill a year - however, maybe they make a lot less. Anyone know why this is going on? Is there a possibility that when I go to the hospital I may not be seen by a specialist because he/she doesn’t have the right insurance. What are the causes of this mess? I know some malpractice suits have awarded huge sums to victims 1.5 Bill etc…etc… Is this making insurance companies charge hundreds of thousands in premiums for docs in the U.S? ---
**Author:** ![Yeah](https://avatars.discourse-cdn.com/v4/letter/y/dbc845/32.png) [@Yeah](https://boards.straightdope.com/u/Yeah)\ **Post date:** [January 11, 2003, 3:48pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/2 "2003-01-11T15:48:33Z")
From "The Median Unadjusted Income of Physicians by Years in Practice-- 1998 " posted at [http://www.ama-assn.org/ama/pub/article/171-207.html](http://www.ama-assn.org/ama/pub/article/171-207.html) With 1-4 years of practice Males $148K Females $120K With 5-9 years of practice Males $185,000 Females $125,000 With 10-19 years of practice Males $192,000 Females $115,000 With 20+ years of practice Males $168,000 Females $120,000 ---
**Author:** ![Epimetheus](https://avatars.discourse-cdn.com/v4/letter/e/c4cdca/32.png) [@Epimetheus](https://boards.straightdope.com/u/Epimetheus)\ **Post date:** [January 11, 2003, 3:54pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/3 "2003-01-11T15:54:32Z")
According to the Occupational Outlook handbook 2002-2003, average median earnings vary depending on the field of practice. [http://www.bls.gov/oco/ocos074.htm](http://www.bls.gov/oco/ocos074.htm) > [@](#): > > All physicians $160,000 > Surgery 240,000 > Radiology 230,000 > Anesthesiology 210,000 > Obstetrics/gynecology 200,000 > Emergency medicine 184,000 > Pathology 184,000 > General internal medicine 140,000 > General/Family practice 130,000 > Psychiatry 130,000 > Pediatrics 126,000 > SOURCE: American Medical Association ---
**Author:** ![Birefringence](https://avatars.discourse-cdn.com/v4/letter/b/7cd45c/32.png) [@Birefringence](https://boards.straightdope.com/u/Birefringence)\ **Post date:** [January 11, 2003, 4:00pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/4 "2003-01-11T16:00:49Z")
\*\*Surgery 240,000 Radiology 230,000 Anesthesiology 210,000 Obstetrics/gynecology 200,000 \*\* Thats the problem, from what I hear. It’s the surgeons - especially, neuro-surgeons because of the risks - and the Obstetrics because they are dealing with brand new human beings. Theys guys and gals are paying hundreds of thousands for insurance and refusing to perform some sureries. To me that violates the physicans philosophy of commiting to preserve life, especially in an emergency situation. ---
**Author:** ![Master\_Wang-Ka](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/master_wang-ka/32/3325_2.png) [@Master\_Wang-Ka](https://boards.straightdope.com/u/Master_Wang-Ka)\ **Post date:** [January 11, 2003, 4:06pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/5 "2003-01-11T16:06:43Z")
Um… I think that’s taking it a little far. I, for one, appreciate the nature of self-interest, and a person’s perfectly natural desire NOT to do something that is NOT in his own best interests. And I sure don’t want a doctor whittling on ME who has been FORCED to do so against his will! No matter HOW sick I am! Not if I can find another one who is willing to do so for money or morals! ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [January 11, 2003, 4:12pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/6 "2003-01-11T16:12:05Z")
From my memories of working 6 years in a pediatric cardiology office and filling out paperwork to get the doctors privileges to work at more than one hospital, some hospitals may require **different** malpractice insurance than what the doctor currently has. Where I worked, our doctors were covered by the (state university) hospital’s policy, but working at a different hospital might require a separate policy in some instances, if I recall correctly. So if a doctor wanted to have a clinic at a different hospital, and admitting privileges, etc., then they might need more malpractice insurance. (Practicing at more than one medical center wasn’t uncommon - the division’s physicians had clinics at as many as six different outside hospitals/medical centers while I was there.) I also know that the hospital I worked for - or at least that department - didn’t exactly give good salaries or raises for the physicians. One who left had received exactly two raises in over a decade, no cost-of-living increases or anything, and he was quite possibly the best physician in the division for much of his time there. I would also suspect, though I don’t know this for a fact, that even having a malpractice suit brought against you - whether valid or not - would cause your premiums to go up. (I know that when applying for privileges at other hospitals, at least, you had to indicate whether a suit had ever been **filed** , and if so, explain the situation. So even having a suit filed against you, ever, causes extra headaches when you’re trying to practice at other medical centers.) ---
**Author:** ![Birefringence](https://avatars.discourse-cdn.com/v4/letter/b/7cd45c/32.png) [@Birefringence](https://boards.straightdope.com/u/Birefringence)\ **Post date:** [January 11, 2003, 4:14pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/7 "2003-01-11T16:14:09Z")
**Wang ka** said: > [@](#): > > I, for one, appreciate the nature of self-interest, and a person’s perfectly natural desire NOT to do something that is NOT in his own best interests. Do something that is not in his own interest? If a doctor is paid big bucks to remove someones scalp and cut into their skull to perform needed surgery to help someone with epiliepsy or some other such ailment needed a specialist. - Then that is what they do. It is in their own best interest because _they_ are the surgeon. There are not many out there who can do this kind of work. Those who can save lives. So doctors striking because of insurance companies raising the anti on their malpractice insurance seems a slightly odd occurance. Maybe not, maybe I’m wrong. ---
**Author:** ![Master\_Wang-Ka](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/master_wang-ka/32/3325_2.png) [@Master\_Wang-Ka](https://boards.straightdope.com/u/Master_Wang-Ka)\ **Post date:** [January 11, 2003, 4:30pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/8 "2003-01-11T16:30:10Z")
Well… Bire, look at it this way. If you got hit by a bus, and you’re lying in the street, bleeding to death, I’d feel kind of a moral obligation to go out there and do first aid on you, try to keep you alive until the paramedics arrive. A moral obligation, you know? If, on the other hand, I could be held responsible for anything that happened to you, before or after I touched you, simply BY touching you… I hate to say it, bud, but I’d hesitate. Do I want your family suing me into oblivion, simply because I tried to save your life and failed? I might add that I’m Red Cross certified – my job requires it. …and this is where “moral imperative” crosses “self interest.” I have nothing against you. I certainly don’t know you. Just out of being who I am, I certainly don’t want you to die, and I wish you no ill luck… but do I want to put my life and fortune on the line to save your life? That’s a question, there. A poser. Something I need to think about. …and do YOU want a surgeon to have this on his mind when he’s standing in front of you with a scalpel? When the situation has arranged it that a surgeon LOSES money, due to insurance premiums, EVERY TIME HE OPERATES… well, jeez, what right do I have to demand that a given physician pay out of his own pocket, simply because I happen to be ill? ---
**Author:** ![Birefringence](https://avatars.discourse-cdn.com/v4/letter/b/7cd45c/32.png) [@Birefringence](https://boards.straightdope.com/u/Birefringence)\ **Post date:** [January 11, 2003, 4:37pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/9 "2003-01-11T16:37:46Z")
You bring up an interesting point **wang ka**. I wonder if premiums go down with experiece. Example: a surgeon with 5 years experience pays 100k in premiums a year, as opposed to a surgeon with 20 years experience pays 60k… or it is vis the verse? Also think about how much a surgeon knows about human anatomy - a lot more than someone with first aide training, thus a higher confidence level. I’d think. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [January 11, 2003, 4:41pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/10 "2003-01-11T16:41:18Z")
Well I’ll try to keep this GQ but yes you are wrong. Every surgery is a gamble and malpractice insurance is a doctor’s way to protect himself. If the cost of protecting yourself from the risk is too high they you don’t take the risk. You see from **Epimetheus** ’s post that the average OBE/GYN income is $200,000. Here are some malpractice rates, reprinted in [USA Today article](http://www.usatoday.com/news/health/2001-12-04-malpractice-usat.htm): > [@](#): > > Obstetricians/gynecologists > • Florida (Dade/Broward counties) $143,249-$202,949 > • Texas (Dallas, Houston, Galveston) $69,918-$160,746 > • New York (New York, Nassau, Suffolk counties) $89,317-$115,429 > • Michigan (Detroit area) $87,444-$123,890 > • Illinois (Chicago/Cook County) $88,928-$110,091 > • Ohio (Cleveland) $58,131-$95,310 > • Nevada (Las Vegas area) $71,092-$94,820 > • Ohio (Cleveland) $58,131-$95,310 > • West Virginia $63,165-$84,551 Check out Florida. How quick you think you are going to pay off your student loans paying over half your income in insurance premiums (not to mention staff/office expenses and taxes). ---
**Author:** ![In\_Conceivable](https://avatars.discourse-cdn.com/v4/letter/i/4bbf92/32.png) [@In\_Conceivable](https://boards.straightdope.com/u/In_Conceivable)\ **Post date:** [January 11, 2003, 4:43pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/11 "2003-01-11T16:43:03Z")
A surgeon with 20 years of experience has probably had a couple of malpractice claims against him. Even if the doctor eventually wins the suit his premiums can still go up. ---
**Author:** ![sailor](https://avatars.discourse-cdn.com/v4/letter/s/a587f6/32.png) [@sailor](https://boards.straightdope.com/u/sailor)\ **Post date:** [January 11, 2003, 4:46pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/12 "2003-01-11T16:46:11Z")
> [@](#): > > \*Originally posted by Birefringence \* > \*\*Maybe I have been disillusioned as to how much Docs really make - I was thinking over a mill a year - however, maybe they make a lot less. Anyone know why this is going on? \*\* What doctors make is totally irrelevant. Insurance premiums are based on how much insurance companies can expect to pay out in claims. American people want to have their cake and eat it to and it just doesn’t work that way. If you want to be able to win the lottery every time you see a doctor, then you have to buy the tickets (which are built into his fees). Doctors are like plumbers and like any other profession. They do it to make money and they charge what the market will bear. Nothing wrong with that. In fact, America has the most advanced medical knowledge in the world and plenty of foreign doctors go there to study. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [January 11, 2003, 6:20pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/13 "2003-01-11T18:20:44Z")
> [@](#): > > \*Originally posted by Birefringence \* > \*\*You bring up an interesting point **wang ka**. I wonder if premiums go down with experiece. Example: a surgeon with 5 years experience pays 100k in premiums a year, as opposed to a surgeon with 20 years experience pays 60k \*\* This is not the case. Premiums go up as the insurance carrier’s costs go up, and as the doctor’s history of malpractice cases goes up. And it’s quite often the technically superior doctors who get sued the most, as they are the ones taking the riskiest cases, with the hightest potential for bad outcomes. Even if the doc wins all his cases (and most do) the costs still rise. And losing a case doesn’t mean the doctor made a mistake or committed true malpractice, it just means the jury was pursuaded by the plaintiff’s story, even in the face of evidence. Lawyers tell us it’s just the cost of doing business and we should get used to it, but with the government regulating what we can receive for our services, physicians are getting squeezed. Quite tightly in some areas. ---
**Author:** ![Master\_Wang-Ka](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/master_wang-ka/32/3325_2.png) [@Master\_Wang-Ka](https://boards.straightdope.com/u/Master_Wang-Ka)\ **Post date:** [January 11, 2003, 6:28pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/14 "2003-01-11T18:28:04Z")
Thanks, Qadgop. Was wondering if we were going to hear from you. Wonder if this is why there are so many doctors from other countries practicing locally these days? ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [January 11, 2003, 6:41pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/15 "2003-01-11T18:41:20Z")
> [@](#): > > \*Originally posted by sailor \* > **Insurance premiums are based on how much insurance companies can expect to pay out in claims.** > [@](#): > > _Originally posted by Qadgop the Mercotan \* > \*\* Premiums go up as the insurance carrier’s costs go up_\* Both statements are false. [A Study By Americans for Insurance Reform (PDF file)](http://www.insurance-reform.org/StableLosses.pdf) > [@](#): > > First, the amount that medical malpractice insurers have paid out, including all jury awards and settlements, directly tracks the rates of medical inflation. Not only has there been no “explosion ” in medical malpractice payouts at any time during the last 30 years, but payments (in constant dollars) have been extremely stable and virtually flat since the mid-1980s. > > Second, medical insurance premiums charged by insurance companies do not correspond to increases or decreases in payouts,which have been steady for 30 years. Rather, premiums rise and fall in concert with the state of the economy —insurance premiums (in constant dollars) increase or decrease in direct relationship to the strength or weakness of the economy, reflecting the gains or losses experienced by the insurance industry ’s market investments and their perception of how much they can earn on the investment “float ” (which occurs during the time between when premiums are paid into the insurer and losses paid out by the insurer) that doctors ’ premiums provide them. In other words, insurance companies do not make their profit on the difference between premiums collected and settlements paid out. Rather, they make their profit by investing premiums in the stock market. The reason rates are increasing now is because the stock market is declining, and the insurance industry is scrambling to maintain profits at the expense of the American health system. For more information on how the insurance industry is ripping you off, visit [Americans for Insurance Reform](http://www.insurance-reform.org/). ---
**Author:** ![Nightime](https://avatars.discourse-cdn.com/v4/letter/n/e9c0ed/32.png) [@Nightime](https://boards.straightdope.com/u/Nightime)\ **Post date:** [January 11, 2003, 7:23pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/16 "2003-01-11T19:23:50Z")
Fear Itself - can you tell us where all the extra money that the insurance companies are taking is going? Not that I don’t believe that insurance companies would charge ridiculously exorbitant prices, but given how heated this issue has become it seems like it would be difficult for them to hide all the money. I think there clearly has to be tort reform in malpractice cases. It is true that we don’t want bad doctors. However, a lot of good doctors are moving or retiring because of the insurance issues. In the end the medical field is becoming a _far_ less attractive option, and that in itself will cause a lot of potentially great doctors to not become doctors at all. Thus huge malpractice payouts, contrary to what lawyers say, will not make the medical profession better. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [January 11, 2003, 7:42pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/17 "2003-01-11T19:42:16Z")
**fearitself** , thanks for those interesting links. Let me rephrase my statement: **Premiums go up as the insurance carrier’s profit margin decreases; cost is but one factor in that equation.** But it can still be a significant factor for certain insurers. I’ve been around long enough to see some smaller carriers leave the med malpractice insurance business or go bankrupt on the basis of a few large judgements. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [January 11, 2003, 7:57pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/18 "2003-01-11T19:57:19Z")
> [@](#): > > _Originally posted by Nightime_ > **Fear Itself - can you tell us where all the extra money that the insurance companies are taking is going?** If by “extra money” you mean profits, they go where all corporate profits go; to the stockholders, in the form of dividends. Since premium increases are not related to settlement losses, tort reform will not halt the upward spiral of premiums. This is clearly shown in states that enacted tort reforms in the 1980’s, yet these states, such as West Virginia, have some of the highest malpractice premiums in the nation. The insurance industry itself has admitted that tort reform will not reduce premiums. In a response to a comprehesive study by Americans for Insurance Reform ([Premium Deceit; The Failure of “Tort Reform” to Cut Insurance Prices](http://www.insurance-reform.org/PremiumDeceit.pdf)), Sherman Joyce, president of the American Tort Reform Association (ATRA), when asked to respond to Premium Deceit, told Liability Week (July 19,1999): > [@](#): > > “We wouldn’t tell you or anyone that the reason to pass tort reform would be to reduce insurance rates.” Victor Schwartz, ATRA’s General Counsel and one of the principal “tort reform” lobbyists in Washington on behalf of business interests, told Business Insurance (July 19) that while he thought some severe “tort reform” measures could reduce insurance rates, he said when pressed that, “More importantly … many tort reform advocates do not contend that restricting litigation will lower insurance rates, and 'I’ve never said that in 30 years.” (emphasis added.) Further backing-down, Mr.Joyce followed with the comment,**"We think the real focus (of tort reform) should be on (restricting) the payment of punitive damages,'rather than on lowering insurance costs."** Tort reform is a red herring, designed to mislead consumers and enrich the pockets of insurance company executives and their stockholders ---
**Author:** ![RM\_Mentock](https://avatars.discourse-cdn.com/v4/letter/r/e274bd/32.png) [@RM\_Mentock](https://boards.straightdope.com/u/RM_Mentock)\ **Post date:** [January 11, 2003, 8:11pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/19 "2003-01-11T20:11:48Z")
> [@](#): > > \*Originally posted by Birefringence \* > \*\*So doctors striking because of insurance companies raising the anti on their malpractice insurance seems a slightly odd occurance. Maybe not, maybe I’m wrong. \*\* Ante. Doctors fees are regulated in certain areas too. The MBAs came into the medical field with a grand promise to make it financially efficient, better for everybody. Their greatest solution? Capitation–they sign up corporations by the head, that way the corporations have a fixed known cost, then they turn around and offer physicians a fixed known per year fee for taking care of every ailment of the covered employee. Who ends up with less money (because the MBA takes the vig), and more management headaches than before (because they have to finance the patient’s appointments to specialists)? The family doctor. A sixth grader could have managed that business administration. ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [January 11, 2003, 8:57pm UTC](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962/20 "2003-01-11T20:57:27Z")
Canada has a national, mandatory insurance plan covering all doctors. It provides malpractice insurance at substantially lower rates than the US only because i) medical lawsuits here are less common and ii) damage amoutns are much lower. My understanding of part of teh problem is that in the US doctors must buy a specific dollar amount of insurance (I am covered for damages up to $3 million) and are on the hook for larger damages. Our insurance covers any damage although in practice would go bankrupt if the modest values the courts award increase. [Next page](https://boards.straightdope.com/t/why-cant-some-doctors-afford-their-own-insurance/147962.md?page=2)