Malpractice Insurance Considerations for Fellows


After 4 years of undergraduate studies, 4 years of medical school, and 3-5 years of residency training, a doctor may choose to finish up their studies by completing a fellowship program. During a fellowship, physicians and surgeons are given the opportunity to focus on their specialty in a more in-depth capacity. Providers looking to deepen their knowledge, sub-specialize, or gain further experience look to fellowships for more hands-on training before beginning their medical practice.

When it comes to medical malpractice insurance and coverage for fellows, there are a few key things to keep in mind.

Rates are typically discounted

Fellowship malpractice insurance rates are often discounted. Although fellows work more independently than a resident or medical student, they are still mentored and supervised by another, more experienced physician or surgeon. Typically, the fellowship program will provide malpractice insurance for you, but in the event that you must obtain your own policy, rates are generally 50-75% of what they would cost normally. Contact a knowledgeable malpractice insurance agent if you need to get a quote.

What kind of malpractice insurance should you get?

It’s important for you to know what type of malpractice insurance policy is being provided for you – Occurrence or Claims-Made?  Claims-Made coverage triggers based on when the claim is made against the provider; so a fellow must carry the insurance while they are actively practicing and then obtain tail insurance (or nose/prior acts coverage from a new carrier) after the policy is cancelled to continue the coverage for future filed claims. Occurrence coverage triggers based on when medical incident actually occurred, even if the claim is filed after the policy has been cancelled.  Tail insurance is not necessary for Occurrence policies. Read more about Occurrence vs. Claims-Made coverage here.

If your fellowship program is providing a Claims-Made policy for you, it’s important to find out who is responsible for purchasing the tail coverage when you finish training.  This is an often-overlooked item that needs to be clarified early so there is no confusion when you leave.  Tail insurance can be expensive (typically 1.5 – 2 times an annual premium), so you’ll need to be prepared for that expense if it will be your responsibility.

Are you covered on a shared-limits basis? Or do you have your own individual limit?

Be sure to understand how much coverage you have in the event that you are named in a medical malpractice claim.  If you are covered on a shared limit policy, that means that you (and all the other named individuals) will be sharing the same policy limit, which potentially reduces the amount of coverage available to you.  It is generally recommended that fellows have their own individual policy limits, unless the shared limits are high enough to comfortably/adequately protect all parties.  

Is coverage limited? What about moonlighting?

Most fellowship programs’ malpractice insurance policies are not written on a broad form; they are limited scope & duty policies. This means that the policy only covers you for claims related to the work that you do within the scope of your fellowship training for that particular program. If the incident that led to a complaint falls outside this scope, you may not have coverage.

Many fellows look to moonlighting as a way to supplement their income while they are finishing up their training. If this is something you are interested in doing, you will need to secure your own separate malpractice insurance. Many carriers offer moonlighting policies or part-time malpractice insurance policies at discounted rates, so obtaining additional coverage is generally affordable.  

Keep good records

It’s wise to keep a copy of your certificate of insurance or policy declaration page, showing your coverage details throughout fellowship. You will need this information for future malpractice applications, credentialing forms, or in the event that you need to report a claim. This is a best-practice for you throughout your medical career, so start a good record-keeping system early on.

What happens after you finish your fellowship program?

After fellowship training, you’ll be on to the real world – whether that’s private practice, joining a group, working for a hospital or university, etc. Again, you’ll be in a situation where you may have your malpractice insurance provided for you, or you may have to obtain your own. It may be helpful to refer back to our guide on questions to ask before starting private practice.

If you will be obtaining your own malpractice insurance, most carriers will offer a discounted premium for at least your first year in private practice (many offer a discount for the first 2-3 years). Be sure to work with a knowledgeable malpractice insurance agent so that you can compares policies, rates, and other key factors to help you find the coverage that’s right for you.