Medical Malpractice Climates Across the US


When it comes to medical liability laws and culture, where you live (and practice) does make a difference. In this article we’ll be discussing malpractice environments across the United States - key things for doctors to consider as they're looking for a place to work or potential states to expand to.

In the past few decades, many states have passed tort reform and attempted to not only reduce malpractice costs and access to quality coverage, but also improve the overall legal environment. In an ideal world, frivolous lawsuits are minimal and the cases with true merit are identified quickly and handled responsibly. This helps to reduce stress, keep malpractice costs at a reasonable amount (allowing doctors to carry the appropriate amount of coverage), and ensure that victims are compensated fairly and in a timely manner.

Best States to Practice Medicine In

So what states are best? The states with the best malpractice environment (i.e. the most doctor-friendly) generally fall into one of three categories:

·       States with malpractice caps

·       States that have passed meaningful tort reform

·       States with the “right culture”

There have been many articles published with rankings of states based on cost of living, average salary, malpractice costs, etc. but looking at the country purely from a medical liability perspective, the best states to practice medicine in are those with malpractice caps or those that have passed meaningful tort reform. States such as Alaska, Colorado, Indiana, Kansas, Texas, North Carolina, North Dakota, and South Dakota have all enacted reasonable malpractice caps, which set a ceiling on the amount of money that can be recovered in a case. In these states, litigation has decreased, premiums remain relatively low, and malpractice payouts tend to be overall less than in other areas. More than half of the states in the US have passed some form of tort reform, so the list of “good” states goes beyond those mentioned here, but it may take several years before the reform has a real impact in some of these areas. Ohio, for example, has made some real strides in tort reform, but experience hasn’t changed much yet. Time will tell how effective some of the most recent tort reform initiatives are.  

Beyond tort reform and malpractice caps, generally the best states to practice medicine in are those with the “right culture”. For example, Minnesota has not passed any tort reform, and yet they have some of the lowest premiums in the country. Some say that the “Minnesota Nice” culture and the tendency not to sue supersedes any cap or tort reform initiative – it’s just not who they are. The same could be said of Montana, Wyoming, Idaho, Wisconsin, Iowa, Nebraska, and other states throughout the Great Plains and the Midwest - which all have much lower claim frequency and severity, and therefore, lower malpractice premiums.

Worst States to Practice Medicine In

Which states should you stay away from? It’s hard to tell a physician not to practice somewhere because quality healthcare is important everywhere in the United States. That being said, some states are generally more litigious and physicians practicing in those areas will likely pay much more for their malpractice insurance. It doesn’t mean you shouldn’t work there – it just means you should be prepared to pay more (and possibly be sued more). Florida, New York, Washington DC, parts of Pennsylvania, New Jersey and Delaware generally experience more litigation, they have some of the highest malpractice payouts in the country, and malpractice premiums can be very expensive. Even in some states where the overall environment is stable, major metropolitan areas always tend to be hot beds for litigation (Ex: Miami, FL; Chicago, IL; New York City, NY; Detroit, MI; Los Angeles, CA; Las Vegas, NV, etc.).

Expanding Your Practice

If you are considering adding an additional location to your practice, make sure you do your research before jumping in and signing any contracts. Adding additional practice locations may seem like a simple change request, but there are risks (and costs) to consider regarding your medical malpractice insurance. Here are some considerations:

1) What is the overall malpractice environment like in this new location? Are you dipping your toe into a higher risk pool?

2) Is your current malpractice coverage sufficient? Are your limits adequate?

3) Will this increase your premium?

4) Are there other future coverage concerns that you should be aware of? If you start working and then change your mind, how does that affect your coverage? Will you have to buy tail?

5) Will your current employer allow you to work in this new location? Will your malpractice carrier even approve it?

Healthy malpractice environments have many obvious advantages: Lower premiums, fewer frivolous cases, and prompt, responsible handling of true negligence events. But have you considered the downstream effects of meaningful tort reform and healthy malpractice climates in a state? Consider this... healthcare providers practicing in doctor-friendly states tend to have improved quality of life as a result of decreased litigation stress, more money in their pockets, heightened morale, and the ability to practice good medicine without being defensive (and costing their patients more money).  Healthy malpractice climates also improve patient safety, as medical practices and hospitals have an easier time recruiting and retaining doctors, which, in turn, equals greater access to quality healthcare, especially those performing high-risk procedures.

Not sure which state/location is right for you? Talk to a knowledgeable malpractice insurance agent to better understand the area where you’re interested in practicing and learn about the coverage options, policy types, rates, and carriers that are available to you. Need an agent? Aegis is here to help. Contact us today to learn more about this topic and get quotes from the best malpractice carriers in your state.