After recently receiving notice of a premium spike coming in July, Vladimir Grnja, M.D., decided that he would "go bare" and drop all malpractice insurance coverage.
Rates for the Hollywood, Fla., radiologist were to rise to $112,000 from $35,000 a year--a 220% increase, mainly because of litigation over mammograms.
"The money I earn won't pay for that kind of premium," he says.
Grnja will join a small but reportedly fast-growing group of doctors in several states who are dropping insurance at a time when premiums are rising fast and coverage is getting scarce.
The Florida Medical Association reports that more than 1,000 doctors in the state have no malpractice insurance. Doctors also have been sighted running bare in West Virginia and Ohio.
But it's not an option for everyone. The AMA reports that 18 states, including Colorado, Georgia and Pennsylvania, have some form of malpractice coverage mandate, while many hospitals and some health plans also require coverage.
"No doctor wants to go bare. That's obviously crazy, because your assets are at risk if there is a big settlement," says Dennis Agliano, M.D., chairman of the FMA special task force on the Florida malpractice crisis. But with significant premium hikes in Florida for specialties like OB/GYN, neurosurgery, thoracic surgery, radiology and even primary care, "some doctors have no choice," he says.
Agliano adds that each round of premium hikes makes coverage less meaningful.
Some neurosurgeons in South Florida, for example, are paying a $200,000 premium for coverage of $250,000 per occurrence, he says.
Going bare seems to attract doctors who, based on their own past records, do not expect to make big payouts. Grnja says he has been sued just three times in the past eight years, and all were dropped without payment. If there is a lawsuit, he expects to get bank loans to cover the costs.
Douglas Wolf, D.O., a family physician in Mannington, W. Va., faces a premium increase from $12,000 to $40,000 in June. He plans to go bare, but only at a big sacrifice.
"To justify that, I'd have to crank out more volume," Wolf says. "And if I move any faster, I actually increase my liability exposure because then you hurry through and get careless."
On the other hand, Wolf says, he will have to part from Blue Cross Blue Shield of West Virginia, which requires physicians to have coverage. The loss of patients will mean laying off much of his staff.
But Florida physicians who went bare years ago have good news for newcomers.
A Fort Lauderdale, Fla., thoracic surgeon who dropped coverage in 1990 says he gets several calls a week from doctors interested in going bare. The doctor, who asked not to be named, says he has been sued several times, but it has been easy to get bank loans to pay his attorney.
"The cost of defending the case is much less than the malpractice insurance would have been," he says, because insurance companies "want to settle right away."
He instructs his attorney to go to court if necessary. "When (plaintiffs) realize you're going to defend these cases, nine times out of 10 they'll back out," he says.
Bruce Trybus, a Fort Lauderdale attorney who represents two thoracic surgeons who also went bare in 1990, reports that all but one of six or seven malpractice suits "went away" after a few thousand dollars' worth of expenses. The one payout was for just $5,000, he says.
Trybus says he keeps his fees down by going to depositions only when absolutely necessary and not ordering copies of all legal documents.
But he wouldn't do the work for just anyone. If he were approached by a bare doctor who had a history of high payouts, "I would probably have second thoughts about representing him," Trybus says.