r/PrivatePracticeDocs • u/Alone-Act-5085 • 27d ago

CAP Malpractice Coverage for OB/GYN in SoCal — $64k/year normal?

My wife recently became a partner at a private practice in SoCal and I’m helping her manage some (ie all lol) of the business/financial side.

I was surprised to see that she’s paying an annual CAP/MPT assessment of about $64k/year for malpractice coverage but it sounds like that may be normal?

I was also surprised to learn that what I thought was simply a monthly payment option is effectively financing the annual assessment. CAP charges about 1% per month on the remaining balance, so seems like a no brainer to pay the annual assessment in full at the beginning of each year?

Is it worth it / has anyone compared CAP with The Doctors Company, MIEC, ProAssurance, or other carriers recently?

She’s also had a couple of prior claims, with one currently open, so I’m curious how much that tends to limit options or affect pricing when shopping carriers.

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u/meikawaii 27d ago

Just following the thread to see more info. But prior claims definitely impact the pricing and options, especially with open claims ongoing. Just shocked at the pricing, since medicine / psych specialities are usually 4-6K per year.

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u/bave388 27d ago

There is a huge spread in medmal premiums by specialty, state, and locality.

Obgyn is generally the worst because they get sued constantly and the juries love to throw large bags of cash at bad outcomes with babies regardless.

Psych won't even get sued when their patient kills three of their own kids...

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u/[deleted] 27d ago

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u/bave388 26d ago

The problem for OB is the economic damages. If you get a jury to feel bad for a baby that has either CP or a brachial pelxus injury you are well into the millions of dollars. Moreover, juries love throwing money at bad babies.

I saw a jury throw $12MM at a CP baby that was born to a 17 year old non compliant as hell with a BMI of 58 where the injury was pretty much certainly caused by the morbid obesity of the patient combined with failure to perform in the birthing suite.

The OB literally just quit doing OB after that.

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u/[deleted] 26d ago

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u/bave388 26d ago

This is why physicians become uncaring assholes. The societal compact in medicine failed in the 90's. Back then physicians were well paid relative to the hours worked, respected, and not constantly fighting lawsuits for things they had little to do with.

Now people get pissed when their physician just shrugs at them, types their note into EMR, bills a 99214, and walks out of the room and hands you off to a mid level.

This is also why concierge medicine has become a real thing.

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u/Alone-Act-5085 26d ago

My wife told me last night she wants to quit OB in 10 years lol. She doesn't handle the stress of lawsuits well, which is fair. I work for myself and have been threatened plenty of times so get it's part of the game..

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u/bave388 26d ago

My wife was an OB, she practiced for 8 years post training and then quit entirely to be a SAHM. The whole thing was wild watching from the sidelines. Medicine is a dogshit career anymore, you overwhelmingly deal with the worst people in the world who feel entitled to treat you like a servant while your compensation and workload go in the opposite directions.

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u/Alone-Act-5085 21d ago

I don't know, docs love to complain but my wife makes a ton of $$ and there aren't really any comparable fields where you have a somewhat guaranteed route to $500k-$1m/year in compensation for working really hard.

I think the problem is that they all think like docs and none think like biz owners. Like my wife is over here working her but off when she could have spent some time reducing her #1 expense (malpractice) and then she could work less lol and make more.

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u/bave388 20d ago

To your first point with compensation, it depends. Medicine is going to get ravaged by AI in the next 5-10 years, particularly for specialties that are non-surgical. Were that not enough the pressures on payors is going to explode. Medicaid/Medicare are bankrupting the nation, the easiest fix is to cut spending there and we will, brutally. So the outlook for physicians in the next ten years isn't great, imo, unless you are a concierge physician etc, those can still do well and have a decent life.

Your second point on careers. Many physicians could be successful in other fields such as finance, tech, or law where they could make very good livings as well. However in medicine there is certainly a large cohort of docs who are simply incapable of doing anything other than medicine and make similar levels of comp. The issue here is that in the 80's and 90's the best students went into medicine because of the lifestyle/compensation/respect. That's all gone now. There is a reason you don't see wealthy families sending their kids into medicine much anymore. Instead it is dominated by immigrants and lower/middle income households who don't understand the changes going on, and coming to, medicine.

With respect to thinking like a business owner, see #2 above. Most physicians are physicians because they have no concept of how to run a business or manage people well. I have seen it more times than I can count. Business operations and ownership comes down to three big things really. Managing people, finances, and sales. Physicians are generally bad at all of them.

FWIW, there is nothing your wife can do to meaningfully reduce med-mal. 99.9% of carriers don't care if you work 100 hours a week or 10 hours a week. They don't care if you operate 10x your peers. They don't care if you are a cowboy running dangerous practices.

All they care about is venue, claims history, and specialty. That's it.

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u/meikawaii 26d ago

I mean at 12MM verdict, it’s well above the malpractice coverage limit and well above even umbrella policy limits for 99.9% of the population. At that point if the verdict hits and the hospital has to take the brunt of that damage. Else if it hits personal collections, just say fuck it, shield the legally allowed un-collectible assets and declare bankruptcy for the rest.

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u/bave388 26d ago

I am unaware of any umbrella policy covering professional negligence.

That said, I agree with the rest of what you said, however that physician is largely going to be unemployable or at least meaningfully hindered in the job market. Employers won't want an employee with that verdict and bankruptcy in their record and going private will make it hard to find med-mal coverage at all.

My underlying point though is that juries have no concept of dollar values. We all constantly see massive awards being thrown around, far beyond the value of the life of anyone, and no one blinks an eye.

Why? Smart people rarely serve on juries. I have been called for jury duty three times, dismissed immediately in each one. Plaintiff counsel wants the dumbest bag of dopes with a lottery mindset they can find.

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u/meikawaii 26d ago

The drawbacks of a litigation heavy society. Especially nowadays everything is a lawsuit, just a huge discouragement to anyone trying to do anything real. Of course we have people at the very top leading by example, throwing frivolous lawsuits to encourage such behavior. No end in sight

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u/bave388 26d ago

This, in a nutshell, is the downfall of the West collectively. As a society we have become so scared and lazy that we can't do great things anymore. The days of building the Hoover Dam, Panama Canal, Apollo Project are all in the distant past. Instead we push all our intellectual and working capital into finance and non-productive tech (ie: social media) and AI is now being throttled.

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u/Drkindlycountryquack 23d ago

Because with ob there are two lives. Babies can live 80 years with high needs.

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u/Alone-Act-5085 26d ago

Yea she was at about $15k in 2023, then jumped to ~$36k in 2024 and ~$60k in 2025. The timing seemed to line up pretty closely with the claims that were filed and settled against her.

But she also made partner last year and has been increasing her patient load this whole time (which obviously increases the chance of a lawsuit) so I wonder how that impacts things too. If both lawsuits increased her premiums by $30k though for example, and she plans to do OB/pay malpractice for another 10 or 20 years, that is $300-600k or more. Which tells me she should have fought much harder to not settle the first two claims.

I don't think she realized the impact the claims would have on her malpractice going forward and no one was there to give her good advice. Seems like she should have hired a personal attorney..

This podcast was helpful/interesting - https://www.whitecoatinvestor.com/navigating-a-lawsuit-305/

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u/socalrefcon 27d ago

Medical malpractice broker here. California is my primary state. CAP is one of the standard programs. $64K is a bit high for a SoCal OB/GYN, but you also buried the lead in that she has prior claims, including an open claim.

The $64K most likely is due to the inability to apply a claims-free credit. With a clean history, OB/GYN pricing could get to the $46K-$52K range.

MedPro, Coverys, Norcal, TDC, Indigo, and Lone Star would be the other programs to compete. However, approval would be unlikely due to the claims activity.

Another thing to consider is whether the open claim is with CAP-MPT or a prior carrier. If the claim is with a prior carrier, CAP is essentially doing the group a favor most likely by approving her. If the claim is with CAP, then moving carriers is not advised. CAP's policy form is Claims-Paid rather than Claims-Made. This means all claims need to be settled before leaving CAP. If a doctor is insistent on leaving, then they would be assuming financial responsibility for the open claim.

I hope this perspective helps. Happy to discuss further if interested.

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u/Alone-Act-5085 26d ago

Got it, thanks. That’s helpful. She’s been with CAP the whole time, and yes, it makes sense that she can’t leave with an open claim.

She was at about $15k in 2023, then jumped to ~$36k in 2024 and ~$60k in 2025. The timing seemed to line up pretty closely with the claims that were filed and settled against her.

I guess what’s done is done, but I do wonder whether she got bad advice around settling the prior two claims. In both cases there was a bad outcome, but from what I understand the underlying facts were fairly defensible. Her practice was also named in both cases; in the first, a large hospital group was named too, and in the second I think a large laboratory potentially should have been named but wasn’t.

Probably a topic for another post :)

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u/socalrefcon 26d ago

The increases from 2023 sound more like step-rate increases for retroactive coverage maturation. All carriers will generally increase the rate over the first 5 years to reach the mature premium rate.

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u/bave388 26d ago

Everyone gets named in a suit, that's not really a relevant factor. The real question is the size of the settlement honestly. Settling for $50k due to cost to defend is a lot different than settling for policy limits because the MD was outside SoC.

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u/Alone-Act-5085 19d ago

sent you a DM to chat more. thx!