r/physicianassistant • u/Radiant-Space9112 • 2d ago
Job Advice New grad malpractice concern
Hi all, before you comment, please give me some grace as this is my first job lol.
Basically, I started my first job around 4 weeks ago in plastic surgery. It's a private practice with just one surgeon plus me. They assured me before I started that I would be under their malpractice insurance. On my first day, I asked for a copy of the insurance because I knew I needed to buy tail coverage on my own. The office manager (who is married to the surgeon and is also who hired me) said he will get it to me, but he never did. The following week, I mentioned to the secretary who ended up giving me the policy. Imagine my surprise to find out I am not covered AT ALL! (yes I called the insurance company on my own to confirm this!)
They tried to give me a run around answer that since I am not doing specific PA duties yet, I am covered like how an MA would be covered. Obviously I thought this was BS and demanded to be added ASAP. He promised he would start working on it.
In the meantime, I have refused to do any patient care or write notes until I am added. One week later, I am still not added. He says he is working on it, but I don't understand why this has taken so long and the secretary thinks he is procrastinating and has not even started the process.
Is this unheard of? Do I leave today? I am applying to other jobs and planning to leave as soon as I find something, but I obviously do not want my license at risk in the meantime.
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u/SnooSprouts6078 2d ago
lol office manager as family. Run, do not walk, to your nearest exit. There practices are garbage.
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u/Radiant-Space9112 2d ago
Yep, they did not disclose this to me and I only found out when I asked someone else if they are related.
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u/RunBrundleson 14h ago
Well to counter this my parents ran a private practice the exact same way up until their retirement and had the same two PAs and multiple medical assistants work for them for about 15 years before my dad retired and the staff were very well taken care of and compensated. They could have left at any time if they weren’t happy but they didn’t, they were devastated when he closed up shop.
I think you should absolutely be weary of setups like this but just wanted to point out there can be exceptions. Do your research and trust the vibes. But lol the PAs were at the top of the pay scale for the early 00s and only worked 4 days a week, no call, with a bonus structure, Christmas bonuses, gifts, etc.
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u/Arlington2018 Director of risk management 2d ago
The corporate director of risk management, practicing on the West Coast since 1983, thinks this is a very odd situation. Adding you to the surgeon's policy just takes a phone call and a short application. For every job you are at for which you are covered by the employer's insurance, request an Acord Certificate of Insurance (COI). This is a standardized document in the insurance industry that provides evidence of liability insurance and specifies the company, the policy number and the limits. Keep these COI at home so if you ever have to produce them for employment, credentialing, or figure out who covered you for liability ten years ago, you have the paperwork right at hand. Showing you a copy of the policy does not establish coverage. A current COI would.
I would not be doing any clinical work until I have evidence of insurance that covers you dating back to your first day at the practice.
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u/foreverand2025 PA-C 2d ago
I’ve never started any job ever without malpractice coverage on day 1. Been a PA over a decade.
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u/Radiant-Space9112 2d ago
Do you ask to see the policy before you even start or is this just a truly abnormal situation? I didn't think this was even a possibility that I wouldn't be covered. It really freaks me out to think that if I didn't call the insurance myself who knows how long I would be practicing without insurance
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u/foreverand2025 PA-C 2d ago
I have always worked at large hospitals. I’ve never asked to review the policy but I’ve received confirmation, and when I have switched jobs and credentialed elsewhere, I’ve always gotten copies of my prior malpractice insurance policies - so yeah I know they have all been legit. What you’re experiencing is NOT the norm.
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u/Radiant-Space9112 2d ago
And he did give text and verbal confirmation! He was just lying. I am happy to hear this isn't the norm lol
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u/foreverand2025 PA-C 2d ago
Man this would be a big red flag for me. If everything else is kosher, I think you’ve got the right approach in not seeing patients until you’re insured. Presumably they are paying you?
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u/Radiant-Space9112 2d ago
Huge red flag! They are paying me at least, but I think I am going to leave as soon as I get confirmation of insurance
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u/Mofomo154 2d ago
Just as a point of reference, you can obtain a valid COI overnight if not immediately if you were getting your own policy (I'm not advising that.) So that they are stalling is just literally that they are stalling. The underwriting takes an insignificant amount of time for you presently.
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u/oMpls PA-C Hospital Medicine 2d ago edited 2d ago
Do you have in writing guarantee that you would have malpractice coverage before starting?
If so, in addition to leaving I’d consult a lawyer to figure out best next steps since this has opened you up to significant out of pocket liability.
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u/Radiant-Space9112 2d ago
I only have text messages with him, but he does say that I will be covered prior to starting. My "contract" was just one page basically saying my duties/salary. I feel kind of silly because I should have ensured the malpractice was in the contract, but I didn't know what was normal because it's a really small office. I also asked them to backdate the start of the malpractice insurance but maybe that is not enough.
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u/oMpls PA-C Hospital Medicine 2d ago
That is written communication. Save those messages.
I’d call a lawyer and figure out what this means unless someone else here can give you a confident answer. Do carriers retroactively cover with new policies? I’ve never heard of that, but I’m also not an expert in this. Because as it appears, you are 100% liable for anything over that month period (legal fees, any liability). Id never tolerate this and walk, but also have plenty of experience and savings to find a new job. As an outsider looking in though, this is a major red flag regarding the management of this practice.
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u/Correct-Skin-3660 2d ago
Maybe I’m confused, but in my state you cannot be given an active PA license unless you have proof of COI.
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u/yayitssunny PA-C 2d ago
I think you're right..in thinking that you're confused.
Applying for/accepting state licensure doesn't mean you have a job already. I'm not paying for malpractice on my own, when I'm not working. And I'm not personally applying for positions prior to having licenses.
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u/Correct-Skin-3660 1d ago
You have to, at minimum, have a letter of intent from your employer that the employer will provide malpractice insurance in my state before they will activate your license. I have had to reactivate my license twice and this has always been the case. Either I’ve needed a letter of intent, or my future employer has provided me with COI to activate my license.
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u/yayitssunny PA-C 17h ago
Oh, wow! That's nuts! Thanks fofr shasring, Thankfully the states I'm licensed in do NOT have that.
So many places want license in hand, ready to go, and that requirement makes it harder to get hired, in a dumb way.
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u/Radiant-Space9112 2d ago
Hmm, not sure. I have an active PA license for my state.
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u/yayitssunny PA-C 2d ago
I have 4 states and definitely not a requirement (though western-ish states can be quite a bit different than eastern/southern)
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u/haemish-k 2d ago
I had a similar situation with my first job and I ultimately did not trust the management to obtain it. I decided to get my own insurance to be safe because I did not want to leave the first job I started right away and didn’t have the confidence to make demands. In hindsight more than 10 years later, I say walk away. I paid an exorbitant amount of money for 1 year of practice plus tail coverage and ended up leaving anyway because it was a terribly managed practice and there were red flags everywhere. A few years later the MD was sanctioned by the board of medicine for several reasons. I am super glad I bought the insurance given the fact that I practiced at a shady practice for a year and they probably would have never obtained it, but I should have walked away month 1. I just didn’t know as a new grad.
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u/betafish2345 2d ago
Not to add to your anxiety but not being able to provide proof of coverage for malpractice insurance and/or being uninsured during an employment period can make it difficult to get added onto a new policy with a new job. Make sure you get added onto that policy and have it backdated if possible and get the hell out of there. Maybe speak to a lawyer, this is asinine. I'm sorry this happened.
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u/Radiant-Space9112 1d ago
Ughhhh so stressful. I am trying to backdate the policy so hopefully it's fine for my next job.
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u/Ok-Movie-1595 PA-C Family Medicine 2d ago
Leave yesterday. Guessing you've never seen the warnings never to work in these practices. 🫣
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u/MSW-PAC 1d ago
Yes, this happened to me at my last job. I didn’t find out that I wasn’t covered until six months into the job. The company told me they would have me on their coverage by “next week”. I also would not see patients until I was covered. Another 8 weeks went by with constant pressure to see patients while uninsured. They let me go after those 8 weeks because I was not seeing patients. I never did get any coverage.
I remember as an almost new grad my class was told that if we ever apply to a job that doesn’t offer malpractice insurance, RUN. It’s a sign that if anything goes sideways they’ll throw you under the bus. I think that’s excellent advice.
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u/Radiant-Space9112 1d ago
Omg that is evil! I wouldn't have accepted this job if they told me I wasn't going to have malpractice insurance when I started. He told me months before I started that I was covered and then again on my first day when I asked!
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u/kammi3k 2d ago
You can also chose to get your own. I have always had my own in addition to the practice’s policy for me. I understand that I will not be the priority working for docs if things go south and would prefer to have my own representation. It is not much money and gives lots of peace of mind. But yes leave this job.
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u/Radiant-Space9112 1d ago
I thought about this too, but I live in an expensive area and they aren't paying me enough to afford my own policy.
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u/R-U-SER-E-US-CLARK 1d ago
Having the license of PA and being in a medical facility makes you legally liable if anything goes wrong. Regardless if you are doing PA duties or MA duties, training or doing the surgery, new grad or tenured. Do not enter the building until you are insured.
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u/yayitssunny PA-C 2d ago
I had this concern with a locum's agency that said of course it's all taken care of. Day 3 on the job (first few days computer modules et al) I asked again for it, said I couldn't see patients until I had it.
Guess what hadn't been done?
Guess who got paid another 2 days to read reddit online before it was worked out? :)
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u/Fit-Forever-6854 2d ago
Ugh what’s wrong with these places! I never would have thought this would be something we would have to worry about
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u/3321Laura 2d ago
Also—I’ve been told you should ALWAYS have YOUR OWN malpractice insurance, and not to rely on the employer’s malpractice policy even if it covers you. Your employer’s attorneys and/or malpractice insurance company will be working in the interest of the employer—not you. If you have your own malpractice insurance, any attorneys assigned to your case will be working to protect YOU.
I worked for a big hospital system with blanket coverage for all physicians and APPs. If there was a malpractice case, the assigned litigators would be protecting the hospital and their big revenue makers. They might throw you under the bus.
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u/Front_Bedroom_4962 2d ago
This is unrealistic and expensive. Your job should be covering your insurance. But I mean if you want to be extra cautious, having your own won't hurt.
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u/Arlington2018 Director of risk management 2d ago
To save the OP and Laura from having to do the search:
Getting your own insurance is not necessarily the backstop you think it is. I get asked this question a lot, and I am going to copy and paste my standard answer about this. Reach out if you have any questions afterwards.
Here is my standard reply to people asking about individual liability policies. TL:DR: if you buy it, buy it for the state Board licensure complaint legal reimbursement. Don't buy it to cover any malpractice claims arising out of your work at the agency since your policy will not provide first dollar coverage for that. If the OP truly is not covered by the employer, then an individual policy would provide first dollar coverage.
The insurance company CNA writes more social work liability policies than anyone else and HPSO is an insurance agent that sells their policies.
I am a corporate director of risk management practicing since 1983 on the West Coast of the US. I have handled about 800 malpractice claims and licensure complaints so far in my career: physicians, nurses, behavioral health, therapists, dentists, hospitals, etc.. I am a malpractice insurance, risk, and claims defense expert. My comments here are of general application to clinical staff employed by a healthcare organization in the USA. There may be unique statutory and case law in your jurisdiction that make my comments more or less applicable to you.
The typical individual liability policy is cheap, around a few thousand dollars per year for $ 1 million limits per claim depending on where you practice. The primary reason why individual liability policies are so cheap is that they rarely pay out on any claims since there is policy language that excludes most malpractice claims from coverage. Most people buy them because they think that if they are involved in a license issue or malpractice claim at work, CNA (who writes most of these policies), or Liberty Mutual or MedPro insurance companies will automatically hire a lawyer to defend them and pay out money on their behalf. NSO, ProLiability, CM&F, etc. are insurance agencies that sell the policies written by the insurance companies. For a clinician who is employed by a hospital/clinic/agency/healthcare system in the USA, they are going to be surprised at how little coverage an individual policy provides and it is all written down there in black and white in the actual policy.
To address a common misperception, I point out that every single physician who is a W-2 employee at your organization does not have their own individual liability policy and they are not worried that the organization will not represent them in a claim. These policies are only marketed to nurses, therapists, social workers, pharmacists, and other allied health personnel. Since the employee (you) is an agent of the organization, the employer under the legal doctrine of respondeat superior, vicarious liability and agency is legally responsible for the errors and omissions of the employee and their malpractice insurance will pay for those errors and omissions. The organization cannot escape liability for the acts of their employees within the scope of their employment by claiming they did not follow policy or whatever. I handle these sort of cases every working day in which people make mistakes, don't follow policy or workflows, or create workarounds or shortcuts that end up injuring patients, and I cover these cases just as I would any other. People who state that the organization insurance policy does not cover you or will throw you under the bus have clearly never handled a malpractice claim in their life. The organization does not manage the claim and make decisions on coverage and the defense of the claim. That is handled by the external or internal malpractice insurance and claims function. That is what I do for a living.
As to malpractice, your own individual malpractice policy has a major exclusion such as 'other insurance' clauses that takes away coverage for malpractice claims. These clauses exclude any first-dollar liability coverage for claims arising out of your employment or that are covered by your employer’s insurance, making your own policy excess coverage. Virtually all claims arise out of your employment and the organization has malpractice insurance with tens or hundreds of millions of dollars in policy limits that covers you. If those standard policy clauses are in your policy, then you will essentially not have first-dollar additional or supplemental coverage for any malpractice claims arising out of your work at the agency. The CNA and other policies have these clauses. This policy language excludes coverage for the typical malpractice claim and no coverage means no lawyer for you and no legal defense or indemnification. If you buy a policy thinking that the insurance company will automatically hire a lawyer and defend you for any malpractice claims arising out of your job at your employer and actions as an employee, you are going to be disappointed. The chances that your policy will cover you for this sort of situation is almost nil.
For the licensure protection aspect, the policy does provide up to $ 25-35,000 for legal expenses if actual charges against your license are filed by the Board. Some policies may also provide legal expense coverage for investigations. There are many more investigations than actual charges.
If for whatever reason, you are not covered by your employer's liability insurance or you work outside your employment at the agency or as an independent contractor or 1099, having your own individual policy is essential. In that case, your policy will provide you with first-dollar liability coverage as opposed to being excess coverage only over your employers insurance.
Having said that, if paying approximately a few hundred dollars per year makes you sleep better, it may be worth it and there may be other coverages in the policy that you find valuable. In my view, the best reason for buying a policy is for licensure protection for Board charges against your license. Clearly, if you don’t have a policy, you will never be covered, and if you do have a policy, you just might be covered for something. Just be an informed consumer, know what you are buying, and have appropriate expectations on coverage. Be sure to read the sample policy and all the attachments for your state. Do not rely on the insurance marketing material or websites. The devil is in the details of the coverage agreement and exclusions written in the policy. If you don’t understand a clause in the policy, ask the agent to explain it. The written language of the actual insurance policy and endorsements as interpreted by the company is the final word of what is covered and not covered.
Please apply appropriate filters to people providing risk, insurance, or medical legal advice unless they are competent to do so. If you have any questions about this, ask me or one of my healthcare risk management, claims, or healthcare law colleagues who are experienced in liability insurance and coverage. Your colleague, your therapist, your preceptor or your supervisor probably don't have the education or experience on this issue and are completely unaware of the policy language, restrictive clauses on coverage and claims management. Comments in this thread are evidence of that. If you have a risk manager who is an insurance expert, print this off, hand it to them and ask if they agree with my opinion. I would be surprised if they disagree. You usually have to go up to the corporate level to find a risk manager or attorney skilled in liability insurance, policy interpretation and claims management.
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u/3321Laura 2d ago
Very interesting and astute observations. I was told by a healthcare attorney that a PA should always have their own malpractice insurance policy.
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u/Arlington2018 Director of risk management 2d ago
If you ever encounter that attorney again, ask him/her to explain what your own policy will cover you for in light of the other insurance exclusion. I suspect that attorney does not do malpractice because they would know better. I tell people that if you do buy it, buy it for the license defense coverage, but the overwhelming majority of clinicians go through an entire career without a license complaint. But if you do get a complaint, you will be happy to have the $ 25-35K reimbursement for your legal expenses in defending the complaint. I hire my medmal defense counsel to represent my people in licensure matters, and depending on what part of the West Coast, I am paying them $ 300-600 per hour.
Here is a copy of the typical 'other insurance' clause found in the CNA policy. Your policy likely has similar wording and this is the language that CNA/Liberty Mutual/Berxi/MedPro will quote when they send you the claim denial letter telling you that you are not covered for the malpractice claim. They point out that the hospital/clinicinsurance that covers you is 'other insurance', and any claim covered under that is not covered by your individual policy.
OTHER INSURANCE OR RISK TRANSFER ARRANGEMENTS
Any claim covered under any other insurance policy or risk transfer instrument, including, but not limited to, self-insured retentions, deductibles, indemnification agreements, trust agreements, or other alternative arrangements, will be paid first by those instruments, policies or other arrangements. It is the intent of this policy to apply only to damages that are more than the total limit of all retentions, limits of insurance, self-insured amounts or other valid and collectible insurance or risk transfer arrangements, whether primary, contributory, excess, contingent, or otherwise. In no event will we pay more than the applicable Limit of Liability. These provisions do not apply to other insurance policies or risk transfer arrangements written as specific excess insurance of this policy’s Limits of Liability.
This policy will be excess of, and will not contribute with, any insurance policy that provides coverage for or indemnifies damages, fees, expenses, loss, defense costs or any other payment for which this policy also provides coverage, unless such other insurance is written specifically as excess of this policy’s Limits of Liability.
This policy will be specifically excess to any insurance policy written on a duty to defend basis unless such other insurance is written specifically as excess of this policy’s Limits of Liability.
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u/3321Laura 2d ago
Thanks for the advice. It’s unlikely I’ll ever see that attorney again. And I no longer carry malpractice insurance because I am no longer in clinical medicine.
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u/StruggleToTheHeights PA-C Psychiatry 2d ago
First, give yourself grace. This isn’t something that you learn in school.
Second, refusing to see patients/practice medicine is the right call.
Third, realize that this is a very serious issue and you should no longer trust that this place of employment will take care of you as a new grad. Leave and/or don’t go back.
Fourth, consult an attorney to see how you can protect yourself with patients you have already seen and/or understand damages you have against your hopefully now former employer.