Researchers looked at 15 years of malpractice payments involving resident physicians across the United States and found paid malpractice claims involving residents were rare, with fewer than one paid claim for every 1,000 years of resident training. Residents had paid claims less frequently than attending physicians. However, when a malpractice claim was paid on behalf of a resident, the median payment was about $199,000, which is about the same as for attending physicians.
Residents in programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) receive professional liability coverage through their residency program for work performed within the scope of their training. That coverage is necessary because residents can still face malpractice claims even while practicing under the supervision of attending physicians.
Residency coverage, however, may not protect you in every situation. Moonlighting, outside clinical work, and other activities beyond the scope of your training can create potential coverage gaps.
Understanding what your program covers, where that protection ends, and when you may need additional malpractice insurance can help you stay protected throughout residency.
Unlike many attending physicians, residents typically don’t shop for or purchase their own malpractice insurance. Your residency program generally provides this coverage for you, so you may not have had much reason to think about the details of your policy yet.
Your program should provide documentation explaining your professional liability coverage. If you don't have it, ask your program administrator or graduate medical education (GME) office for a copy or summary. That documentation will tell you the terms of your coverage and help you determine which clinical activities and locations are covered.
Residency malpractice coverage usually applies to clinical care you provide within the scope of your training program, including duties performed during assigned rotations and at approved training sites.
Coverage also typically provides legal defense if a malpractice claim is brought against you for covered work. Settlements or judgments may also be covered, depending on your program’s coverage and applicable policy limits.
Being a resident doesn’t mean that every clinical activity you perform is automatically covered. Before providing care outside your usual assignments or training sites, verify that the activity is covered by your program.
Your residency malpractice insurance likely won’t cover clinical work that hasn’t been assigned or approved by your residency program. Depending on your program and policy, this can include:
Basically, don’t assume that an activity is covered simply because you’re permitted to perform it as a licensed physician. Check with your residency program before taking on clinical work outside your assigned training responsibilities.
To understand exactly where your residency coverage applies, check the following with your program:
Keeping a copy of this information can also make it easier to verify your coverage if questions arise later.
Yes. You can still be involved in a malpractice claim as a resident, even when you’re working under the supervision of an attending physician. In one study of 57,744 malpractice cases from 2007 to 2016, 4% involved a resident physician.
Residency can be a major adjustment. You’re still developing your clinical judgment and technical skills while managing a demanding workload and taking on greater responsibility for patient care. As you adjust, mistakes involving clinical decision-making, procedures, communication, or documentation can lead to malpractice claims.
Supervision can also become an issue in a malpractice claim, particularly if there are questions about whether an attending physician provided appropriate oversight or was available when needed.
The available research doesn’t prove whether residents are more or less likely than attending physicians to be sued. Research on paid malpractice claims does show that residents have a lower rate of claims resulting in payment than attending physicians, as discussed earlier.
Among paid claims involving residents, obstetrics and gynecology had the highest rate, at 2.96 paid claims per 1,000 resident-years. Neurological surgery followed at 2.01, while pathology had the lowest rate at 0.12.
Training level may matter, too, although the research is limited. One study looked at 87 malpractice lawsuits involving surgical trainees. Among the cases that identified the resident’s training level, 69% of those named as defendants were junior residents in their first or second postgraduate year. Most of these cases involved medical decision-making rather than errors made during surgery.
However, because the study only looked at a selected group of surgical malpractice cases, the findings may not apply to residents in other specialties.
The types of malpractice claims involving residents can vary. Of the resident-involved cases in the study of 57,744 malpractice cases mentioned earlier, 32% involved a surgical specialty. In these surgical cases, 39% involved claims that a procedure was performed improperly, while 28% involved problems with patient management. Diagnosis-related allegations accounted for 9% of cases, and medication-related allegations for 3%.
The researchers also looked at factors that may have contributed to these cases. Clinical judgment was a factor in 65%, technical skill in 64%, communication in 39%, and documentation in 28%.
Supervision can also play a role. In the same study, supervision was a contributing factor in 26% of the surgical cases involving residents.
Residents were named as defendants in 18% of the surgical cases. However, just because a resident was named as a defendant didn’t mean they were ultimately deemed liable. Most resident defendants were dismissed from the case. Twenty-eight cases were settled, six went to trial and ended in the resident’s favor, and none resulted in a verdict against a resident.
Residents also weren’t necessarily the only defendants. Hospitals were named as defendants in 85% of these cases and attending physicians in 59%, showing that multiple parties can be involved in a malpractice case involving a resident.
An attending physician or healthcare institution may also bear responsibility for a resident’s care. Supervising physicians and teaching hospitals may face liability, especially if there are questions about whether the resident was properly supervised. One way an institution may be held responsible is through vicarious liability, a legal principle that can hold an employer responsible for the actions of an employee.
Ultimately, who may be held responsible depends on the circumstances of the case, including the resident’s role in the patient’s care, their level of independence and supervision, and applicable state law.
Your medical license may allow you to take on clinical work outside your residency, but that doesn’t mean your residency malpractice insurance will cover it. Before taking on outside work, confirm whether your program’s coverage applies or whether you’ll need coverage from another source.
Before purchasing your own policy, find out whether the outside employer or facility provides malpractice coverage. If coverage is provided, make sure it applies to the specific clinical services you’ll perform and each location where you’ll practice. You should also review the coverage limits and policy type, since these can affect how much protection you have and whether you may need additional coverage later.
If neither your residency program nor the outside employer provides coverage for the work, you may need to purchase an individual malpractice policy.
Before beginning outside clinical work:
Malpractice insurance also generally excludes intentional or criminal acts and may contain other policy-specific exclusions. Review any exclusions before beginning outside clinical work.
Your residency program may allow you to moonlight, but permission to moonlight doesn’t necessarily mean you’ll be insured for that work by your program’s malpractice coverage. Whether you’re covered by your program may depend on specific circumstances, such as whether you’re moonlighting within your institution or working for an outside employer.
Before you begin moonlighting, confirm who will provide your malpractice coverage and that it applies to the work you’ll be doing.
Internal moonlighting generally refers to additional paid clinical work you do for the institution where you’re completing your residency. Your malpractice coverage may extend to this work, but that depends on your program and institution.
Don’t assume you’re covered simply because you’re working at the same institution. Before you begin moonlighting, confirm that your malpractice coverage applies to the specific duties you’ll be performing.
External moonlighting, on the other hand, generally refers to additional clinical work you perform outside your residency program. The employer or facility where you’re moonlighting may provide malpractice coverage, but this can depend in part on how you’re hired.
If you’re hired as an employee, the employer may provide malpractice coverage as part of your employment. If you’re hired as an independent contractor, you’re working for the organization without being its employee and may be responsible for obtaining your own malpractice policy unless your contract provides otherwise.
Before beginning external moonlighting, confirm how you’ll be classified and who is responsible for providing your malpractice insurance. If the employer doesn’t provide coverage and your residency insurance doesn’t extend to the work, you may need to purchase an individual policy.
If you need malpractice coverage beyond what your residency program provides, such as for moonlighting or other outside clinical work, you may receive coverage from another employer or need to purchase your own policy.
Regardless of where that coverage comes from, it’s important to understand how the policy works. That includes knowing what type of policy you have, how long the protection lasts, and how much coverage it provides.
Three policy details are particularly important:
Understanding these details can help you determine whether your current coverage is enough or if you need additional protection.
Malpractice insurance generally comes in two forms: a claims-made policy and occurrence coverage.
A claims-made policy generally provides coverage if a claim is made against you while the policy is active. If the policy ends and a claim is made later, you may need additional protection even if the incident occurred while the policy was active.
Claims-made policies also typically include a retroactive date. For a claim to be covered, the incident that led to it must have occurred on or after that date.
Alternatively, an occurrence policy generally covers incidents that happen while the policy is active, even if a claim is made against you after the policy ends. This means that if you provided care while covered under an occurrence policy, any claim arising from that care can still be covered years later, subject to the terms and limits of the policy.
If you aren’t sure which type of coverage you have, review your coverage documents or ask your residency program or outside employer. If you’re purchasing your own policy, consider the policy type when comparing your options, since it can affect whether you’ll need additional protection after the policy ends.
Whether you’ll need tail coverage generally depends on the type of malpractice policy you have:
As a resident, whether you need tail coverage for outside work depends on the specific limits of your malpractice coverage. If you’re in an ACGME-accredited program, your professional liability protection extends to claims filed after you complete your training when they arise from care you provided within the scope of the program. However, if you purchase a separate claims-made policy through a moonlighting employer or for other outside work, that same protection may not apply.
Before that coverage ends, find out whether you’ll need tail coverage to remain protected against claims that arise later from care you provided while the policy was active.
Here’s a quick look at how claims-made and occurrence coverage compare:
Your malpractice insurance coverage limits determine how much the insurer will pay toward covered claims. The per-claim limit is the maximum the insurer will pay for a single claim, while the aggregate limit is the maximum it will pay for all covered claims during the policy period.
It’s also important to understand whether defense costs are covered. Depending on the policy, defense costs, like legal fees, may or may not count toward your coverage limits. If they do, the amount that goes toward your legal defense reduces the amount available to pay a settlement or judgment.
Even if you aren’t purchasing the policy yourself, it’s important to know your coverage limits. Check your policy documents or ask your residency program, outside employer, or insurer to confirm them. If a claim exceeds your coverage limits, you could be responsible for paying the difference.
During residency, malpractice insurance is generally provided through your training program at no additional cost to you. The cost of malpractice insurance generally comes into play once you need to purchase coverage for work outside your residency.
The cost of an individual malpractice policy can vary depending on factors like:
If you need to purchase your own malpractice insurance, compare more than just the premium. The type of coverage, policy limits, and whether you’ll need tail coverage can all affect the overall cost of your protection.
The professional liability malpractice insurance you receive through your residency that covers work you do within the scope of the program ends when your residency does. That doesn’t always mean, though, that you won’t be protected if a claim is filed later related to care you provided during your training. Before you complete your residency, confirm with your program how such claims will be handled and whether you need any additional protection, such as tail coverage.
Keep copies of your malpractice insurance records. This includes any declarations pages or other documentation showing when you were covered, the work the coverage applied to, and your policy limits.
When you get your first job as an attending physician with a practice or hospital system, your new employer may provide you with malpractice insurance. Review your employment contract and coverage documents to confirm:
Reviewing these details ahead of time can help you understand exactly how you’ll be covered in your new position and make sure there isn’t a gap in protection as you transition out of residency.
If you plan to work as an independent contractor, you’ll likely be responsible for purchasing your own coverage for the job, depending on the arrangement.
This can also come up with locum tenens, or temporary physician assignments at any healthcare facility. Locum tenens work is often arranged through a staffing agency, which may provide malpractice coverage for the assignment. If you arrange an assignment directly with a facility, however, you may be responsible for purchasing your own coverage. In either case, confirm who will provide your malpractice insurance before you begin working.
Understanding malpractice coverage can be challenging, especially as a new physician purchasing your first individual policy after residency. Don’t rush into any decisions. Compare policies and providers, ask questions about anything you don’t understand, and consider getting guidance from an insurance professional if you need it. Most importantly, make sure your new coverage begins when your residency coverage ends so you don’t unintentionally leave a gap between the two.
As a final check, make sure you understand what your program-provided malpractice coverage covers and where there might be any gaps. You should be able to:
If there’s anything on this list you can’t confirm, check with your residency program, employer, or insurer. If you’re considering work outside your residency, address any potential gaps in coverage before you begin providing care.
Shopping for malpractice coverage for the first time can feel quite overwhelming, especially when you’re trying to figure out how your coverage applies to different types of work and situations during residency.
Here are answers to some common questions about how your coverage may apply in different situations.
It’s best not to assume that your attending physician’s malpractice insurance will also cover you if you’re named in a claim. Your residency program will typically provide professional liability coverage for the clinical work you perform within the scope of your training.
While an attending physician may also face liability related to care you provide, that doesn’t mean their individual malpractice policy covers you. Check your program’s coverage documents to verify that you’re personally covered.
Your residency program generally provides malpractice insurance for the clinical work you do within the scope of your training at no additional cost to you. You typically won’t have to pay a separate premium for this coverage out of pocket.
You may need to pay for your own malpractice insurance if you take on moonlighting or other outside clinical work that isn’t covered by your residency program or the outside employer.
It might, but not in all cases. If telemedicine is part of your assigned residency duties and performed within the scope of your training, your program’s malpractice coverage may apply.
If you provide telemedicine services outside your residency, make sure your program’s coverage applies to that work, or find out whether the employer or company you’re providing telemedicine services for provides malpractice coverage. You may need your own policy if neither does.
It’s possible, but not always the case. Whether you’re covered for volunteer medical work through your residency malpractice insurance policy depends on your program and how the volunteer work is arranged.
Before volunteering or participating in a medical mission, find out whether the activity falls within the scope of your residency program. If it doesn’t, check whether the organization you’re volunteering with provides malpractice coverage. If it does, ask for written documentation confirming that you’re covered before you begin providing care.
Resident physicians generally don’t need to purchase their own malpractice insurance to cover their residency duties. Residents in ACGME-accredited programs usually receive professional liability coverage through their institution for work performed within the scope of their training.
If you take on outside work, though, such as moonlighting or volunteer work, there may be legal requirements that depend on the type of work you’re performing and where you practice. Requirements can also vary by state. Before taking on outside work, confirm whether you’re legally required to carry malpractice insurance and whether the employer or organization you’ll be working with provides coverage.
Completing residency doesn’t necessarily end your protection against claims related to care you provided during your training. If you’re in an ACGME-accredited program, you can still be protected if a claim is filed after you finish residency, as long as it relates to care you provided within the scope of your training.
Coverage for moonlighting or other outside work may be different. If you had separate claims-made coverage for that work, check whether you need tail coverage to remain protected against claims filed after the policy ends.
As a resident physician, you’ll generally receive malpractice protection for the clinical work you perform within the scope of your training. However, that coverage usually won’t extend to every type of clinical work you’re licensed to perform as a resident outside of your program.
Understanding exactly which work is covered by your residency malpractice insurance can help you avoid potential gaps in protection. Before taking on moonlighting or other outside clinical work, find out whether your program’s coverage applies and, if it doesn’t, make sure you have coverage from another source.
If you need additional malpractice coverage during residency or as you transition into practice, compare your options before you begin providing care.
Indigo offers malpractice insurance designed for physicians, with coverage options you can explore based on your individual needs.
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