It is commonly referred to as “going bare.” Doctors fed up with the cost of medical malpractice insurance are refusing to pay the premiums necessary to secure coverage in Florida. Instead they are shouldering the risks on their own, putting dollars that would have gone for premiums into an escrow account or letter of credit, or by simply keeping liquid assets on hand. About 10 percent of Florida’s 44,625 active licensed physicians in 2008 are seeking alternatives, according to the Florida Department of Health.

Medical malpractice insurance rates in Florida are among the highest in the country and can cost as much as $100,000 for a $250,000 policy, according to Florida Medical Association Director of Legal and Governmental Affairs Jeffrey Scott, who blames an “aggressive and active trial bar and high jury awards” for the crisis. “At some point it doesn’t make economic sense to pay so much for that level of coverage,” he says.

Dr. Aaron Sudbury, a Bradenton OB/GYN and president of the Manatee County Medical Society, says Florida has some of the highest awards for medical malpractice in the country. “The mentality is that if something bad happens then somebody needs to pay me something,” he says. None of the seven OB/GYNs in private practice in ManateeCounty carry malpractice insurance, he says, and many physicians in other high-risk specialties, such as orthopedic surgery and neurosurgery, are also opting out.

But going bare can be a high-risk proposition, warns Sarasota attorney Bill Partridge.  “Many physicians are under a false impression that there are caps on damages for medical malpractice cases, but that simply is not the case. There are no limits for substantiated economic damages such as loss of wages and medical bills, and on top of those amounts, physicians can be held liable for non-economic damages such as pain and suffering of as much as $500,000.”

Scott points out that the medical malpractice insurance situation in Florida has far-reaching consequences for Florida’s competitive edge in attracting industry to the state. “It is already hard to recruit and keep physicians in Florida,” he says, citing factors such as Florida’s low Medicaid reimbursement rate, the high penetration of managed care that contributes to a “hassle factor” in collecting fees, and the 2004 state constitutional “three strikes and you’re out” amendment, which revokes the licenses of doctors who have either three malpractice judgments, three disciplinary actions, or three adverse outcomes in binding arbitrations.

“When you can’t recruit doctors you aren’t able to compete with other states as far as attracting new business,” Scott says. “This is bigger than just a doctor-patient thing.”