The Impact of Physician Extenders on Medical Malpractice Insurance

With the growing shortage of primary care physicians, there is a dramatic increase in the number of employed Physician Assistants and Nurse Practitioners—who function under the supervision of a physician. These “Physician Extenders”, the term used to describe healthcare providers who are not physicians but who perform medical activities typically performed by physicians, play a vital role in the healthcare system in this country. Physician Extenders can perform physical exams, diagnose, order tests, develop treatment plans, and write prescriptions, among other vital tasks normally performed by a doctor.

Why are Physician Extenders employed by Physicians and facilities?
Nurse Practitioners often pursue a more holistic approach to patient care than many physicians or surgeons. They can coordinate the medical, emotional, family and social needs of a patient. They tend to be available for the patients when the physician or surgeon cannot be present.

It has been well documented that many malpractice lawsuits result from a patient’s anger at a perceived failure of communication, empathy, or follow-up from the physician. A Physician Extender can improve communication with patients, providing a vicarious bond between the patient and the doctor.

How many Physician Extenders are there in the U.S.?
The number of Physician Extenders is growing by leaps and bounds. For instance, according the American Association of Nurse Practitioners, there were more than 205,000 Nurse Practitioners licensed in the United States in 2013. According to the National Commission on Certification of Physician Assistants, there were more than 95,500 Physician Assistants by the end of 2013.

The Medical Malpractice Implications of Physician Extenders
Although Physician Extenders can effectively allow the physician to better serve patients, it is important to recognize that the physician is ultimately responsible for the care provided in their name. The most common medical malpractice claim for the doctor who supervises a Physician Extender is responsibility for his or her own actions, known as direct liability. Under the concept of vicarious liability, however, the physician could be held responsible for medical malpractice for the failure of the Physician Extender, even if the physician acted appropriately.

Medical malpractice lawsuits against Physician Extenders are not common, but most medical malpractice cases filed against a Physician Extender also name the supervising physician; settlements that do not involve the physician are rare. When a medical malpractice lawsuit hits a hospital, clinic or private practice, the facility and the physician are not the only ones at risk. Physician Extenders can be targeted alongside a physician or facility when medical malpractice lawsuits are filed. According to the American Academy of Physician Assistants (AAPA), as patients and lawyers realize the prominent role that Physician Assistants have in patient care, Physician Extenders are at increasing risk of being targeted in medical malpractice lawsuits.

The primary reason for medical malpractice insurance claims against Physician Extenders can be grouped into the following four primary areas: (1) inadequate examination; (2) lack of adequate physician supervision; (3) delayed referral to a consultant (the supervising physician); and (4) failure to diagnose. Across all specialties, diagnostic errors are the most prevalent medical professional liability insurance claim involving Physician Extenders.

Sometimes, the physician and the assistant can fail to communicate about the seriousness of a patient. The doctor cannot simply rely on the Physician Extender to take their place. According to spokesman from The Doctors Company spokesman, there needs to be an understanding of what type of patient can be assigned to the assistant, and at what point the physician needs to intervene and work with the patient directly.

According to The Doctors Company, when the Physician Extenders’ skills are employed appropriately and statutory guidelines are followed, the risk of medical malpractice can be reduced. On the other hand, if protocols are not followed, the risk of a medical malpractice lawsuit can be enhanced significantly.

Given these trends, it is increasingly important that Physician Extenders purchase quality medical malpractice insurance (medical professional liability insurance or healthcare professional liability insurance) from a reputable medical malpractice insurance provider. Although Physician Assistants may think they are covered by employer-provided coverage in a lawsuit, these policies often fall short of protecting them and their assets.

The Limits of Employer Policies
There are several reasons why a Physician Extender needs to carry a medical malpractice insurance policy separate from that of the physician or the facility.

  1. Physician Extenders often share limits of liability with the physician under their medical malpractice insurance policy, even though all of the physicians and the assistants might be named in a medical malpractice lawsuit. Even though Physician Extenders are dependent on a physician for guidance, they still have considerable personal risk for negligence if attributable to them. Unfortunately, the interests of the Physician Extender may not be a high priority when the healthcare facility determines how to defend itself and negotiate a settlement.
  2. Another hidden risk for the Physician Extender is the fact that many healthcare facilities have a large self-insured retention or deductible, which means the facility is responsible for paying the first claim dollars—often $1 million or more—of a medical malpractice judgment. This structure gives a healthcare facility great incentive to settle a medical malpractice lawsuit regardless of the employee’s degree of negligence. In fact, if an employer chooses to settle a medical malpractice lawsuit, Physician Assistants may have to partially or fully compensate the employer for all or part of a settlement. He or she may also be held liable for part or all of the claimant’s award.
  3. Another reason for a Physician Extender to purchase his or her own policy: the policy needs to be portable to respond if the assistant changes practices, changes facilities, or gives advice outside of the office. In addition, the assistant needs to be sure that, if the facility or practice closes, he or she has proper medical malpractice insurance in place.
  4. If there is a licensing complaint against the Physician Assistant, which is different from a medical malpractice lawsuit, the Physician Assistant needs to have coverage which is not often available on the physician’s policy.
  5. Finally, in many cases, a third-party administrator handles medical malpractice insurance claims involving multiple physicians. These administrators may not communicate to the Physician Assistant as well as they do to the facility or to the physician. This can leave the Physician Extender out in the cold on a medical malpractice claim until it is settled.

Advantages of a Personal Policy
Physician Extenders are much better served by carrying an individual medical malpractice insurance policy with a quality medical malpractice insurance provider to advocate for them and help them prevent a potential malpractice claim. Physician Extenders deserve to have a medical malpractice insurance policy tailored to their needs and not to the needs of the supervising physician or facility. Physician Assistants and Nurse Practitioners need help with pre-lawsuit discovery, medical review panels, depositions, mediations and arbitrations, and the disposition of the medical malpractice claim. They need their own medical malpractice attorney who understands their unique position in the healthcare system and who has a genuine interest in defending them. They need a Risk Management Program which can help prevent them from having a medical malpractice claim in the first place and keep them out of the courthouse. Remember—medical malpractice insurance claims are awful even with the best insurance.

The central question a Physician Extender should ask when purchasing medical malpractice insurance: If a patient makes a medical malpractice claim against me, my supervising physician, and my facility, whose interests would the facility’s attorney put first?

A personal medical malpractice insurance policy can answer that question.

Barbara Gracey Backer
Barbara Gracey Backer

Barbara Gracey Backer is the Vice-President of Gracey-Backer, Inc., an Insurance Agency in Delray Beach, Florida specializing in All Lines of Professional and Personal Insurance. She may be contacted at (561) 404-5746 or at

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