Why physicians are getting sued less and paying more, with The Doctors Company President Robert White

Malpractice premiums have held close to flat for physicians, and that stability is not a sign that claims are getting cheaper to resolve. It is the product of claims frequency falling to its lowest level since 1973, which has masked a severity trend running well ahead of inflation. There are early signs the frequency decline is ending.

Medical Economics Managing Editor Todd Shryock sat down with Robert White, president of The Doctors Company and TDC Group.

White walks through the arithmetic behind the numbers practices budget against. He explains how a single plaintiff's verdict resets the settlement value of every comparable case that never reaches a courtroom, why nuclear verdicts now land somewhere in the country roughly once a week, and what carriers expect rates to do over the next few years. He also makes the case that artificial intelligence in diagnosis and treatment is the emerging exposure worth watching, and argues that carrier selection is a reputational decision as much as a financial one.

This conversation was recorded in the spring. On June 26, The Doctors Company completed a $1.3 billion acquisition of ProAssurance Corporation, creating a combined insurer covering more than 200,000 health care professionals and organizations. The transaction is not discussed in this episode.

Don't miss our recent episodes on physician-owned hospitals, vaccine stocking costs, prior authorization and independent practice technology.

Music Credits:
Healing Breeze by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:29 | Cold open White on the two malpractice numbers moving in opposite directions.

0:29 – 1:33 | Introduction Austin Littrell introduces the episode and the guest.

1:33 – 1:52 | Meet Robert White Shryock opens on current trends in malpractice.

1:52 – 3:11 | Claims frequency at a 53-year low One in 21 physicians was sued in 2025, down from one in five in 1999. White credits the patient safety push and tort reform.

3:11 – 4:29 | Severity has never been higher The average payment reported on behalf of physicians reached $514,000 per closed report in 2025, up about 20% since 2022, and carriers will not know whether today's rate is correct for three to five years.

4:29 – 5:17 | Early warning signs Severity trending up roughly 5% a year, and bellwether states showing increased claims frequency in 2026.

5:17 – 6:35 | What a nuclear verdict is Any award above $10 million, and the 2009 book that gave rise to reptile theory.

6:35 – 8:24 | Why one loss sets the price of every settlement Only 7% of malpractice cases reach trial and the defense wins six of every seven, but the seventh becomes the yardstick.

8:24 – 9:49 | Where nuclear verdicts are landing Georgia recorded 11 in 2025 and 33 across four years. Illinois leads since 2015 with 58, followed by Georgia, New York, Florida, Pennsylvania and California.

9:49 – 11:10 | The consent policy Why carriers think twice about trying any case, and why physicians rarely withhold permission to settle once they have seen the verdicts.

11:10 – 12:44 | Thermonuclear verdicts Awards above $100 million, three already by April 2026, and the largest medical liability award on record: $963 million in Utah, decided by a judge rather than a jury.

12:44 – 16:47 | What it all means for rates Falling frequency masked the pressure from severity for years. With frequency flat, White expects increases of 1% to 3% nationally and warns that plaintiffs' lawyers are not spending this effort for nothing.

16:47 – 17:39 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

17:39 – 18:43 | The specialties carrying the most risk Cardiovascular, orthopedic and general surgery, plus obstetrics.

18:43 – 20:31 | Artificial intelligence as the next liability frontier AI is already embedded in diagnostic imaging, and White explains why the legal system's lag is the real exposure.

20:31 – 22:48 | The question to ask before choosing a carrier The carrier's name never reaches the data bank. The physician's does.

22:48 – End | Closing thoughts and outro Shryock thanks White and Littrell wraps the episode.