Malpractice Insurance for Locum Tenens Dermatologists
I'll start this post with the disclaimer that at every locums assignment I've taken, I've negotiated for the practice to cover my malpractice insurance, so I've never bought my own policy. That happens to be the path I'd guide most people toward, for reasons I'll get to. But some locums derms, especially those direct contracting with smaller practices, end up needing to buy their own. Since I haven't walked that road myself, I researched it a bit for your benefit.
Basic Malpractice Terminology
Occurrence. Covers any incident that happens while the policy is active, no matter when the claim is filed, even years after the policy has lapsed. I would consider this to be the gold standard, and there's nothing to buy when you leave the practice or gig.
Claims-made. Covers a claim only if the policy is active both when the incident happened and when the claim is filed. It's cheaper up front, which is why practices favor it, and there's an obvious downside to it: once the policy lapses, claims filed later for your past work aren't covered. That gap is what tail coverage fills.
Tail coverage (sometimes referred to as an Extended Reporting Period endorsement) extends your reporting window after a claims-made policy ends. It's a one-time cost that can range from 150 to 300 percent of your annual mature premium. On a cheap policy that's manageable; on an expensive one it can be a five-figure bill that lands right as you're heading out the door. If you're planning on signing on to a claims-made policy, you need to understand who is footing the cost for tail coverage.
Nose coverage, or prior acts, closes the same gap from the other direction: a new carrier agrees to cover your old retroactive date, so you skip buying tail from the departing one. If you move between carriers, ask about it, since it can sometimes come out cheaper than tail.
Malpractice coverage scenarios
A locum tenens agency covers it. Work through a staffing agency and they almost always provide malpractice for the assignment, usually occurrence-based and included as part of your dealings with them. Remember that "included" doesn't mean free. The agency recovers its cut elsewhere, usually through a lower hourly rate.
The practice/facility covers it (what I recommend negotiating for). Contracting directly, I negotiate malpractice into the deal alongside travel and lodging. In my opinion, a practice or agency covering your malpractice is standard in locums and doesn't, on its own, change your status as an independent contractor. Make sure that you fully understand the policy they're agreeing to provide you with. Remember that if it isn't in the written and signed contract, it doesn't exist.
You buy your own. There might be a scenario where you want continuous coverage that follows you across assignments, or a clinic you really want to work with simply refuses to cover malpractice. In these instances, you might consider shopping for your own policy.
To the best of my understanding, this process can involve an insurance broker, multi-state complexity, matching limits to every facility, the full premium out of pocket, and tracking your tail every time you switch carriers. I've attempted to give you an overview of this process below.
Purchasing your own policy
Expect to go through a broker. Independent and locum physicians usually shop through an insurance broker who pulls quotes from several insurers and knows which are comfortable with 1099, multi-state, part-time work. Some of the players in this space are Gallagher Healthcare, the Cunningham Group, and MEDPLI.
Major carriers of medical malpractice policies include The Doctors Company, MedPro Group (Berkshire Hathaway's medical arm), ProAssurance, Coverys, MagMutual, and Curi, along with risk retention groups like AMS RRG and Lone Star Alliance built to write across many states. A broker can help you shop for policies from these carriers that suit your specific situation.
Multi-state coverage is possible but not automatic. A policy is rated state by state, and premiums swing enormously with location. A national carrier or RRG can cover you across several states on one policy, but you have to disclose every state, and sometimes every county, where you see patients. Tell your carrier the moment you add a state, well before your first clinic day there.
Cost is low for dermatology, but it's set almost entirely by geography. Dermatology is one of the lowest-risk specialties in medicine. An older New England Journal of Medicine analysis found it had one of the lowest annual claim rates and the lowest average payout of any specialty, which is why its premiums sit near the bottom. What actually sets your number is location: for example, the Medical Liability Monitor's annual rate survey prices coverage state-by-state and county-by-county at the standard $1 million/$3 million limits, because where you practice drives premiums far more than specialty does. Hard dermatology-specific figures are scarce in public data. A national survey of dermatologists once put the average premium near $10,900, but that was 2004, so treat it as a dated reference point rather than a current quote. Because the range is so wide and so local, the only number that means anything is a real quote for your specific situation.
Quick malpractice reference checklist
Whether the practice provides it or you buy it, get these answered in writing and understand what they mean before you sign any contract:
Occurrence or claims-made?
If claims-made, who pays for the tail? Get an actual dollar figure.
If applicable, do the limits meet every state and/or facility requirement on your schedule?
Are you covered in each specific state and county where you'll work?
Does the policy cover your actual scope, including cosmetics and any mid-level supervision?
I'm a dermatologist sharing my own experience, not a lawyer, accountant, or financial advisor, and nothing here is legal, tax, financial, or medical advice. Consult a qualified professional about your specific situation.
