AAMC Reporter: January 2005

Insurance Requirements Limit Residents' Options

Each year, hundreds of medical residents across the country look for rotation programs away from their home institutions. Most will have no problem securing a position, but for others, the cross-country pursuit can carry a high price tag.

Medical malpractice insurance for out-of-state rotations or visiting medical students is necessary, according to medical school officials. But the amount of coverage given to students differs by institution, making it difficult for some students who must pay hefty insurance policies. Liability coverage ranges from $50,000 to more than $5 million per incident.

For some students, out-of-state rotations are the only opportunity they have to experience what it is like to practice medicine in another part of the country, according to Ryan Gregory, M.D., a resident at the University of Texas Medical Branch at Galveston. Many students would be disappointed if inequities in insurance coverage and school requirements kept them from temporarily studying at another school.

"Some residents really want to study somewhere else," said Dr. Gregory, now completing a rotation at Beth Israel in Boston. "If they didn't have this possibility and they really wanted it, they would be disappointed because they won't get to see what it's like to work and interact with others elsewhere."

Several schools provide students $1 million in coverage per incident, opening the door for them to study at virtually any institution where they are accepted. Offering this much coverage benefits students who may need to leave the state to prepare for a specialty practice and virtually ensures they will secure an out-of-state rotation, according to Judy DeMers, RN, associate dean of student affairs and admissions at the University of North Dakota School of Medicine and Health Sciences.

"It's just the right thing to do," she said. "Our students don't have any trouble in securing any out-of-state rotations, and since we don't have a lot of residencies here at North Dakota, they need to go out of state for many of their electives."

But North Dakota's high liability insurance requirements prohibit some outside students from coming to the university for a rotation. Without sufficient coverage residents must work with their home university to secure additional insurance or they will be denied admission to North Dakota, DeMers said.

Out of Pocket

"This is a real hassle," Dr. Olsen said. "We encourage our students to have free range to broaden their experiences, and they end up paying out of their own pockets to get an insurance certificate to go to another school."

Every year, approximately 30 students leave Oklahoma for external rotations, and five to 10 visiting students come into Oklahoma's medical school. In his 27 years with the university, Dr. Olsen said he's never seen any situation or lawsuit that would require such substantial insurance coverage for medical students.

The AAMC recommends host institutions document students' coverage amounts before enrolling them in any rotation programs. Currently, the Group on Student Affairs (GSA) and the Organization of Student Representatives (OSR) are working on coverage guidelines that will be announced later this year.

Residents are usually dropped from an initial complaint, including the University of Washington School of Medicine, said Tom Norris, M.D., vice dean of academic affairs. Washington also offers its students $1 million insurance policies.

"According to our risk management, no one can remember a time when we paid money out on behalf of a student," Dr. Norris said. "So, the key question here is what is the actual risk? I haven't seen any good data about medical students getting sued."

Dr. Olsen, Dr. Norris and Randy Eken, associate dean for administration and finance at North Dakota, agreed that academic medicine and medical students would benefit from a standard liability insurance cap that would apply to all institutions, though they did not point to a specific amount. This measure could level the playing field and open the door for medical students to study at any institution across the country without undue financial concerns.

"I can see how a national policy on a limit would be good," Eken said. "It is difficult for students who want to work at other schools to call and realize there is an issue with their insurance coverage."

-Whitney L.J. Howell, whowell@aamc.org

Contact Us    © 1995-2008 AAMC    Terms and Conditions    Privacy Statement