Florida charges an OB-GYN $243,988 to insure against a claim the defense wins 89% of the time

Every obstetrician-gynecologist and general surgeon practicing in Florida pays a malpractice insurer roughly a quarter-million dollars a year before they treat a single patient.▸ The bill is not proportional to fault. It is proportional to specialty and geography — and, per the industry's own closed-claim data, only loosely proportional to whether the doctor did anything wrong. The American Medical Association's April 2026 analysis of the Medical Liability Monitor's 2025 rate survey puts a number on the first half of that; a companion AMA report on claim frequency puts a number on the second.

Malpractice insurers set premiums by specialty and state, not by individual track record, using data the Medical Liability Monitor collects annually from the insurers that write most of the market (the AMA report puts MLM's coverage at 60–80% of it).▸ For a standard $1 million/$3 million policy in 2025, the reported rate for an obstetrician-gynecologist or general surgeon in Florida was $243,988 — against $59,736 for an internist under the same insurer, a 4.1-times gap. Connecticut shows the same pattern at lower absolute levels: $22,467 for internal medicine, $159,537 for OB-GYN, a 7.1-times gap.

These are "manual" rates — the sticker price an insurer files, before the credits, debits, and dividends that shift what any one doctor actually pays — so they understate the range in the market.▸ They still show the mechanism plainly: the premium tracks the specialty's litigation exposure and the state's legal environment, not an individual physician's record. California, which caps non-economic damages, has the lowest premiums of any state in the AMA's comparison across all three specialties it tracks — a gap the report and the research it cites attribute directly to the cap.

Nationally, the trend is one direction.▸ The share of reported premiums that rose year over year climbed from 13.7% in 2018 to a peak of 49.8% in 2024, then 39.9% in 2025 — seven straight years of net upward pressure, a run the AMA says hasn't been matched since the liability crisis of the early 2000s. Thirty-six states saw at least one premium increase in 2025; in 11 of them, some premium rose 10% or more.

Here is the part the pricing model doesn't show.▸ The same AMA report cites a 2019 study by the Medical Professional Liability Association finding that of claims closed between 2016 and 2018, 65% were dropped, dismissed, or withdrawn. Only 6% ever reached a trial verdict — and defendants won 89% of those. Getting sued, in other words, is a weak signal of medical error. It is a near-certain signal of specialty and geography.

That mismatch shows up starkly in who actually gets sued.▸ Using the AMA Physician Practice Benchmark Survey — a nationally representative, biennial poll of physicians that, unlike claims databases, captures unpaid as well as paid claims — the AMA's claim-frequency report finds 59.6% of obstetrician-gynecologists and 53.1% of general surgeons say they have been sued at least once in their career, against 29.7% of physicians overall in the pooled 2022–24 sample. Age compounds it: among OB-GYNs and general surgeons 55 and older, the career-sued rate approaches 75%.

Look at the one-year figures and the exposure is even more concentrated: in the same pooled sample, 5.9% of general surgeons and 4.6% of OB-GYNs reported a new claim in just the past 12 months, against 1.8% for all physicians.▸ A career in either specialty means carrying, year after year, both the field's highest litigation odds and its highest insurance bill — a bill that keeps rising even as the physicians' own survey data show most of what triggers it goes nowhere.

Premium figures are 2025 manual rates for a single insurer selected per state for year-over-year continuity in the Medical Liability Monitor survey — they show the pricing mechanism, not the average premium every physician in a state or specialty actually pays. Claim-frequency figures are self-reported by physicians to the AMA Physician Practice Benchmark Survey, not verified against court or insurer records; the 65%/89% claim- outcome figures are drawn from a 2019 Medical Professional Liability Association study as cited in the AMA's April 2026 report, not independently re-verified against the original MPLA publication.