Specialized Business Insurance & Risk Management Blog

Physician Assistants: Considerations to Make Before Moonlighting

Moonlighting is no longer an activity solely practiced by residents to earn a little extra cash during their residency to make ends meet. The allure of moonlighting has attracted a larger crowd of doctors due to the extra experience, networking opportunities, and of course, the extra income.

More and more, physicians and physician assistants alike are actively seeking and taking on moonlighting opportunities. However, there are many precautions that need to be taken to ensure that moonlighting doesn’t land a medical professional in some kind of legal bind.

Some steps to being able to moonlight include:

  • Make sure the moonlighting organization provides the flexibility to allow you to take time off from the moonlighting job if the primary position requires your presence.
  • Avoid competitive situations. If the moonlighting job is merely serving on a speaker’s panel, there is usually no problem. But your employment contract at your primary job might prevent you from practicing medicine in competing groups. Even if it doesn’t, working for competitors can have a negative effect on your relationship with co-workers.
  • Check your primary job’s employment contract for disincentives to moonlighting. For instance, some contracts might state, “While employed by employer, any remuneration generated by employee belongs to employer.”
  • Residents moonlighting within their own organization are limited to a total of 80 hours of work each week. There is no such limit for doctors who moonlight outside their programs. But check with your program director to ensure that the hospital in which you plan to moonlight does not have a relationship with your primary placement, in which case the 80-hour limit might apply.
  • Some employment contracts include specific language about what constitutes moonlighting — clinical and nonclinical — and the approval process necessary before the employee engages in any moonlighting. Make sure you read and follow any such policies exactly.


These are all solid guidelines to moonlighting as a physician assistant. However, the most important step to moonlighting is to be certain that insurance coverage is intact in a secondary office. Portable medical malpractice coverage is the answer for moonlighting PAs.

Portable coverage will follow a physician assistant wherever their moonlighting work takes them. Unlike employer provided coverage which will only help them in their primary job, portable coverage will protect them no matter where they are practicing.

For more information on portable medical malpractice coverage, visit www.MedEdge.com.

Why Nurse Practitioners Need Personal Medical Malpractice Coverage

Nurse PractitionerNurse Practitioners face a unique set of legal risks because they may frequently be named in a lawsuit also naming a physician. Some NPs make the mistake of assuming that if they are named in a malpractice lawsuit, their employer’s coverage will fully defend them or that only the physician is sued if something occurs during patient care. This is not always the case; NPs are named in malpractice suits as well, and employer policies have limitations.

It is important that Nurse Practitioners keep their own legal interests top of mind and have their own medical malpractice liability insurance in place to protect their personal finances and career. Research and case studies show there is a need for NPs to carry their own medical professional liability coverage that will protect their interests and career at all times, with their own dedicated policy limits.

Who is Defending You?
Having a Nurse Practitioner Malpractice insurance policy means that your own defense attorney is provided in the event of a claim and he/she looks after the interests of you alone. And, in the event a claim is filed, Nurse Practitioners who have their own medical malpractice policy find there is less of a conflict of interest with their employer.

Consistent Protection
Nurse Practitioners change policies from one insurance company to another each time they switch from their primary place of employment, which can cause serious “gaps” in protection because of differences in conditions of the various policies. Coverage gaps can also occur if a Nurse Practitioner is laid off and at this time coverage is typically cancelled for this provider. By purchasing individual insurance coverage, the policy will follow you through any job change and eliminate coverage gaps.

Shared vs. Separate Limits of Liability
With employer-provided coverage, limits are oftentimes shared with all defendants. That means that less coverage may be able to respond to a claim leveled against you. Purchasing an individual medical professional liability policy with separate limits of liability ensures your limits are there if and when you need them.

Multiple Offices and/or Consulting
Do you work for multiple physician offices, facilities or consult on the side of your regular full-time position? Your primary employer-provided policy will not cover these activities. Purchasing an individual medical professional liability policy means you, the Nurse Practitioner, own the policy and you select your own limits of liability to meet your type of practice and needs, to provide coverage to you even if you hold multiple positions or do consulting on the side.

Are you Covered Outside of the Office?
With employer-provided medical professional liability insurance, coverage is oftentimes limited to the services provided at that employer. A Nurse Practitioner typically has no coverage for incidents occurring outside of that particular employer. Purchasing an individual medical professional liability policy means you, the Nurse Practitioner, own the policy and you select your own limits of liability to meet your type of practice and needs, even if you hold multiple positions or do consulting on the side.

Ultimately, medical professional liability insurance is required for all healthcare providers. Beyond that, individual coverage can provide peace of mind especially for those who work for multiple employers or whose current coverages are inadequate. As with any insurance policy, the most important reason to have professional liability insurance is to protect your career and your family’s financial future. Just as you would not consider being without health or automobile insurance, you should not be without malpractice insurance.

For more information on portable medical malpractice insurance, visit www.MedEdge.com.

Physician Assistant Medical Malpractice: Diagnostic Error

Diagnostic ErrorDiagnostic errors are the most prevalent medical malpractice claim involving PAs. The most common diagnostic errors occur when PAs fail to order diagnostic tests, report the results to their patients or follow up when testing reveals abnormal findings.

In one case, a 39-year-old woman visited a PA for a physical exam and the PA found a lump in her breast, but failed to diagnose it as breast cancer. During the 2001 exam, the PA pointed out a firm lump in the patient’s left breast, but diagnosed it as a fibrocystic breast formation. Two years later, when the patient saw the PA’s attending physician, she again asked about the breast lump, which had increased in size and become tender. The physician ordered a biopsy, which was positive for breast cancer with lymph node involvement.

As the patient began chemotherapy treatments, she realized the implications of the missed diagnosis could be dire. The time lost in treating the cancer had greatly reduced her chances of remission. She filed a lawsuit against the PA for failure to timely diagnose breast cancer. The PA argued that the 2001 breast exam was normal – when she had examined the breast lump, she found no signs of cancer and had the patient complained of a breast lump, she would have recorded that on the record and ordered the proper diagnostic tests.

The patient died one year after the suit was filed. A judge denied the PA’s motion for summary judgment based on expiration of the statute of limitations. But because the PA had a medmal policy of her own, she was able to hire her own attorney. After a fair mediation, the parties settled the case quickly for less than $200,000.

For more information on personal medical malpractice insurance for physician assistants, visit www.MedEdge.com.

Why Physician Assistants Need Their Own MedMal Policy

Physician Assistant InsuranceWhen a claim is made against any medical professional, it is common for multiple healthcare professionals and organizations to be named. It follows, then, that PAs are commonly named in medmal claims alongside a physician or surgeon they work with. In this case, PAs may find themselves liable for their own negligence and for all or part of a plaintiff’s award or settlement. Or they may be in a position of having to compensate their employer who has paid damages to the claimant.

It’s true that under the concept of vicarious liability, the physician is ultimately responsible for the care provided in his/her name. However, this coverage is almost always too limited to fully protect the interests of a PA. Therefore, physician assistants need their own personal advocate to protect their interests and their career. Physician Assistants need individual medmal insurance.

Some PAs falsely believe that if they are named in a malpractice lawsuit, their employer’s coverage will fully defend them. This is not always the case and there are several disadvantages to only being covered under the employer’s coverage. With employer-provided coverage, limits are oftentimes shared with all defendants; a PA may have no coverage for off-duty incidents, or the coverage may be canceled following a job change. Even if PAs have reviewed their employer’s policy, they will need to inquire again about whether or not the limits are separate for each professional or shared among all professionals in the facility.

Additionally, coverage through an employer rarely includes coverage for defense of a license complaint. Because of this, PAs need a policy that covers disciplinary actions that go before state licensing boards, not just malpractice suits. This protection ensures that legal counsel is covered in both situations. In any case, having individual coverage protects PAs beyond the limits of their employer provided plan.

For more information on physician assistant medical malpractice insurance, visit www.MedEdge.com.

Health Care Providers and The Affordable Care Act Pt. 2

With the Affordable Care Act being deemed as constitutional by the Supreme Court, sweeping change is coming for healthcare patients and providers alike. Over the course of a few blog posts, the team at MedEdge, a comprehensive malpractice insurance designed for the needs of physician assistants, nurse practitioners, and optometrists, would like to break down what the changes coming with healthcare reform will mean specifically for providers of healthcare.

Continued From Part 1.

New investments in prevention and public health will support your efforts to help patients live healthier lives.
In addition to expanded access to preventive services, the Affordable Care Act will give states and local communities new resources to address the nation’s mounting health problems, such as the increase in chronic diseases, or in conditions linked to obesity.  This will strengthen provider efforts to help patients make healthy choices like losing weight or quitting smoking.


With government investments in preventative care under the Affordable Care Act, in which preventative visits will be covered, healthcare providers will have more of an ability to help their patients stay healthy through preventative initiatives like losing weight and maintaining a healthy weight or quitting smoking.

Health care providers will help drive improvements to health care delivery.
New models of patient-centered, coordinated care will give you and your patients more control over how care is delivered.  Investments in medical homes and other advanced care coordination and disease management models will help you ensure that your patients receive seamless, efficient care.  Providers who provide high-quality services will be rewarded based on standards that they help develop, based on solid medical evidence.  And Medicare will pay bonuses to qualified primary care doctors and general surgeons, particularly those who practice in underserved areas.


Healthcare providers are going to be given more control on how care should be delivered to their patients in an effort to make receiving care more efficient. Also, Medicare is going to be paying bonuses to primary care physicians and general surgeons who practice in areas that don’t have enough healthcare providers to administer care to patients.

The Affordable Care Act is aiming to put more control in the healthcare industry in the hands of healthcare providers and their patients, while eliminating a lot of the back and forth with paperwork involved in coverage and administering treatment. Hopefully, this will lead us to a more efficient form of health care, where patients can get treated faster and doctors can play more of a role in the delivery of that care.