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Employee or contractor. Full or part time. State of license. Specialty. Role. Statute of limitations. All these factors influence how much malpractice insurance or professional liability insurance physician assistants (PAs) need to protect themselves from financial loss due to misdiagnosis, treatment errors, or care omissions.
Historically, PAs have experienced significantly fewer malpractice claims than physicians — one 2016 study found only 1.4-2.4 malpractice reports per 1000 PAs compared with 11.2-19.0 reports in the same number of physicians.
But William Sullivan, JD, LLM, executive vice president and chief underwriting officer at CM&F Group, a leading liability insurance agency specializing in coverage for healthcare professionals, said the passing of PA modernization laws across different states, which often untether PAs from physician supervision, is likely to make them a larger target for malpractice suits in the future.
“In many places, PAs no longer have a physician signing off on everything. The PA may be the only supervisor within an emergency room or primary care practice,” he explained. “That expansion in the scope of practice can leave them open to more liability.”
About Medscape Insights
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Medscape Physician Assistant Practice Report 2025 found that:
- 55% of PAs surveyed felt more positive about their career when their scope of practice was expanded.
- Two out of three PAs surveyed practice in states that give them optimal team practice (OTP).
- 96% of PAs surveyed want more states to allow PAs to exercise OTP.
Understanding the Nuts and Bolts of PA Malpractice Insurance
To better protect themselves, PAs need to pay careful attention to their malpractice coverage from the very beginning of their careers, said Sondra DePalma, DHSc, PA-C, vice president of reimbursement and professional practice at the American Academy of Physician Associates. She said, because of the historically low rates of malpractice suits in the profession, many PAs may not be adequately covered in the event of a claim.
“In many cases, it’s important for PAs to not only have employer coverage but their own liability plan separate from their employer,” she said. “If you only have employer coverage, you do not have the ability to decide whether you want to settle or defend a claim — the employer makes that determination on behalf of the employee.”
That’s a decision that not only influences potential financial liability for the PA but also their reputation.
Then there’s the matter of state licensure. While some may frame malpractice largely in terms of protecting healthcare providers from financial losses in the event of a claim, Sullivan said you also want coverage if you are reported to the state-specific regulatory body responsible for licensure.
“Employers may respond to a lawsuit related to you, but they may not respond to a board of action,” he said. “Who covers those costs? You’ll need an attorney. You need a defense. Your individual coverage can do that.”
Sullivan added that employer malpractice policies protect the hospital or practice first — and the individual provider second. In addition, individual coverage can follow you if you work at multiple sites, moonlight for a medical spa or other type of organization or are thinking of starting your own business.
Dragging One’s Tail
Understanding what your plan covers, whether provided by your employer or purchased individually is paramount, said Sullivan. There are two basic types of malpractice plans: occurrence or claims-made. Occurrence covers incidents that occur during the policy period, even if the claim is filed years later. Claims-made, on the other hand, covers only the claims filed during the policy. While this type of plan tends to be less expensive than an occurrence plan, if any claims come in after the policy ends — due, for example to a change in employment — PAs will require “tail” coverage to protect them until the statute of limitations for claims expires.
Typically, Sullivan said, PAs working in a hospital or practice setting will receive tail coverage as part of their employment agreement. Unfortunately, contractors will likely be responsible for obtaining tail coverage themselves — which is why it’s important for 1099 employees to carefully consider both the short-and long-term costs of any plan they acquire.
“If I’m working per diem and going to three different surgical centers to help out, I’m likely to have my own claims-made coverage,” Sullivan said. “That means the onus will be on me to buy any tail coverage for later claims. And those costs can really add up later.”
Yet even W-2 employees can sometimes find out, after leaving a position, that they are now responsible for tail coverage. Sullivan recommends that PAs look carefully at their employment contract to understand who is responsible for tail coverage — and whether the employer sets any conditions, like a specified number of years of service, to continue providing it once you’ve left the organization.
Other Considerations for Coverage
Like physicians, PAs also require adequate coverage based on their specialty. Higher-acuity specialties like surgical assisting, emergency medicine, and critical care, to name a few, require PAs to make split second decisions about complex patient cases — and that can increase the risk for a potential surgical, medical, or medication error.
“There is the potential for more claims in these kinds of specialties,” said Sullivan. “You want to be covered for that.”
Yet, he added, even primary care and dermatology are not immune from malpractice claims. PAs need to understand their potential liability to make sure they have adequate coverage for their specific role and scope of practice. There may be differences if they have prescribing authority or practice telemedicine. There may be a need for more coverage if they are in a supervisory role. So much, Sullivan said, depends on a PA’s individual situation, and both employer and individual coverage should reflect those specific needs.
PAs, trained in the medical model of healthcare, are incredibly cognizant that they are accountable for the care they provide patients, said DePalma. Which is why there is no one-size-fits-all plan for finding the “right” malpractice coverage.
“What you need depends on your employment status, your specialty, and the location you are practicing,” she said. “We recommend that PAs speak with an insurance carrier or a malpractice attorney familiar with their state’s laws about what they need. There are variations in statute of limitations, in amounts that can be settled, and amounts that can be covered. There are even states that require PAs to have a certain minimum amount of coverage.”
By discussing your situation with a reputable source who understands your needs, you’ll be in a better position to make an informed decision.
Kayt Sukel is a healthcare and science writer based outside Houston.
