Soaring Malpractice Premiums Drive OB-GYNs From Specialty, Leaving Nationwide Shortages

An obstetrician-gynecologist in Miami-Dade County pays more in malpractice insurance each year than most Americans earn. The 2025 standard premium for an OB-GYN in that Florida county clocks in at $243,988 a year, nearly five times the national average of roughly $46,000 for the specialty. The cost has sent practitioners fleeing their field, shuttered labor and delivery wards from rural Pennsylvania to the high desert of New Mexico, and left millions of American women with nowhere to give birth within a reasonable drive of home.The burden extends well beyond Florida: OB-GYNs in New Mexico pay roughly double what their counterparts in surrounding states pay, at $107,961 on average, compared to $59,133 in Arizona and $48,966 in Colorado.Across all specialties, OB-GYNs rank among the most sued physicians in the country, with 139 claims filed per 100 physicians over their careers, and malpractice premiums have risen for seven consecutive years, a trend not seen since the early 2000s.In 2025, nearly 40 percent of malpractice premiums across the country went up — continuing a seven-year streak that has squeezed obstetrics harder than almost any other field. The attrition shows: Roughly 30 percent of OB-GYNs walk away from delivering babies within 12 years of starting, with insurance costs cited as a driving reason.At the heart of this quiet catastrophe, critics contend, sits a legal system in urgent need of tort reform to limit how much money a patient can sue a doctor or hospital for, and to raise the legal bar for what counts as genuine negligence. Advocates say it has turned the miracle of childbirth into the highest-stakes liability gamble in American medicine, and that Congress has, for decades, declined to act.“Malpractice insurance is a costly reality of providing both gynecologic and particularly obstetric care,” the vice president of government and political affairs at the American College of Obstetricians and Gynecologists, Rachel Tetlow, tells The New York Sun. “The threat of malpractice suits looms over the heads of ob-gyns from the time they are in training, it is estimated that roughly 40 percent of ob-gyns experience a claim while in residency.”So who, exactly, is being protected, and from what?A critical specialty no one wants to practiceThe figures tell a grim story. Seventy-nine percent of OB-GYNs will face at least one malpractice lawsuit during their career, not because the specialty attracts bad doctors, but because birth itself is inherently unpredictable, and American juries have historically awarded substantial damages to families of injured newborns.Settlement payments in birth-related malpractice cases reported to the National Practitioner Data Bank totaled $4.8 billion in 2023, with a growing number of verdicts topping $10 million.In Utah, a judge ordered bankrupt hospital operator Steward Health Care to pay a family $951 million — the largest medical malpractice award in state history — after inexperienced nurses gave a laboring mother excessive doses of a labor-inducing drug while the on-call physician slept nearby. Signs of fetal distress went unaddressed for more than 24 hours before a cesarean was performed, leaving the child with permanent brain damage.In Pennsylvania earlier this year, Jefferson Health was ordered to pay $108 million after a Philadelphia jury found physicians at Einstein Pediatrics, a practice Jefferson acquired in 2021, liable for brain injuries sustained by a baby delivered by forceps in December 2018. Jefferson has disputed the verdict and plans to appeal.A Philadelphia jury had not delivered an award of that size since 2023, when Penn Medicine was ordered to pay $183 million after a mother alleged that staff at the Hospital of the University of Pennsylvania sat on a decision to perform a cesarean section while she was fighting a uterine infection. Her lawyers argued that the delay left her son with cerebral palsy and permanent brain damage that he will carry for the rest of his life.The verdict later grew to $207 million after a Pennsylvania appeals court unanimously upheld the award.What makes obstetrics uniquely punishing in the liability landscape is a feature invisible to most patients: Birth-related claims can be filed until an injured child reaches the age of majority, effectively a 21-year window, compared to two or three years in most other medical specialties. A physician who delivered a baby in 2010 may not face a lawsuit tied to that delivery until 2031.Tennessee-based physician Dr. Matt Tipton, who has delivered between 30 and 50 babies across emergency medicine, EMS work, and military service, points to several compounding factors.“A lot of states don’t have caps on malpractice, and several state medical boards have a punitive fee structure, like Florida, where if you get sued three times and lose you’re penalized,” he explains.Florida’s so-called “three-strikes” rule, passed by voters in 2004, requires the state’s Board of Medicine to revoke a physician’s license after a third medical malpractice judgment against them. The practical effect, critics say, is that doctors facing even questionable claims rush to settle rather than fight them in court.Dr. Tipton also points to why juries tend to award bigger sums in obstetric cases than in almost any other area of medicine.“When you have a 26-year-old come in with what’s been a normal pregnancy, and something goes wrong, you lose the mother, the baby, or both — the family is devastated,” he explains. “The loss of total life years is just much higher when you lose an infant and a woman of childbearing age.”In practical terms, that means the projected cost of a lifetime of care for a brain-damaged newborn, combined with a mother’s lost earnings and the family’s pain and suffering, routinely produces damages that dwarf what juries award in cases involving older patients. That makes birth injury claims among the most lucrative in all of medicine, and among the most aggressively pursued by plaintiffs’ attorneys.Doctors are absorbing the financial hit directly. Premiums have climbed for seven years straight, and in 2025, 36 states reported increases. In Pennsylvania and New York, more than 90 percent of reported premiums went up.For doctors running their own practices, it is personal. One Albuquerque OB-GYN’s premiums went from $44,908 in 2018 to $77,394 by 2023, nearly double in five years. In 2024, she quit performing gynecological surgery. Her premiums dropped to $16,463. She had a word for it: survival.A separate New Mexico OB-GYN paid $92,000 in 2024 and expects his rate to increase by at least 15 percent in 2025. Despite the insurance rates rising, the physician claimed, his salary hadn’t risen to accommodate them.Deserts spreading across the mapFor millions of American women, this is not a policy debate, it is a drive of hours to reach the nearest delivery room.A 2025 report found that nearly half of all counties in America lack a single obstetrician, midwife, or birthing facility. Between 2010 and 2022, more than 500 hospitals shut their obstetric units, with rural facilities accounting for over 200 of those closures. The pace accelerated in 2025, with rural labor and delivery hospital closures in just the first half of the year nearly matching the total for all of 2024.Wyoming offers a window into how fast the situation can unravel. A Casper OB-GYN told state lawmakers that 18 months ago her city had six obstetricians. Now there are two. “My personal assets are at risk,” Dr. Susan Sheridan said, pointing to the state’s lack of damage caps as the reason it has become nearly impossible to recruit specialists in the field.Meanwhile, the average Medicaid reimbursement for a birth in Wyoming runs approximately $7,500. At the same time, the actual cost of that delivery often nears $20,000, making obstetric services a money-losing proposition even before malpractice costs are factored in.Ms. Tetlow says ACOG sees the legal system itself as a primary force behind those closures. The central argument here is that the current tort system — the body of law governing how patients sue doctors and how much they can recover — punishes physicians for bad outcomes even when no one did anything wrong, while doing little actually to root out the genuinely negligent doctors.“The current system is absolutely one of the myriad factors contributing to and exacerbating growing maternity care deserts and accelerating labor and delivery unit closures,” Ms. Tetlow tells the Sun. “It cannot accurately distinguish bad outcomes from genuine negligence, and the escalating premium costs are borne by physicians and the hospital systems where they work.”The founding head of the Division of Medical Ethics at NYU Grossman School of Medicine, Arthur Caplan, says the system is failing both doctors and patients.Malpractice and government meddling, Mr. Caplan tells the Sun in an email, “are the two major reasons my med students and those at other med schools I talk to give for avoiding OBGYN.”He also points out that the tort system does little to protect the patients it is supposed to serve, because the doctors most likely to cause harm are rarely the ones who lose in court. Physicians with established patterns of negligence routinely avoid verdicts by settling claims quietly.Meanwhile, underfunded medical boards lack the teeth to pull licenses, and patients have almost no way of knowing whether their doctor has a history of paid-out claims. The result, Mr. Caplan argues, is a system that extracts enormous sums from hospitals and insurers — costs that get passed on through higher premiums and unit closures — while the bad actors it was designed to stop keep practicing.“Bad apples who truly are bad float through the health care world crossing state lines and getting jobs despite malpractice convictions and letters of censure,” Mr. Caplan observes.Reform stalled, crisis deepeningThe solutions most often proposed are not complicated. ACOG has long called on Congress and state legislatures to place a cap on the amount a patient can be awarded for pain and suffering — so-called non-economic damages — pointing to California and Texas as evidence that it works.In those two states, payouts were effectively capped, stabilizing premiums and reducing doctor turnover. Insurers were able to price against this ceiling, and doctors’ annual bills went down. As long as there is no ceiling, the numbers will continue to rise. Federal action, however, has never materialized, and the reasons are more political than medical.Dr. Tipton offers a frank diagnosis.“Lawyers typically take 30 to 40 percent of the settlement, so they have a strong incentive to pursue the highest number and not settle,” he says. “That creates perverse incentives throughout the system.” In other words, the bigger the verdict, the bigger the attorney’s cut, which means plaintiffs’ lawyers have every financial reason to push cases to trial, reject reasonable settlements, and target deep-pocketed hospitals, regardless of whether the underlying care was genuinely negligent.Mr. Caplan is equally direct about why Washington has not moved.“Lawyers run Congress,” he concurs. “Lawyers respect torts and malpractice. Doctors and hospitals are seen as very rich, so no one cares. Costs of insurance are buried in hospital prices and admin overhead so there’s no pressure to reform.”It has played out that way repeatedly: The Senate has voted down federal tort reform across multiple administrations, with trial lawyers’ groups pushing back hard each time, casting caps as an attack on injured patients while directing campaign money toward legislators who might otherwise have backed reform.During the Obama administration, when the issue briefly surfaced as part of the broader health care debate, capping judgments was quickly declared a nonstarter by Senate Democrats.At the state level, the picture is fractured and, in some places, moving in the wrong direction.In Colorado, the pain-and-suffering ceiling was raised from $300,000 and will reach $1.5 million by 2028. Advocates claim it is long overdue, recognizing that $300,000 doesn’t cover a lifetime of care for a birth injury. Physicians and hospital groups, however, simply anticipate another premium increase in a state where costs had been under control until recently.New Mexico went further still: It raised the cap on what hospitals can owe in a malpractice case to $6 million, while removing hospitals from a state fund that previously helped cover large verdicts. The practical effect is that hospitals — and the OB-GYNs who work in them — now face the full financial exposure of any judgment against them, with no backstop.Just 82 percent of the nation’s OB-GYN needs are expected to be met by 2037. Shortfalls will not be evenly distributed. Rural towns, low-income communities, and places with the highest maternal mortality and preterm birth rates will be hardest hit.Ms. Tetlow, for her part, holds out little hope for a federal fix anytime soon.“We are very frustrated by the lack of federal action to reform our broken medical liability system,” she says. “In recent years, even limited reforms garnering bipartisan support have failed to advance; we don’t see immediate opportunities for a clear path forward at the federal level.”

Soaring Malpractice Premiums Drive OB-GYNs From Specialty, Leaving Nationwide Shortages

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