On November 1, Physicians Insurance A Mutual Company welcomed Dr. David Carlson, DO, as our new President and Chief Executive Officer as we wish Bill Cotter all the best in his retirement. Dr. Carlson has served on PI’s Board of Directors since 2018 and as Chair from 2019 to 2023. He comes to his new role with a unique perspective, informed by decades of clinical and business experience.
A board-certified family practice physician, Dr. Carlson has held several senior executive roles at major health systems, including MultiCare Health System in Washington, Hospital Sisters Health System in Illinois, and Conemaugh Health System in Pennsylvania—roles in which he also oversaw those health systems’ captive insurer organizations. He was most recently Vice President of Medical Operations–King County at Virginia Mason Franciscan Health.
Physicians Report sat down with Dr. Carlson to talk about his career to date, what drew him to Physicians Insurance, and what excites him about his new role and the future of PI.
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Q1: What drew you to Physicians Insurance, and what stood out to you during your board tenure prior to becoming CEO?
A1: While serving on the PI board for the past eight years, I saw firsthand that this is a company with the heart to take care of those of us who have devoted our lives to taking care of patients. PI understands Member needs and exists to help manage, resolve, and mitigate one of the most stressful aspects of delivering care: our liability. PI is true to the physician-focused philosophies upon which it was founded almost 45 years ago and, in recent years, revisited and rededicated itself to the purpose of protecting, defending, and supporting its Members in the medical community. PI’s staff, the board, and Members who have utilized PI services all know that this is a special place—and it’s rewarding to be a part of it.
Q2: What do you consider some of your most meaningful professional accomplishments to date?
A2: In 20 years of executive leadership, it’s been rewarding to lead a wide range of initiatives. Immediately relevant for PI, I thrived working with and helping manage the captive insurance companies at my previous employers, and quality and risk management have also been a rewarding focus of my leadership work. Accomplishments of which I’m most proud include creating a strategic partnership with the third-largest FQHC in the U.S. to help create a sustainable care-delivery model for underserved populations. I helped to build a population health team that operated the third-most successful NextGen ACO, and led the development of a program creating inclusive care for the elderly.
In my leadership roles, I found success and support, and I was able to make a difference for people in those organizations. Perhaps as an inherent extension of leadership, a great source of joy for me has been watching other people grow and do new things while we accomplish our goals.
Q3: How do you see the relationship between the healthcare community and liability insurers evolving, and how can PI help lead that evolution?
A3: The stress of liability and/or a claim can be a debilitating burden for us in the healthcare community. It’s not enough to deliver a high caliber of expertise during the defense of a claim; healthcare professionals also need liability carriers who are dedicated to supporting them in avoiding claims altogether, as PI is. The liability insurers who really “get” physicians, and the facilities where care is delivered, help avoid claims in the first place, with real support and risk management services. This can be in advance of a claim through preventative efforts, in immediate response to a bad outcome, or in response to gaps that are realized after a claim occurs.
An insurer whose collaborative team can provide services that integrate with a hospital’s, clinic’s, or provider’s existing framework or initiatives—rather than creating additional burden on their already stressed system—is paramount. PI is already this kind of partner, there for its Members before, during, and after a claim.
Q4: Are there any unique trends impacting the MPL and/or HPL insurance industry today that you’d like to highlight, and moreover, any specific trends for physicians to be aware of?
A4: Probably the most powerful trend is the pending updates to damages caps. Related to this is the dramatic impact of social inflation, which has jurors deciding on incredibly high damage awards, in turn raising expenses across the board for healthcare. It’s not financially sustainable or good for patient care in the long run. It’s imperative for PI to continue participating in the dialogue of damage caps, seeking solutions that contribute to a stable marketplace and are in support of overall care quality in cities and rural areas. The ~$250K caps from decades ago are certainly due for an update, and PI advocates for reasonable caps.
Early settlement demands from plaintiff attorneys are another rising trend. This is where a claimant receives an early, aggressive letter from a plaintiff attorney, intended to create fear and division regarding the defense approach while demanding an outsized settlement before the medical facts have even been reviewed. In such instances, PI recommends that a defendant work closely with their claims team to navigate the demand with an appropriate legal response in their best interest.
Q5: As you look to the future, what opportunities do you see for PI to continue expanding its value for Members?
A5: PI will continue to reserve and devote tremendous resources to our Members’ defense, and negotiate appropriate settlements when needed. We exist to defend and pay claims. But I also know that PI offers so much more than its financial strength and litigation expertise. In the future, PI will continue to grow our risk management services and support, while keeping a sharp pencil on its underwriting approaches to meet Members’ shifting needs.