Medical indemnity has long been priced on a blunt instrument: income. It is time for the profession – and for underwriters – to ask whether that is good enough. At THEMIS, we believe it is not.
The limitations of income-led underwriting
For decades, the dominant model of medical malpractice underwriting has been built around a single axis: how much does this clinician earn? Income has served as a convenient proxy for exposure – more procedures, greater income, greater risk. But this approach flattens a richly complex picture into a single number, and in doing so, it fails both clinicians and the patients they serve.
A consultant performing a high volume of complex orthopaedic procedures carries an entirely different risk profile to a colleague in cardiology practice at a similar income level. A clinician who actively seeks patient feedback, maintains transparency in their outcomes, and commits to continuous professional development is demonstrably different from one who does not – yet traditional underwriting treats them identically.
This is not merely an abstract concern. Inaccurate risk pricing has real consequences: it cross-subsidises high-risk practice at the expense of clinicians who have invested in doing things right, and it removes any financial incentive for consultants to improve the patient experience. The result is a market that inadvertently rewards mediocrity and penalises excellence.
THEMIS and the pursuit of intelligent underwriting
When THEMIS set out to build a different kind of medical indemnity provider, we started with a fundamental question: what actually predicts risk? The answer, we found, is not income alone. It is a constellation of factors: the speciality and scope of practice, the flexibility with which a clinician works across different settings and procedures, the quality of communication with patients, their engagement with clinical governance, and – crucially – what patients themselves say about their care.
This belief sits at the heart of how we have built our underwriting engine. THEMIS uses real claims data and specialist medical malpractice underwriters to develop premiums that are meaningfully tailored to the individual clinician – not to a generic income band. Our bespoke, contractual indemnity policies are designed to reflect who a clinician actually is, not simply what they earn.
Our AI-assisted underwriting engine is built to do exactly this: to hold multiple dimensions of a clinician’s practice in view simultaneously, and to translate that nuanced picture into a premium that genuinely reflects their risk. This is not just a technical achievement – it is an ethical one. Pricing risk accurately means pricing it fairly, and that matters enormously to the clinicians we serve.
Three pillars: Risk, flexibility, and patient safety
Our underwriting philosophy rests on three interconnected commitments.
1. A thorough understanding of clinical risk
Risk in medicine is not static. A consultant’s scope of practice may evolve; they may expand into new procedures or reduce their caseload as their career matures. Our underwriting engine is designed to engage with this dynamism – assessing not just what a clinician does today, but how the texture of their practice is likely to develop. This requires access to rich data and the analytical capability to interpret it, and it is precisely what artificial intelligence enables us to do at scale.
2. Flexibility of practice
Modern consultants in private practice do not fit neatly into boxes. Many work across NHS and private settings, across multiple specialties or sub-specialties, and in a variety of clinical environments. Traditional insurance products frequently struggle to accommodate this complexity, leaving clinicians either underinsured or paying for coverage that does not reflect the reality of how they work. THEMIS’s approach is different: we build policies around the individual, not the other way around. Our AI engine allows us to assess portfolios of activity with a precision that bespoke human underwriting alone could not achieve.
3. A commitment to patient safety
This is, perhaps, the most important pillar of all. Patient safety is not merely a regulatory requirement or a marketing phrase – it is the purpose around which all sound clinical practice should be organised. We believe that insurers have a role to play in reinforcing that culture, not just responding to it after the fact. When we reward clinicians whose patients consistently report outstanding experiences, we are making a statement about what good practice looks like. We are saying, in concrete financial terms, that transparency and excellence are not just morally admirable – they are measurably lower risk.
The Doctify partnership: Turning patient voice into underwriting signal
Our new partnership with Doctify is, I believe, a natural and important expression of this philosophy. Doctify is one of the UK’s leading platforms for clinician reviews and patient booking in private practice. Consultants who consistently earn outstanding patient reviews through Doctify will now be rewarded with meaningful savings on their THEMIS indemnity premiums.
This is not a marketing exercise. It is an underwriting decision – one grounded in the genuine belief that patient experience data is a meaningful predictor of clinical risk. Clinicians who attract consistently positive reviews are, as a population, doing things right: they are communicating well, managing expectations, maintaining good outcomes, and creating the conditions in which complaints and claims are less likely to arise.
By integrating Doctify review data into our underwriting approach, we are adding a new and powerful dimension to our AI engine. We are enabling our underwriters to see not just the clinical and procedural profile of a consultant, but the lived experience of their patients. That, to my mind, is a genuine step forward for the profession.
“By aligning patient feedback with our underwriting approach, we are continuing to champion consultants who place excellence at the heart of their practice.”
What this means for the future of medical indemnity
The medical indemnity market is at an inflection point. Litigation risks facing clinicians and hospitals are higher than ever, as Miss Lorna Phelan, Consultant Obstetrician at Imperial College Healthcare NHS Trust, has noted – and the consequences for the advancement of medicine and provision of patient care are real. Against this backdrop, indemnity providers who continue to rely on crude proxies for risk are not just being imprecise. They are failing the clinicians and patients who depend on them.
At THEMIS, we are committed to a different path. Our underwriting engine will continue to evolve – incorporating new data sources, refining its analytical models, and deepening its understanding of what good clinical practice looks like. The Doctify partnership is one significant step along that road, but it is not the last.
We believe that the consultants who invest in their patients – who seek feedback, who embrace transparency, who strive to improve – deserve to be recognised for it. Not just with a certificate on a wall, but with a premium that reflects the lower risk they genuinely represent. And we believe that underwriters who cannot see that difference are not doing their jobs properly.
A call to the profession
If you are a consultant in private practice who takes patient experience seriously, I would encourage you to explore what THEMIS and this partnership with Doctify can offer you. The era of one-size-fits-all medical indemnity is drawing to a close. The future belongs to providers who are willing to look further, think harder, and build insurance products that are genuinely worthy of the professionals they serve.
At THEMIS, that is the standard we hold ourselves to. And with partnerships like this one, we are just getting started.
