Doctors Insurance Reciprocal (DIR) is a specialty insurance company that provides medical malpractice insurance to physicians throughout the Southeastern United States.  During the 1990s, the medical malpractice industry experienced increasingly lower premiums, and a number of insurance companies entered the marketplace because business was good. By 2000, more physicians were being sued than ever before, higher monetary awards were being made to plaintiffs and, in Virginia, where DIR has the largest market share, the state legislature increased the medical malpractice cap.

DIR made the decision to raise its premiums to meet the increased costs of insuring physicians.  It was one of the first insurance companies to do so, and the new rates were substantially higher than its competitors – sometimes two or three times higher. Competitors reduced staff and services to cut costs and manage the increased frequency of payouts, hoping that the downturn in the market would be temporary. Physicians were going to shop around – how could DIR quickly educate physicians that insurance is not a commodity before decisions were made based on price alone?


The purpose of the communications plan was to reduce the defections from DIR stemming from increases in premiums.


Carter Ryley Thomas Public Relations & Marketing Counsel interviewed physicians, office managers, group administrators along with DIR underwriters and marketing staff.  Research showed that price is the overwhelming factor in purchasing insurance, followed by financial stability and the quality of defense counsel.  

Physicians are the decision makers but office administrators are the “gatekeepers” that could keep DIR from being considered.  Since administrators are hired to keep office costs down, they look at price first – an immediate barrier for DIR.  In the selection process, it was important that DIR make the “first cut.”

Research also revealed that many physicians have not shopped for malpractice insurance in a long time, and, unless they had been sued, they do not value an insurer with full services and expert legal defense.


To educate key audiences about the alarming realities of medical malpractice insurance.

To reduce the number of physicians who may switch insurance from DIR due to rate increases.  Keep retention rates at 70 percent.


To introduce new factors (other than price) that should impact carrier selection.

To educate and inform the target audiences, so that they will ask prospective carriers difficult questions regarding how they are dealing with industry trends.

To position DIR as the authority in medical malpractice insurance.


CRT developed hard-hitting messages that were presented in an easy-to-read manner with facts supporting DIR’s position.  The messages were:

Purchasing medical malpractice insurance is the most important choice in your career.

If your carrier is not raising premiums, this should raise a red flag.

We cannot promise physicians who leave DIR can return if another carrier drops them, raises premiums or becomes insolvent.

Audiences: Physicians, office administrators, brokers and DIR employees.


Letters were sent to physicians on (1) the realities of the medical malpractice industry, (2) price and (3) the importance of expert defense counsel. The letters were brief with an enclosed article from a respected physician trade magazine, supporting DIR’s messages.

The same letters and articles were sent to office administrators about a week later. Research showed that office administrators rarely receive information addressed to them so any correspondence received would be read.  Getting to the gatekeeper was paramount for DIR.  It would keep them in the race for renewals.

A video e-mail was sent to physicians from DIR’s CEO, telling them DIR was responding to the market and to expect a visit from DIR staff.   DIR underwriting and marketing staffs made one-on-one visits to physicians and office administrators. A “Shopping Tool,” a one-page sheet comparing DIR to its competitors was created.  It was an apples-to-apples comparison showing details such financial ratings, legal representation and win/loss records.

A doctor talking to another doctor is a powerful tool.  A “Doctor-to-Doctor” approach was created.  Physicians insured by DIR agreed to be on a list in which a marketing staff person could contact them if a DIR physician was sitting on the fence about whether to renew.  The physician on the list then contacted the physician fence sitter.

By-lined articles were published in DIR’s physician newsletter, reiterating the messages of price, financial stability and legal defense.  A DIR board member wrote an editorial in a medical society newsletter about shopping for insurance, using DIR’s “Shopping Tool.”

To position DIR as the authority in medical malpractice, an educational speaking circuit was created.  DIR executives, board members, staff and legal counsel spoke to physicians and office administrators at professional seminars and regular meetings of medical and professional societies.  While individuals affiliated with DIR gave the talks, these were educational sessions about the medical malpractice industry and why changes were occurring nationwide.     

Video e-mails from the CEO also were sent to brokers, telling them of DIR’s decision to remain financially strong during the down period in industry by increasing premiums.  Brokers also received the letters sent to the physicians and other information from the DIR marketing staff – keeping them in the loop at a time when they could recommend another carrier.   

DIR employees were part of the communications process. The CEO gave them the communications plan, explaining the steps outlined to retain DIR subscribers and the role of employees in the plan. In turn, staff kept executives and CRT informed about rumors and concerns in the marketplace that could be addressed quickly. Staff celebrations were held when renewals were announced each month, keeping enthusiasm and encouragement high.

As of December 2000, the retention rate for DIR was 88 percent overall. For November, it was 95 percent. The communications plan developed and executed by CRT and DIR was highly successful in stemming defections, as retention was 25 – 30 percent about previous DIR objectives.