I wouldn’t characterize it as “paranoid about litigation”. Lawsuits against physicians are common, and you absolutely have to consider the small but real risk of having to defend your actions in court. I’m a physician and see this play out all the time, and there’s a reason malpractice insurance is as expensive as it is.

Just because you're paranoid doesn't mean they're not out to get you. Justified paranoia is still paranoia.

No it quite literally isn't

How expensive is malpractice insurance, as a proportion of your salary?

Depends on the specialty, but roughly $500–$1500 (higher for surgeons and proceduralists; ~5% of your salary). However, if you work as an employee for a hospital or a large group practice, you don't pay for malpractice insurance directly. The institution covers it, but obviously it will indirectly impact your salary.

Malpractice can be $30-$90k/year for an OB-GYN. Hospitals may cover part of this, but a private practice may not. This is a huge percentage of an OB-GYN salary, and creates negative career satisfaction across the specialty. (As if medical school debt and the residency hazing process were not enough.)

In private practice, OB's also often have to pay for their own tail insurance, which also means if they quit the practice, they have to pay malpractice insurance (basically in perpetuity) to protect against late-arriving lawsuits. This also traps physicians in their job/specialty and makes early retirement challenging.

It's a great system. /s

I would question whether extra treatments for an end of life patient is really a profitable venture for a hospital vs the opportunity cost of more lucrative elective stuff.

End of life treatments are, I assume, very profitable, because either they'll be covered by insurance, or they'll be paid by the deceased's estate. They'll probably get paid the full asking price rather than having to give a discount too.

I wouldn't argue they aren't profitable, but there is a good chance Medicare is covering it, which is substantially lower reimbursement than private insurance.

If they have a limited volume of beds, I'm sure a focus on profit would drive a private patient getting care versus an elderly Medicare patient.

If the estate can’t pay then the debt is just written off though.

That aside, ability to pay is not going to be the top consideration of the baseline profitability of a procedure.

I don’t know any specifics though.

But most people do die with an estate of some kind