Mandy Anderson, who has served for 23 years as CEO and Managing Director for MIGA, a mutual non-profit organization which provides a range of membership services and benefits to doctors, the healthcare sector, privately practising midwives, and medical students across Australia, has seen it all. Her CEO tenure began just before Australia’s medical indemnity crisis in 2000, through which she successfully guided the company and its members.
Since that crisis, MIGA’s revenue has increased 10-fold, while membership has increased 8 times. Significantly, net assets rose from -$27 million in 2000 to $159 million in 2022.
As a leader, Anderson has paid special attention to corporate culture and high-quality service, which was recognized by Kincentric Best Employer Awards in 2019 and 2021 for Australia and New Zealand. In 2010, MIGA successfully secured an appointment from the Australian Federal Government as the sole provider for the Midwives Insurance Scheme, which the Group has continued to service.
Her dedication to member service resulted in the negotiation of an exclusive partnership between MIGA and Qantas, which provides frequent flyer member benefits to MIGA’s members and clients, a strategy that has assisted greatly with the Group’s growth and retention. Anderson also guided the Group through a period in which it achieved and has maintained a Standard and Poor’s rating for its insurance subsidiary, Medical Insurance Australia, of A-Stable, indicating strong financial characteristics.
She has been a dedicated proponent of international collaboration within the MPL industry, serving on the board of the Medical Professional Liability Association for the past two years. In this interview, she discussed her successful career, the state of the MPL industry in Australia and around the world, and more in the context of her upcoming departure from MIGA.
IML: Mandy, what have been some of the notable events and trends that you've seen during your career?
Anderson: In the time that I've been at MIGA there has been a very big change in terms of patient expectations and the impact that that has on the medical profession and the risks they face. And I know that's a worldwide phenomenon. It's really, really difficult for everyone to deal with. It's hard for the medical professionals because the expectations placed on them, too, at times become pretty unrealistic. And, of course, Dr. Google has played a role in this increase in expectations.
IML: What other changes have you noticed?
Anderson: Workforce issues, especially post-COVID, are a significant issue in Australia. The level of burnout, the inadequacy of resourcing particularly in our public sector, and the pressures these create for doctors. Going back further, there were significant financial problems in our industry, right before I took over at MIGA. Our federal government actually stepped in and intervened in the industry in the early 2000s; I was part of a task force that worked on legislation that was brought in to help support the medical profession and the medical professional indemnity industry to ensure premiums were affordable. This was a huge change, but a very important outcome was achieved (and continues to this day), which is that in Australia medical indemnity is heavily supported, secure, and affordable because of the legislation that our federal government has in place.
IML: What does that support mean in practice?
Anderson: As a result of the legislation, for example, the government will step in for 50% of the cost of claims over $500,000 (AUD) under the high-cost claims scheme. This provides very good reinsurance support. Also, the government’s premium support scheme provides subsidies for eligible practitioners whose premiums exceed 7.5% of their income from private practice. There are also subsidies for practitioners in rural areas as well as ongoing federal government runoff insurance for practitioners who have retired, are disabled, or are on parental leave. Practitioners are also protected under the exceptional claims scheme against personal liability from claims made against them that exceed the protection they receive from their MPL insurance (above $20 million). It was extremely gratifying for me personally to have a part in developing such a strong program for the MPL sector.
IML: What other changes have occurred within the industry in Australia during your tenure at MIGA?
Anderson: There's been quite a bit of consolidation. When I first joined the industry, I think that we started with something like nine participants in it and we're now down to five. I’m very proud of the fact that I led the successful acquisition of one of our competitors in 2014, which changed the profile of MIGA nationally, increasing our market share and consolidating our national position. Another major change was that when I joined MIGA it was a medical mutual and was actually unregulated. As I dug into the financials, I discovered that despite my due diligence there were significant unfunded liabilities and that the coverage wasn’t limited or properly funded. Instead of operating on a claims-made basis, we were operating on a claims-incurred basis. This was common in Australia at the time and was the central problem that caused the medical indemnity crisis in the early 2000s, which caused the federal government to step in. We’ve gone from being very lightly regulated to being quite heavily regulated as an industry. Whilst this has created complexities and increased workloads, it is so important to support the sustainability of the industry and its strong capital position.
IML: Would you say that MPL companies in Australia have become more like traditional insurance companies?
Anderson: In the fact that we are financially stable and highly regulated, yes. But we are different in that, like our counterparts in America and elsewhere in the world, our approach to our members, to looking after them, to supporting them and protecting them is very different from the typical insurance company. I have made sure that we maintain a really strong ethos of personal support and quality advice for our members and policyholders. Unlike many sectors of the insurance industry, where the first impulse is to deny a claim, we look for a reason to cover, which is a hallmark of our approach.
IML: That’s because you, and other MPL companies, are succeeding in a mission-driven approach. Tell us more about that.
Anderson: As you know, this is very different from other insurance lines. Practitioner’s medical indemnity exposures are very personal, and they go to the heart of their professional lives and their reputation and livelihood. Providing medical professional liability insurance is more than insurance, which is how we view our calling here at MIGA. We provide a 24-hour response service to our members and policy holders that is covered by our staff, not outsourced to a call center. Our members and policy holders can call anytime and talk directly to lawyers we employ. We offer an educational program that is second to none in terms of offering extensive education about the risks involved in MPL as well as incentives for completing the programs.
IML: What concerns do you have as you prepare to leave MIGA?
Anderson: I'm really concerned for the healthcare profession, in terms of the burnout, fatigue, and shortage of practitioners. I know these are issues that our government is focused on, but what is occurring is a really significant challenge. There’s a big rebuild needed both in Australia and around the world in terms of supporting practitioners around burnout and fatigue and in sourcing more practitioners. COVID-19 added to the problem. I’m also concerned about the increasing regulation of the sector, which is needed, but potentially puts pressure on smaller providers in terms of their ability to sustain themselves.
IML: Any other thoughts on this subject?
Anderson: I think it’s really important that we also continue to strive to find the right people to bring into our MPL companies. Recruiting in this industry is not just about insurance; instead, it’s about maintaining a workforce that is passionate about their mission. Finally, I would also say that COVID continues to create challenges. Of all the issues I’ve faced during my 23 years at MIGA, COVID was and continues to be the most significant. Australia had many long significant periods of lockdown, much more than America experienced. For many months at a time, our workforce had to provide all of our services from their homes while we had to ensure they were motivated while also taking care of themselves.
My desk was two meters from my kitchen. Some days I didn’t stop from 7:00 in the morning until 7:00 at night except to eat or take a short break—nothing else. It was hard for us and our people, but even harder for our members, who had to cope with lockdowns, cancellations of elective surgeries, vaccines, and more. We had to advise them about what to do in an environment where the rules were constantly changing. There was no rule book for any of us. Looking back at that period, it was two to two-and-a-half years that were pretty rough on everyone. But as tough as it was here, the things we did helped Australia in minimizing the infection and death rate, so it was the right thing to do.
IML: What are you most proud of from your tenure at MIGA?
Anderson: First of all, I am so proud of our people, the staff that I work with every day. They’re hand selected for their experience, commitment to the MPL sector, and most importantly, for their commitment to our members and policy holders. We have a wonderful workforce, and I think the support and compassion that they show our members and policy holders is amazing. As a result of that, our national growth and our retention rates are extremely good. We are growing as a company. When I joined MIGA we were only a state-based company in South Australia. We only had 4,500 members; today we have nearly 38,000. I also am proud of our commitment to our mission, to our support for our members. I think that's so important. I have so much respect and admiration for our staff and their commitment and passion, not just MIGA but also our members and clients.
We do a lot of advocacy on behalf of the profession, because we have the skill and the expertise to identify the issues that emerge so that we can be effective advocates. Another program that I’m very proud of is our relationship with Qantas through which our members and policy holders receive frequent flyer points based on the premiums they pay. Our members love this program—it’s been incredibly successful. Finally, I’m proud of my participation in the MPL Association, through which I was able to meet many CEOs and CFOs of companies like ours. Networking opportunities like this are so valuable, and the MPL Association plays such an important role in bringing like-minded companies from around the world together to learn from each other.
I will miss everyone and the industry so much and hope to play an ongoing role is some way, albeit different, in the future.