Celebrating 15 Years at the Reins
Some experts say that competitive horse jumping is an extreme sport, sharing the danger scale with bull riding and motocross.
Sitting astride an animal weighing as much as 1,500 pounds and leaping through the air over a variety of obstacles is the definition of a death-defying act.
So too, it could be argued, is taking the CEO position at a small, local medical-liability insurance company—facing money issues, including an operating loss, and already under the close scrutiny of the state insurance commissioner—and then turning that company into a model for others to follow.
Mary-Lou Misrahy has accomplished both of these challenges with body, soul, and reputation intact. The qualities of good horsemanship are not unlike the qualities of good leadership. “You can’t out-muscle a horse,” Misrahy says. “It takes finesse, feeling, and communication to build a relationship between horse and rider.”
In 15 years at the helm of Physicians Insurance A Mutual Company, she has earned the admiration of both her staff and a cross-section of leaders in medical-professional liability. She is known for firmness, fairness, and fearlessness. The president and chief executive officer of Physicians Insurance and its subsidiaries, which now constitute the largest provider of medical-professional insurance in the Northwest, Misrahy has enjoyed 37 years in the insurance industry and has the serene confidence that comes from having achieved much of what she set out to do. With a steadily growing national reach, Physicians Insurance currently serves more than 8,500 members, providing them with risk-management consulting, continuing medical education, claims administration, and a myriad of targeted services designed to increase patient safety, support the independent practice of medicine, and decrease care-team burnout.
On the eve of retirement, Misrahy no longer jumps horses quite as high as she once did, nor admittedly does she “bounce as well” after a fall as in her equestrian heyday. Checkers, her current jumping horse—imported from Germany and stabled two miles from her home—is what she calls her “horse of a lifetime”: easier on the body than others she’s jumped with.
From horse jumping, she’s earned a measure of competitive success and a knack for riding horses that others couldn’t. From the corporate world, she’s earned something similar: a reputation as a compassionate leader known for her keen ability to transform companies.
How Misrahy steered so straight a course for years is due, in part, to science. The holder of a bachelor’s degree in science from the University of California at Davis, she once planned to become a veterinarian in the days when women were forced to fight for equality in the veterinary field. Her parents, both MDs (and her father an equestrian), knew that path would not tap her full potential. “I’d want to take all the animals home,” she explains, recalling the time she’d harbored a number of animals that she’d saved from being euthanized. But as far as a career goes, she says, “it’s a tough way to make a living.”
What science had taught her, though, was ideal for corporate leadership. “It teaches you to be analytical, not emotional,” she says. “It sharpens the ability to consider multiple thought processes, walk through the facts, and objectively make good decisions. It equips you to quickly change course if required, and teaches you how to measure success.”
In 1982, that analytical turn of mind led her to join what later became Fremont Compensation Insurance Company as a claims manager. Her rise within the company was a rapid one, leading to her taking a number of senior positions that, in the late ‘90’s, culminated in her promotion to senior vice president of marketing, customer service, and loss control, and eventually to president and CEO.
Today, chair of the board of directors for the Medical Professional Liability Association (MPLA) and a member of the board at the Washington Physicians Health Plan, Misrahy joined Physicians Insurance in 2004. She is proud of having created a climate there of doing the right thing. “We put together a really good team,” she says. “And the board of directors showed courage to say, ‘We believe in this company,’ and they supported everything that had to be done to rebuild and put us on a firm footing.” She and the board also believed in giving back to the communities the company served, and by 2010, Misrahy and her company were finalists for the Ernst & Young Entrepreneur of the Year Award. Strongly believing that she, too, should give back to her community, from 2009 to 2014 Misrahy served as chair of the board for Little Bit Therapeutic Riding Center in Redmond, Washington.
As CEO at Physicians Insurance, she learned to play to her strengths. IT, for example, was not one of them—she was inquisitive about technology, but knew to hire someone who could straighten things out and establish a good path forward. Today, that person—one of four senior positions Misrahy hired in her first year—is the company’s senior vice president and chief information officer.
Misrahy says that she’s not always as good with work/life balance in her own life, despite it being one of Physicians Insurance’s major initiatives in regard to the self-care of physicians and care teams. “I work a lot; I’m all in,” she says. “Much of my energy goes to this company, to helping others balance their lives, and to giving our company employees a good place to work.” She knows she has an innate ability to fix things and to develop company strategies and implementation, and that day-to-day maintenance of programs and initiatives is well entrusted to those who are so gifted.
It’s great exposure for everyone in the company, to get out there and make presentations and to learn what others face.
When we keep learning, it helps us anticipate needs and the opportunities to meet them.”
- MARY-LOU MISRAHY
“I maintain a very open-door policy in my office,” Misrahy says. “I’m a good listener and collaborator who often finds consensus, yet I know that if that’s not possible, the final decision is mine.” She is careful to set objective goals for people and hold them to those goals. “I may not be liked all the time, but I think I’m fair and respected,” she says. “Change can be hard for people. As things become more complex in the industry, it can be difficult for some. It may not be right for everyone.”
According to Physicians Insurance board chair Ralph Rossi, MD, Misrahy has changed Physicians Insurance and medical-professional liability for good. “Mary-Lou has expanded our company and stewarded our growth expertly by responding to changing market needs,” he says. “With her, we have grown from a single-line, single-state company to a national company with multiple service lines. She has brought financial success to our firm by raising our profile at the national level, resulting in new business opportunities and sources of value for our clients.”
The signs of financial success and growth under Misrahy’s leadership are robust:
- Number of members grew more than 41%
- Dividends have been paid to policyholders for 11 consecutive years
- Surplus grew more than 300%
- Assets grew to more than half a billion dollars
That said, has she accomplished everything she hoped to? “I feel a sense of satisfaction,” she says. “But there is more to be done in keeping up with a changing business and assuring company sustainability. We’re still the underdog in the insurance world, though the fact that we’re smaller, more nimble, and able to adapt to changing conditions can be an advantage.”
She also points to the advantages of being a part of the MPLA network. “We gain international exposure at conferences, and hear from representatives from places such as Africa, Australia, and Ireland,” she says. “It’s fascinating to understand what people face in other countries, in terms of healthcare. It’s great exposure for everyone in the company, to get out there and make presentations and to learn what others face. When we keep learning, it helps us anticipate needs and the opportunities to meet them.”
In retirement, Misrahy plans to remain in leadership at the MPLA. She will keep competitively jumping Checkers (whose registered show name is MTM Check Me Out). She also plans to try new things: she aspires, for example, to become a master gardener. It is also important to her to give back, and she will continue to look for opportunities to use her skills to bring value to other organizations within her community.
With so much healthcare advocacy in her blood, Misrahy will continue to lobby for broader coverage. For example, she wants hippotherapy to be recognized as a legitimate therapy and covered by health insurance. Currently a member of the advisory board at Little Bit Therapeutic Riding Center, she has witnessed firsthand the healing that equine therapy provides to people, especially children and adults in need of physical and speechlanguage therapy, and says that significant numbers of autistic children benefit from the practice. “I will never forget the mother at Little Bit who said, ‘This is the first time I’ve heard my child speak,’” she says.
Even in retirement, opportunities abound for Misrahy to bring her influence to bear on the world. Like any physician or healthcare advocate with her level of drive and breadth of experience, she will always jump at the chance to improve the lives of others.
Professional Reflections on Mary-Lou Misrahy
For a CEO in a highly competitive field to remain at the top of her game requires a rare blend of inspiration, innovation, and decisiveness. It is those very qualities that insurance-industry spokespeople and healthcare advocates admire in retiring CEO Mary-Lou Misrahy.
“In every way, she leaves the company in much better shape than she found it,” says her longtime friend Andrew Short, former managing director at Guy Carpenter & Company and one of Misrahy’s reinsurance brokers for more than 25 years. “She always puts the interests of her staff and the company ahead of her own.”
Misrahy has been unstinting in her focus on physicians and patient safety. It is that regard for others, a can-do spirit, and her big-picture view of systemic changes in the delivery of healthcare that have made Misrahy not only a strong voice for Physicians Insurance, but an effective advocate for the medicalliability protection field at large.
Here, in their own words, are the reflections of eight individuals on the impact of Misrahy’s achievements over a 37-year career.
"Mary-Lou’s name, in this industry, is gold. She leverages the strength of her employees and her board members to meet company goals, while at the same time developing talent and being a respected mentor to many. Her expertise has stewarded our growth from a single-line, single-state company into a national company with multiple service lines. Her national participation on the board of the Medical Professional Liability Association has raised our profile, and we are now considered a leader in the industry. Mary-Lou taught me about insurance and about leadership. She will be greatly missed.”
- RALPH A. ROSSI, MD, FORMER CHAIRMAN OF THE BOARD, PHYSICIANS INSURANCE
"Mary-Lou has an unerring commitment to innovation, and is constantly striving to make sure Physicians Insurance responds effectively to change. She is indefatigable in her work ethic and strictly adheres to accountability, including her own, yet remains an approachable leader who fosters inclusivity. Unaccepting of mediocrity, she acts quickly and decisively when needed, ever in search of new ways to solve numerous and fastdeveloping business challenges. A person of integrity, she represents a safe pair of hands at the helm.”
- ANDREW SHORT, FORMER MANAGING DIRECTOR (RETIRED), GUY CARPENTER & COMPANY
"Mary-Lou has been a preeminent leader in discerning the larger systemic changes in the delivery of healthcare, and in recognizing how risks have evolved. She has provided ways to insure and protect against these risks. She knows not only how to assess these changing dynamics, but how to devise and apply initiatives that focus on moving forward constructively. She has also been instrumental in bridging philosophical and business differences between disparate members of the medical-professional liability industry.
Skilled at diplomacy, Mary-Lou is adept in guiding difficult discussions among board members and helps them come to a constructive resolution. She has proven to be a masterful board chair, able to harness the views and perspectives of 12 other smart, strongwilled industry leaders.”
- BRIAN ATCHINSON, PRESIDENT AND CEO, MEDICAL PROFESSIONAL LIABILITY ASSOCIATION
"Mary-Lou’s primary contribution to the medical-liability insurance industry is her real concern for the physicians and healthcare providers who work every day to help patients. She has the uncanny ability to see the entire scope of our industry without missing any of the details. With leadership that is collaborative and results-oriented, she hears all sides. When I worked with her on the MPLA board, she attentively listened to the issues under discussion and—presto!—came up with a great idea and a straightforward solution. When the MPLA directors struggled to develop a governance-succession plan, Mary-Lou was the key to helping us create a plan that was multifaceted and diverse. I’m going to miss her dependability, loyalty, and hardworking style. No one is as dedicated as she is, or works harder than she does.”
- GLORIA H. EVERETT, PRESIDENT AND CEO, THE MUTUAL RISK RETENTION GROUP
"I don’t know of any other CEO as knowledgeable as Mary-Lou is about every functional area of her company. From the beginning, she reached out to Physicians Insurance insureds and to the broader medical community. She is widely known, and has developed many important healthcare relationships. Her leadership allowed the company to prosper and at the same time reduce premiums for physicians. Mary-Lou has an extremely kind heart, and is always reaching out and helping employees and others with their personal and professional problems.”
- ROD PIERSON, FORMER EXECUTIVE VICE PRESIDENT, CFO, AND TREASURER (RETIRED), PHYSICIANS INSURANCE
Thoughtful and deliberate, Mary-Lou looks at our business in a very holistic manner, always keeping the insureds at the center of her analysis. She shows great respect and admiration for the healthcare community and its caregivers. Often referencing her mother, a physician, Mary-Lou works diligently to make sure that her customers’ needs are met with the best products at the most reasonable rates. Remembering her roots, she will say, “We do it because it is the right thing to do”—and like all good leaders, she knows that it is the team that drives success.”
- GERRY LEWIS-JENKINS, COO, COPIC INSURANCE COMPANY
"From her early years at Physicians Insurance, Mary-Lou stressed the vital importance of regulatory compliance. Today, the Washington Department of Insurance, in addressing compliance issues with other companies, has been known to cite Physicians Insurance as an example of how to do things the right way. Mary-Lou launched efforts to address the challenges created by the decline in private practice and the growth of large organizations preferring selfinsurance—such as providing services to groups that chose self-insurance.
She also reached out to physicians in personal ways. One memorable example is her attendance at jury trials to support physicians facing the stress of defense.
Mary-Lou invites a diversity of ideas. It is safe and important for an employee to disagree with her because such disagreements lead to discussions that improve quality.”
- GARY MORSE, FORMER SENIOR VICE PRESIDENT AND GENERAL COUNSEL (RETIRED), PHYSICIANS INSURANCE
For 15 years at the helm of Physicians Insurance, and in the wake of the availability crisis of privatepractice physicians in the late 1990s and early 2000s, Mary-Lou provided a strong and clear vision that allowed Physicians Insurance to remain at the forefront of the physician malpracticeinsurance sector. She stood strong when the healthcare market felt the pressure applied by the implementation of the Patient Safety and Affordable Care Act. The company has grown significantly under her stewardship, building its surplus by more than 360%, in spite of a backdrop of flat-to-reducing premiums, while still managing to return significant dividends to policyholders. Mary-Lou has also overseen the succession planning in all the senior roles within the company, undoubtedly positioning the company for a prosperous future.
On a personal note, as a client Mary-Lou has always been transparent, considerate, and fair in all our business dealings. Her loyalty has been unquestionable. I wish her every success in the next chapter of her life, which I hope will not be too far away from the healthcare space.”
- IAN SAWYER, HEAD OF CASUALTY LONDON, SIRIUS RE, SIRIUS INTERNATIONAL, LONDON