US doctors increasingly use offshore trusts as malpractice fears rise

A Southpac Group report says more US physicians are moving wealth into offshore trusts as malpractice exposure grows, especially in high-risk specialties like obstetrics and general surgery. The shift reflects a broader push to protect personal assets before litigation begins.

Why it matters: - More US doctors are looking for ways to shield personal wealth from malpractice claims, insurance gaps and legal costs. - The trend is strongest in specialties with higher litigation exposure, including obstetrics, gynecology and general surgery. - Southpac Group says the demand shows offshore asset protection is moving beyond the ultra-wealthy and into mainstream professional planning.

What happened: - Southpac Group says new US client numbers rose more than 290% between 2022 and 2025. - The United States now accounts for about 85% of Southpac Group’s client base. - The firm says physicians, surgeons and business owners are increasingly setting up Cook Islands and Nevis structures before disputes arise. - The article cites new US research showing almost 60% of obstetricians and gynecologists have been sued at least once in their careers. - The same research found more than half of general surgeons have faced a malpractice claim.

The details: - Southpac Group manages about US$4 billion in assets. - Matthew Smith, Southpac Group’s director of business development, says malpractice insurance may not cover a claim if damages exceed policy limits. - Smith says offshore asset protection structures are typically part of a broader risk management and wealth preservation strategy. - Smith says the key is to establish asset protection before any dispute begins. - Southpac CEO Mike Arand says the firm was the first licensed trustee company in the Cook Islands. - Southpac says it has established more than 4,000 trusts over the past 40 years. - Arand says most of the firm’s medical professional clients hold between US$2 million and US$10 million in assets. - The Cook Islands gained its asset protection reputation after adopting specialized legislation in the late 1980s to protect assets from future creditor claims, if structures are created before legal action starts. - Southpac also uses Nevis, a Caribbean jurisdiction known for protective company legislation, in some client structures. - Arand says many clients pair a Cook Islands trust with a Nevis company to create two layers of protection across separate jurisdictions. - Southpac says its due diligence process includes client verification, background checks, sanctions screening, politically exposed person checks and ongoing monitoring. - Arand says the firm can decline prospective clients over sanctions exposure, criminal activity, tax transparency concerns or existing legal claims. - The Cook Islands was rated compliant or largely compliant on 38 of 40 Financial Action Task Force recommendations in its latest international review. - Southpac administers trusts for clients from 51 countries and has teams in New Zealand, the Cook Islands, Nevis and the Philippines.

Between the lines: - The growth points to rising anxiety among affluent professionals about how easily a large claim can threaten decades of savings. - The push toward offshore structures also reflects a belief among some advisers that domestic planning tools may not be enough in aggressive US litigation environments. - Southpac is also betting that many US attorneys and wealth advisers still lack familiarity with offshore structures. - The firm says that knowledge gap creates a major growth opportunity.

What’s next: - Southpac is expanding its referral network of attorneys, wealth advisers and other professional advisers across North America. - The firm is meeting with specialist asset protection lawyers in California, Florida and Canada. - Southpac expects demand to keep growing as more US professionals seek asset protection structures once associated mainly with ultra-wealthy investors.

The bottom line: - For many US doctors, offshore trusts are becoming a preemptive defense against litigation risk rather than a last-minute response to a lawsuit.