As 2010 results are tallied for medical professional liability (MPL) insurers, it appears that net income will be on par with the excellent results of the past three years. But this trend will not hold for long. In the future, as reserve redundancies are recognized and exhausted, calendar-year results are likely to move in the direction of coverage-year results. Declining investment income, a rising underwriting expense ratio, and other risks are putting pressure on profitability as well, and there are indications that the decline in claim frequency may be reversing.