In light of 2009 results, it appears that the financial performance of the medical professional liability industry is closely tied to the adequacy of the reserve position. Rate-level adequacy is critical, as well. The authors predict a lengthy but not severe softened market in the future, and anticipate that inflation in loss costs and downward competitive pressure on rates will negatively affect future coverage-year underwriting results. Also, the ongoing financial pressure on the healthcare system and the difficulty in absorbing higher medical professional liability costs will have an impact on the future market cycle of the industry.