Malpractice insurance increases have not yet seriously affected California's physician supply or services, but have spurred practice changes affecting availability, cost, and quality of care. Findings indicate the public is paying part of the cost in fee increases. Some physicians are going without insurance; some have made practice changes, such as family physicians reducing or limiting surgery and obstetrics. Rural areas are hardest hit by such changes. Medi-Cal data indicate no measurable decrease in physicians treating Medi-Cal patients or in services or visits. Total physician supply in and migration to California have not been reduced. The author suggests that ways be considered to make the rate structure more flexible and that the state monitor and document the impact of rate increases in terms of (1) practice changes, (2) residency and practice location choices, (3) malpractice insurance rates in other states, and (4) effect on physician provider participation and distribution of Medi-Cal patients among physicians.