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OCR for page 187
APPENDIX
A
Summary of Methodology Used
in Studies of Changes in
Obstetrical Practice
Appendix A summarizes the meth-
odology of each study reviewed. Major differences among them and in
their implications for the findings include the following.
Survey Population
The majority of the studies surveyed members of the society sponsor-
ing the project. The proportion of all physicians who are members of a
society varies both among specialties and geographically. Each of the
American College of Obstetricians and Gynecologists' (ACOG) surveys
used a stratified random sample of members based on the organization's
nine geographical districts and the state of Florida. Residents, military
personnel, and members outside the 50 states were excluded from all
three ACOG surveys, and the 1987 survey also excluded Founding Life
and Life Fellows (who are inactive practitioners). Ninety percent of all
obstetrician-gynecologists are members of ACOG, but not all of the 90
percent are necessarily members of a state society. Conclusions drawn
from these studies are based on the assumption that member physicians
are representative of all practitioners.
Samples
Some of the studies drew samples of the membership, and others
surveyed all members. For example, ACOG uses a sample of approx
187
OCR for page 188
188 APPENDS A
imately one in four, and the American Academy of Family Physicians
(AAFP) surveyed its entire membership. The majority of state-specific
studies surveyed the relevant society membership, but a few (for exam-
ple, Texas) drew a sample. When samples were drawn, the methods used
appear to have varied among the studies.
Response Rates
These vary widely, from 23 percent in the Texas Medical Association
1985 survey to more than 80 percent in Alabama and in the 1985
Washington State surveys of family practitioners. The median response
rate for the state studies was 60.2 percent. The total response rate for the
1987 ACOG survey was 48.4 percent (N= 1,984~.
Phraseology
Questions were often imprecisely or suggestively worded. Almost all
the studies sought to determine whether physicians were changing
their practices or abandoning obstetrics altogether because of profes-
sional liability concerns. Certain survey questions were worded in such
a way as to make it impossible to distinguish between situations in
which the physician ceased the practice of obstetrics because of age,
health, or simply boredom and situations in which professional liability
was the predominant factor.
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Representative terms from entire chapter:
professional liability
