Medical Professional Liability and the Delivery of Obstetrical Care Volume I (1989) / Chapter Skim
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3 The Effects of Medical Professional Liability on the Availability of Obstetrical Providers
3 The Effects of Medical Professional Liability on the Availability of Obstetrical Providers
Pages 35-53
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From page 35... ...
To this end, it consulted extensively with experts in the fields and commissioned several studies to determine the effects of insurance costs and liability concerns on the practice patterns of the three kinds of obstetrical providers covered in this report. OBSTETRICIAN GYNECOLOGISTS The average cost of professional liability insurance for an obstetrician-gynecologist was $37,015 in 1987.
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From page 36... ...
Concerns About Professional Liability The question of whether professional liability concerns are causing obstetrician-gynecologists to forego obstetrical practice is much more difficult to answer. Although the available data are not nearly as good as the committee had hoped, the committee was able to discern certain important trends.
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From page 37... ...
This body of literature focused almost exclusively on physicians' own reports of their decisions to provide obstetrical care. The studies vary enormously in scope, methodology, and rigor.
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From page 38... ...
However, the committee was persuaded that, despite their limitations, these surveys indicate a consistent trend: a significant number of obstetrician-gynecologists and family physicians are eliminating obstetrics, reducing care to identifiable high-risk populations, or reducing the overall number of deliveries they perform in response to professional liability concerns (see Appendix B)
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From page 39... ...
Washington, D.C.: National Academy Press. TABLE 3.4 Age at Which Obstetrician Gynecologists Stopped Obstetrical Practice Age 1985 (%)
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From page 40... ...
However, the committee notes that these surveys neither report the actual changes in average caseload nor quantify the reduced volume of deliveries, making it difficult to evaluate the implications of these reductions. Only eight of the state studies report this practice change, with 6 to 28 percent of physicians saying they were reducing the number of deliveries they perform.
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From page 41... ...
The committee was concerned, as noted above, that the questions used in these surveys tended to overstate the effect of professional liability concerns on obstetrician-gynecologists' decision making. However, in those surveys where the question of motivation was separated from the act of changing obstetrical practice, professional liability issues were consistently cited by more than half the respondents as a major determinant in their decision to change their obstetrical practice.
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From page 42... ...
Accordingly, the committee wanted to determine what effect professional liability concerns were having on family physicians and on the delivery of obstetrical services by them to women in rural areas. Malpractice Insurance Costs Like other providers of obstetrical care, family physicians have been affected by professional liability problems.
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From page 43... ...
The authors reported premiums for family physicians practicing obstetrics at $ 13,511; premiums for those not practicing obstetrics or performing surgery were $4,324. For obstetrician-gynecologists, premiums were $33,026 with obstetrics and $21,782 for surgical gynecology without obstetrics.
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From page 44... ...
Finally, family physicians may be serving a higher proportion of nopay patients than obstetrician-gynecologists. The data on services by specialty and patient payer status are quite limited.
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From page 45... ...
particularly vulnerable to suit in such circumstances. Response to Insurance and Liability Concerns The committee identified 21 state studies and 5 national studies addressing professional liability and family physicians or obstetrical care in rural areas.
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From page 46... ...
Further examination of the state studies revealed that the attrition rate among family physicians providing obstetrical care appears to be higher than that among obstetrician-gynecologists. ACOG reports in its most recent study that approximately 12 percent of obstetrician-gynecologists have stopped obstetrical practice in response to professional liability concerns, half the rate reported for family physicians by AAFP (ACOG, 19881.
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From page 47... ...
· A survey of small, rural California hospitals reported that 30 of 56 respondents providing obstetrical care had family physicians on their staff who were planning to drop obstetrics. Thirty-six of the hospitals (64 percent)
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From page 48... ...
The data on the implications of professional liability for family physicians' provision of obstetrical services are imperfect, but they point in one direction: significant numbers of family practitioners are curtailing or eliminating obstetrical care in response to malpractice concerns. As noted earlier, the importance of professional liability issues, as distinct from personal considerations, can never be precisely known from survey data based on physicians' own reports.
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From page 49... ...
In Medical Professional Liability and the Delivery of Obstetrical Care: Vol. II, Interdisciplinary Review.
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From page 50... ...
Data from a recent survey of approximately 300 nurse-midwives indicate that the average insurance premium of $4,000 represents close to 14 percent of a nurse-midwife's gross income; obstetricians pay approximately 10 percent of their gross income on professional liability insurance (ACOG, 19881. Sixty-four percent ofthe nurse-midwives sampled were working full-time, 21 percent part-time.
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From page 51... ...
which affords maximum profes ~ ~ -- - - - 7 ~ signal autonomy, while not illegal, is practically impossible. The availability of medical liability insurance has also affected birth centers, which represent an innovation in obstetrical care that is favored by nurse-midwives.-These centers were significantly affected by the loss of the ACNM master policy.
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From page 52... ...
1987. Family Physicians and Obstetrics: A Professional Liability Study.
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From page 53... ...
1988. Professional liability issues affecting family practitioners and delivery of obstetrical services in rural areas.
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