Physician perceptions regarding competence of obstetrical providers and attitudes about other issues in obstetrical...

Access to obstetrical care in the United States is unevenly distributed and is limited by provider availability, geography, and finances. Obstetrical care is provided by three distinct groups: obstetricians, family physicians, and certified nurse midwives (CNMs). Outcomes among these groups have not been shown to differ, but the attitudes and perceptions of these groups may impact access to obstetrical care. We examined physicians' perceptions regarding competence of obstetrical providers for low- and high-risk care and attitudes regarding CNMs and malpractice insurance costs.

We mailed a survey containing twenty value-neutral questions on competency, attitudes, and demographics to a randomized list of 3,000 OB/GYNs and 3,000 FPs obtained from the American Medical Association. Physicians surveyed included obstetricians (OB/GYNs), obstetricians specializing in high-risk (HROBs), family physicians who include obstetrics in their practice (FPOBs), and family physicians who do not do obstetrics (FPs).

The response rate was 14.5 percent. All respondent types expressed a high degree of confidence in OB/GYNs to provide low-risk obstetrical care. FPOBs were not perceived to be as competent to provide the same care, but FPOBs have more confidence in their ability to provide low-risk obstetrical care than OB/GYNs have (71.4% versus 43.8%, P = .0001). Attitudes differed among the physicians about malpractice insurance fees paid by OB/GYNs and FPOBs. OB/GYNs strongly supported a similar fee schedule for these two groups and FPs supported differential rates (P = .001). CNMs were generally perceived as competent and were thought to warrant hospital privileges for vaginal deliveries.

Physicians view their own and others' obstetrical competence and outcomes differently, but not necessarily accurately. Malpractice rates are not perceived by OB/GYNs as fair. Specialty societies need to promote cooperation and enhance education of all providers of obstetrics.