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Why do physicians stop practicing obstetrics? The impact of malpractice claims
R A Rosenblatt1, G Weitkamp, M Lloyd
1University of Washington School of Medicine, Seattle.
Insights
Older physicians, especially those in urban or solo practices, are more likely to stop delivering babies. Malpractice claims also influence obstetricians
Area of Science:
- Medical Malpractice
- Physician Practice Patterns
- Obstetrics and Gynecology
Background:
- Physician retention in obstetrics is crucial for maternal care access.
- Factors influencing practice discontinuation in obstetrics are not fully understood.
Purpose of the Study:
- To identify characteristics of physicians discontinuing obstetric practice.
- To examine the role of malpractice claims in obstetric practice decisions.
Main Methods:
- Retrospective cohort study of physicians with obstetric malpractice insurance.
- Analysis of practice discontinuation and malpractice claim rates between 1982 and 1988.
Main Results:
- 171 of 690 physicians discontinued obstetrics.
- Physicians leaving obstetrics were older, more likely in urban/solo practice.
- Obstetricians who discontinued had higher malpractice claims (14.5 vs. 6.2 per 100 physician-years).
- Family physicians leaving obstetrics had lower claim rates.
Conclusions:
- Older physicians, particularly in urban and solo practices, are prone to leaving obstetrics.
- Malpractice claims significantly influence some obstetricians' decisions to discontinue practice.
- Specialty and practice setting are key factors in obstetric practice cessation.
Abstract:
We studied all physicians who purchased obstetric malpractice insurance from the Washington State Physicians Insurance Exchange and Association between January 1, 1982 and July 1, 1988. Of the 690 physicians studied, 171 (32% of the family physicians and 10% of the obstetricians) discontinued obstetrics but remained in practice. Physicians who discontinued obstetric practice were older, more likely to practice in an urban area, and more likely to be in solo practice than those who did not. Obstetricians who discontinued obstetric practice had a higher rate of new obstetric malpractice claims than did those who did not quit practicing obstetrics--14.5 versus 6.2 claims per 100 physician-years of coverage. By contrast, those family physicians leaving obstetrics had a lower rate of new claims than their peers who did not quit. We conclude that older physicians--particularly those in urban and solo practice--are most likely to stop practicing obstetrics, regardless of specialty. In addition, being named as the target of an obstetric malpractice claim plays a significant role in the decision of some obstetricians to discontinue obstetric practice.
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