Adverse perinatal outcomes: is physician specialty a risk factor?

An investigation was conducted in a community hospital to determine whether physician specialty (obstetrics vs family medicine) is a risk factor for adverse perinatal outcomes. Over a three-year period, there were 6,856 deliveries, of which 713 (10.4 percent) were attended by family physicians. Overall, there were 301 (4.4 percent) cases with adverse outcomes, of which 32 (10.6 percent) were attended by family physicians. The charts of a weighted random sample of 117 cases with adverse outcomes and 468 controls were reviewed to determine potential risk factors, including prenatal risk status, race, insurance, and specialty of the attending physician. The risk ratio for family physician as attending was 0.99 (95 percent confidence interval, 0.69 to 1.42) after multivariate adjustment for the other risk factors. Only high prenatal risk status was found to be an independent predictor (risk ratio 1.75, 95 percent confidence interval, 1.23 to 2.49). A chart review of a random sample of 146 patients (73 each of family physicians and obstetricians) revealed no difference in the proportion of high-risk patients in each specialty. It is concluded that in the setting studied, specialty is not a risk factor for adverse perinatal outcomes, and that this finding is not confounded by the patient's prenatal risk status.