Maternity care in family medicine: economics and malpractice

The number of family physicians delivering babies in Florida in 1991 was at an all-time low. Concerns about malpractice risk and insurance costs have resulted in only 2% of Florida's family practice residency graduates choosing to deliver babies. The purpose of this study was to compare the practices of family physicians in Florida who delivered babies in private practice (termed the "OB group") with those who did not (the "non-OB group").

A potential study group of 293 family physicians was mailed an extensive survey that explored 132 variables related to medical practice economics and demographics, lifestyle and satisfactions, and malpractice costs and risks.

The obstetrical (OB) group was significantly more likely than the non-OB group to perform a variety of procedures and report more patients under age 6 years (15% vs 5%; P = .003) and fewer patients 65 years or older (19% vs 33%; P < .001). Even though the number of patients seen and the number of hours worked were similar, the 1991 incomes were much higher for those practicing maternity care (mean = $164,000 vs $104,000; P = .04). Compared with the non-OB group, the OB group was more likely to report that their financial and psychological compensation was adequate (P < .001), would be more likely to choose medicine as a profession again (94% vs 60%, P < .05), paid more for malpractice insurance (mean = $22,000 vs $11,000; P = .01), and reported 30% fewer nonobstetrical malpractice claims.

Family physicians in Florida who deliver babies, as compared with those who do not, are more likely to report (1) increased financial and psychological satisfaction for the same hours worked; (2) increased satisfaction with medicine and family practice; (3) more frequent performance of a wider range of procedures; (4) younger practices serving a greater number of complete families and fewer Medicare patients; (5) a more diverse and comprehensive hospital and office practice; and, despite paying significantly higher malpractice insurance premiums, (6) few obstetrical malpractice claims and lawsuits, and (7) fewer nonobstetrical malpractice claims and lawsuits.