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Charges for obstetric liability insurance and discontinuation of obstetric practice in New York
K Grumbach1, K Vranizan, D Rennie
1Primary Care Research Center, University of California, San Francisco 94143-1364, USA.
Insights
Increased obstetric liability insurance costs did not lead New York physicians to stop practicing obstetrics. Physician career stage and practice scope, not insurance premiums, influenced decisions to discontinue obstetric care.
Area of Science:
- Medical Economics
- Physician Practice Patterns
- Health Policy
Background:
- Rising obstetric liability insurance premiums are a concern for physicians.
- Potential impact on obstetrician workforce availability requires investigation.
Purpose of the Study:
- To determine if higher obstetric liability insurance charges correlate with physicians discontinuing obstetric practice in New York.
- To analyze factors predicting the cessation of hospital-based obstetric practice.
Main Methods:
- Physician-level analysis of obstetricians in New York active in 1980, tracking practice changes by 1989.
- Logistic regression models assessed predictors including insurance charges, physician, and practice characteristics.
- Examined complete clinical inactivity and selective discontinuation of obstetrics.
Main Results:
- No association found between increased liability insurance charges and discontinuation of obstetric practice.
- More years since medical licensure correlated with complete practice cessation and selective discontinuation.
- Family physicians were less likely to cease practice entirely but less likely to continue obstetrics compared to obstetrician-gynecologists.
Conclusions:
- The level of increase in liability insurance premiums does not influence decisions to discontinue obstetric practice.
- Physician career lifecycle and the scope of general or family practice are primary drivers for discontinuing obstetrics.
Background:
The study objective was to determine whether New York physicians facing higher charges for obstetric liability insurance coverage are more likely to discontinue obstetric practice than physicians experiencing lower levels of increases in liability insurance charges.
Methods:
We performed a physician-level analysis of factors predicting discontinuation of hospital-based obstetric practice by 1989 for physicians active in obstetrics in 1980. We examined both physicians who became completely clinically inactive in New York between 1980 and 1989, and physicians who remained clinically active but restricted their hospital practice to areas other than obstetrics. Multiple logistic regression models were used to analyze predictors of discontinuation of obstetrics, including regional malpractice insurance charges, physician characteristics, and practice characteristics.
Results:
Although increases in malpractice insurance charges differed considerably among regions within New York State, there was no association between level of increase of charges for liability insurance and discontinuation of obstetric practice. A greater number of years since medical licensure was associated both with complete discontinuation of hospital practice in New York and selective discontinuation of obstetrical practice. Compared with obstetrician-gynecologists, family physicians were less likely to become completely clinically inactive. Among physicians who remained clinically active in hospital care, however, family physicians were less likely than obstetrician-gynecologists to continue to include obstetrics in their practice.
Conclusions:
There is no relationship between the level of increase in liability insurance premiums and the likelihood of discontinuing obstetric practice in New York. Discontinuation of obstetric practice appears to mainly reflect trends in the physician's life cycle of practice activity and in the scope of family and general practice.