Availability of Rural Minnesota Obstetric Services: Is It a Problem?

Abstract

In the late 1980s several published articles predicted a crisis in the availability of obstetric care due to declining numbers of rural obstetrical providers. Several state and national studies documented the adverse impact of malpractice and time demands on both urban and rural physicians. But only limited information is available to document current trends in rural obstetrical practice and assess whether or not the predicted crisis occurred. This study sought to provide that updated information for rural Minnesota. A telephone survey of all rural Minnesota obstetrical providers was used to document the number, location, and specialty of rural obstetrical providers, their practice limitations, and plans for future practice. This data was combined with state perinatal statistics for each county to further assess obstetrical care availability and perinatal outcomes. All rural Minnesota obstetricians and certified nurse midwives provide obstetrical care as did 69 percent of all rural family physicians. Only 27 percent of rural obstetrical providers put any type of restrictions on their obstetrical practices. During the past year, 67 currently practicing rural physicians have stopped providing obstetrical care while 55 new obstetrical providers have begun rural practice. Two to 3 percent of current rural providers plan to retire or discontinue obstetrical services during the next five years. The provider demographics from the survey identified eight counties with no prenatal providers, and 12 additional communities of decreased provider availability. However, only two of the counties with no prenatal providers and five of the counties with areas of limited providers had increased percentages of adverse prenatal outcomes such as low birthweight or late prenatal care. This study concluded that Minnesota does not have a serious statewide problem with availability of rural obstetrical providers. However, a few isolated regions of the state have limited provider availability, including limited availability of local high-risk services and consultants.

Malpractice Burden, Rural Location, and Discontinuation of Obstetric Care: A Study of Obstetric Providers in Michigan

“…This has led to several studies examining the influence of medical liability issues in rural areas of the U.S. with quite mixed findings. Some suggested that increasing malpractice premiums could cause a severe drop in obstetrical services,3, 17, 29 while others showed no association between malpractice insurance costs and the likelihood of providing maternity care among rural physicians 30, 31. Our study found no significant effects of malpractice claims or payment experience on obstetric providers’ odds of stopping obstetric care whether in rural or urban Michigan.…”

“…Some suggested that increasing malpractice premiums could cause a severe drop in obstetrical services, 3,17,29 whereas others showed no association between malpractice insurance costs and the likelihood of providing maternity care among rural physicians. 30,31 Our study found no significant effects of malpractice claims or payment experience on obstetric providers' odds of stopping obstetric care whether in rural or urban Michigan. However, because rules governing Estimates were reported in odds ratios (95% confidence intervals).…”

Medical malpractice in Iran: A systematic review

“…On the other hand, studies have shown that increasing the number of complaints in some medical specialties reduces the willingness of candidates to enter these disciplines (10). Due to the complexity of the health system and the fact that there is no system without any fault, the incidence of medical error is inevitable in all countries (11).…”

A systematic review and meta-analysis of valued obstetric and gynecologic (OB/GYN) procedures in resource-poor areas

“…These findings underscore the need for general surgeons or obstetricians/gynecologists to be able to train across the 2 specialties to optimally address the disparities that exist in surgical care. Many articles in this review discussed strategies to provide this type of training, including rotations for medical students in rural or low-income areas [ [77] , [78] , [79] ], residency tracts for rural or global surgery [ 23 , 28 , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] , [95] , [96] , [97] , [98] , [99] , [100] , [101] , [102] , [103] ], and training courses for general surgeons to enhance their obstetrical skills if they desire to practice in an underserved location locally or abroad [ 13 , 60 , 115 , [121] , [122] , [123] , [124] , [125] , [126] , [127] , [128] , [129] , [130] , [131] , [132] , [133] , [134] , [135] ]. Although it is challenging to provide this broad-based surgical training, sustainable models have been created when continued support is provided to those recruited locally to the area in need [ 31 ].…”