The Effect of Malpractice Liability on the Delivery of Rural Obstetrical Care*

Gordon, Rena J.; McMullen, G; Weiss, Barry D.; Nichols, Andrew W.

doi:10.1111/j.1748-0361.1987.tb00153.x

Cited by 16 publications

(8 citation statements)

References 1 publication

(1 reference statement)

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“…A number of studies in the 1980s focused exclusively on the role of medical malpractice in physicians' obstetrical care practice decisions (Calonge, 1988;Chappell, Cianciolo, Harris, & Denton, 1990;Fondren & Ricketts, 1993;Gordon, et al, 1987;Greer, et al, 1992;Kruse, et al, 1989;Langholz & Ricketts, 1989, Nesbitt, Scherger, & Tanji, 1992. The results of later studies suggest that a combination of professional and personal reasons may influence these decisions (Nesbitt, Connell, Hart, & Rosenblatt, 1991;Nolan, 1990;Rosenblatt, et al, 1990;OTA, 1990).…”

mentioning

confidence: 99%

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

Yawn¹,

Wellever²,

Hartley³

et al. 1995

The Journal of Rural Health

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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.

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mentioning

confidence: 99%

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

Yawn¹,

Wellever²,

Hartley³

et al. 1995

The Journal of Rural Health

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“…2,[9][10][11] A large body of literature from the 1980s and 1990s documented a decline in the provision of maternity care by family physicians. 1,2,[10][11][12][13][14][15][16][17] Even though more recent evidence is sparse, the available evidence suggests that this decline has persisted. Data from the American Academy of Family Physicians indicates that in 1986, 43% of responding family physicians performed deliveries compared with 28% of respondents in 2006, although interpretation of these data are limited by a variable response rate.…”

Section: Introductionmentioning

confidence: 99%

Declining Trends in the Provision of Prenatal Care Visits by Family Physicians

Cohén¹,

Coco²

2009

The Annals of Family Medicine

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PURPOSE We wanted to measure trends in the proportion of prenatal visits provided by family physicians nationally for a 10-year period and determine characteristics of prenatal visits made to family physicians compared with visits made to obstetricians. METHODSWe analyzed the National Ambulatory Medical Care Survey to identify prenatal visits made to family physicians and obstetricians between 1995 and 2004. The primary outcome measure was the trend in proportion of prenatal visits seen by family physicians. Multivariate logistic regression analysis determined characteristics of a prenatal visit occurring with a family physician vs an obstetrician.RESULTS A total of 6,203 records were included in the study, representing 244 million prenatal visits. The percentage of prenatal visits provided by family physicians decreased from 11.6% in 1995-1996 to 6.1% in 2003-2004 (P = .02 for trend). In non-metropolitan statistical areas, family physicians decreased their provision of prenatal visits from 38.6% in 1995-1996 to 12.9% in 2003-2004 (P = .03 for trend). Prenatal visits made to family physicians were associated with location in a non-metropolitan statistical area (OR = 5.56; 95% CI, 3.23-9.62), Medicaid insurance (OR = 1.76; 95% CI, 1.10-2.82), and younger maternal age (aged 30 years and older vs aged less than 24 years: OR = 0.63; 95% CI, 0.41-0.95).CONCLUSIONS Family physicians reduced their provision of prenatal visits by nearly 50% during a 10-year period and at an even greater rate in rural, non-metropolitan statistical areas. These fi ndings should be considered as family medicine considers the role of maternity care and strives to provide accessible prenatal services for all. INTRODUCTIONA ccess to maternity care for women in the United States remains a public health concern. Previous studies have established the contribution of family physicians to maternity care, particularly in rural areas.1-8 A decline in maternity care clinicians in rural communities where physicians may be in short supply has also been associated with poorer perinatal outcomes. 2,9-11A large body of literature from the 1980s and 1990s documented a decline in the provision of maternity care by family physicians. 1,2,[10][11][12][13][14][15][16][17] Even though more recent evidence is sparse, the available evidence suggests that this decline has persisted. Data from the American Academy of Family Physicians indicates that in 1986, 43% of responding family physicians performed deliveries compared with 28% of respondents in 2006, although interpretation of these data are limited by a variable response rate.18 Guirguis-Blake et al showed that family physicians decreased their contribution nationally to prenatal care from 17.3% of total visits (between 1980 and 1992) to 10.2% of visits (between 1993 and 1999

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“…The worsening medical liability milieu has been suggested as a substantial contributor to the increasing attrition from obstetrics in multiple studies, [18][19][20][21] although some studies have disputed this association. 22,23 Our study's fi ndings support this concern, as between one-half and three-quarters of those physicians who had stopped practicing obstetrics listed some aspect of the litigation environment, including the affordability of malpractice insurance, as a contributor to their decision to quit.…”

Section: Discussionmentioning

confidence: 99%

Influence of Obstetric Practice on Workload and Practice Patterns of Family Physicians and Obstetrician-Gynecologists

Dresden¹,

Baldwin²,

Andrilla³

et al. 2008

The Annals of Family Medicine

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PURPOSE Obstetric practice among family physicians has declined in recent years. This study compared the practice patterns of family physicians and obstetrician-gynecologists with and without obstetric practices to provide objective information on one potential reason for this decline-the impact of obstetrics on physician lifestyle. METHODSIn 2004, we surveyed all obstetrician-gynecologists, all rural family physicians, and a random sample of urban family physicians identifi ed from professional association lists (N =2,564) about demographics, practice characteristics, and obstetric practices.RESULTS A total of 1,197 physicians (46.7%) overall responded to the survey (41.5% of urban family physicians, 54.7% of rural family physicians, and 55.0% of obstetrician-gynecologists). After exclusions, 991 were included in the fi nal data set. Twenty-seven percent of urban family physicians, 46% of rural family physicians, and 79% of obstetrician-gynecologists practiced obstetrics. The mean number of total professional hours worked per week was greater with obstetric practice than without for rural family physicians (55.4 vs 50.2, P = .005) and for obstetrician-gynecologists (58.3 vs 43.5, P = .000), but not for urban family physicians (47.8 vs 49.5, P = .27). For all 3 groups, physicians practicing obstetrics were more likely to provide inpatient care and take call than physicians not practicing obstetrics. Large proportions of family physicians, but not obstetriciangynecologists, took their own call for obstetrics. Concerns about the litigation environment and personal issues were the most frequent reasons for stopping obstetric practice.CONCLUSIONS Practicing obstetrics is associated with an increased workload for family physicians. Organizing practices to decrease the impact on lifestyle may support family physicians in practicing obstetrics.Ann Fam Med 2008:6(suppl 1):s5-s11.

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The Effect of Malpractice Liability on the Delivery of Rural Obstetrical Care*

Cited by 16 publications

References 1 publication

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

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

Declining Trends in the Provision of Prenatal Care Visits by Family Physicians

Influence of Obstetric Practice on Workload and Practice Patterns of Family Physicians and Obstetrician-Gynecologists

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