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The Impact of Malpractice Burden on Michigan Obstetrician-Gynecologists' Career Satisfaction

      Background

      Medical services for pregnancy and childbirth are inherently risky and unpredictable. In many states, obstetrician-gynecologists (OB-GYNS) who attend the majority of childbirths in the United States and provide the most clinically complex obstetric procedures are struggling with increasing malpractice insurance premiums and litigation risk. Despite its significant implications for patient care, the potential impact of malpractice burden on OB-GYN physicians' career satisfaction has not been rigorously tested in previous research.

      Methods

      Drawing on data from a statewide survey of obstetric providers in Michigan, this paper examined the association between medical liability burden and OB-GYNs' career satisfaction. Malpractice insurance premiums and malpractice claims experience were used as 2 objective measures for medical liability burden. Descriptive statistics were calculated and multivariable logistic regressions estimated for data analysis.

      Results

      Although most respondents reported satisfaction with their overall career in medicine, 43.7% had become less satisfied over the last 5 years and 34.0% would not recommend obstetrics/gynecology to students seeking career advice. Multivariable regression analysis showed that compared to coverage through an employer, paying ≥$50,000/year for liability insurance premium was associated with lower career satisfaction among OB-GYNs (odds ratio, 0.35; 95% confidence interval, 0.13–0.93). We found no significant impact of malpractice claims experience, including both recent malpractice claims (during the last 5 years [2001–2006]) and earlier malpractice claims (>5 years ago), on overall career satisfaction.

      Conclusions

      The findings of this study suggest that high malpractice premiums negatively affect OB-GYN physicians' career satisfaction. The impact of the current medical liability climate on quality of care for pregnant women warrants further investigation.
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      Biography

      Xiao Xu, PhD, is a research investigator in the Department of Obstetrics and Gynecology, University of Michigan. Her research focuses on the improvement of health care access and quality of care.

      Biography

      Kristine A. Siefert, PhD, MPH, is a professor of social work at the University of Michigan School of Social Work. Her research focuses on women's health, maternal and child health, and health disparities.

      Biography

      Peter D. Jacobson, JD, MPH, is a professor of health law and policy in the Department of Health Management and Policy, University of Michigan School of Public Health. His research focuses on the relationship between law and health care delivery and policy, law and public health systems, and health care safety net services.

      Biography

      Jody R. Lori, CNM, MS, is a lecturer IV in the nurse-midwifery program at the University of Michigan School of Nursing and a doctoral student at the University of Arizona, Tucson. Her research focuses on health disparities and improving women's health care.

      Biography

      Scott B. Ransom, DO, MBA, MPH, is a professor in obstetrics, gynecology, and health management and policy at the University of North Texas Health Science Center. His research focuses on women's health, health disparities, and improvement of health care delivery system.