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.
Article info
Publication history
Accepted:
February 27,
2008
Received:
July 2,
2007
Footnotes
Funded by grant number 1060.II from the Blue Cross Blue Shield of Michigan Foundation. Some preliminary work for this study was supported by the National Institutes of Health Roadmap Initiative grant number 1 P20 RR020682-01.
Identification
Copyright
© 2008 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.