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


      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.


      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.


      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.


      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American Medical Association (AMA)
        Medical liability crisis map.
        (Accessed February 6, 2007)
        • Baldwin L.M.
        • Hart L.G.
        • Lloyd M.
        • Fordyce M.
        • Rosenblatt R.A.
        Defensive medicine and obstetrics.
        Journal of the American Medical Association. 1995; 274: 1606-1610
        • Becker J.L.
        • Milad M.P.
        • Klock S.C.
        Burnout, depression, and career satisfaction: Cross-sectional study of obstetrics and gynecology residents.
        American Journal of Obstetrics and Gynecology. 2006; 195: 1444-1449
        • Bettes B.A.
        • Strunk A.L.
        • Coleman V.H.
        • Schulkin J.
        Professional liability and other career pressures: Impact on obstetrician-gynecologists' career satisfaction.
        Obstetrics and Gynecology. 2004; 103: 967-973
        • Buchbinder S.B.
        • Wilson M.
        • Melick C.F.
        • Powe N.R.
        Primary care physician job satisfaction and turnover.
        American Journal of Managed Care. 2001; 7: 701-713
        • Bhat V.N.
        Medical malpractice: A comprehensive analysis.
        Auburn House, Westport, CT2001
        • Center for Studying Health System Change
        Community Tracking Study Physician Survey, 2004–2005.
        ([UNITED STATES] [Computer file]. ICPSR version) Center for Study Health System Change, Washington, DC2006
        • Cypel Y.S.
        • Sunshine J.H.
        • Ellenbogen P.H.
        The current medical liability insurance crisis: Detailed findings from two ACR surveys in 2003 and 2004.
        Journal of the American College of Radiology. 2005; 2: 595-601
        • DiMatteo M.R.
        • Sherbourne C.D.
        • Hays R.D.
        • Ordway L.
        • Kravitz R.L.
        • McGlynn E.A.
        • et al.
        Physicians' characteristics influence patients' adherence to medical treatment: Results from the Medical Outcomes Study.
        Health Psychology. 1993; 12: 93-102
        • Dubay L.
        • Kaestner R.
        • Waidmann T.
        The impact of malpractice fears on cesarean section rates.
        Journal of Health Economics. 1999; 18: 491-522
        • Freeborn D.K.
        Satisfaction, commitment, and psychological well-being among HMO physicians.
        Western Journal of Medicine. 2001; 174: 13-18
        • Glymour M.M.
        • Saha S.
        • Bigby J.
        Physician race and ethnicity, professional satisfaction, and work-related stress: Results from the Physician Worklife Study.
        Journal of the National Medical Association. 2004; 96: 1283-1289
        • Grant D.
        • McInnes M.M.
        Malpractice experience and the incidence of cesarean delivery: A physician-level longitudinal analysis.
        Inquiry. 2004; 41: 170-188
        • Grol R.
        • Mokkink H.
        • Smits A.
        • van Eijk J.
        • Beek M.
        • Mesker P.
        • et al.
        Work satisfaction of general practitioners and the quality of patient care.
        Family Practice. 1985; 2: 128-135
        • Grumbach K.
        • Vranizan K.
        • Rennie D.
        • Luft H.S.
        Charges for obstetric liability insurance and discontinuation of obstetric practice in New York.
        Journal of Family Practice. 1997; 44: 61-70
        • Haas J.S.
        • Cook E.F.
        • Puopolo A.L.
        • Burstin H.R.
        • Cleary P.D.
        • Brennan T.A.
        Is the professional satisfaction of general internists associated with patient satisfaction?.
        Journal of General Internal Medicine. 2000; 15: 122-128
        • Hadley J.
        • Mitchell J.M.
        The growth of managed care and changes in physicians' incomes, autonomy, and satisfaction, 1991–1997.
        International Journal of Health Care Finance and Economics. 2002; 2: 37-50
        • Kahn R.L.
        • Byosiere P.
        Stress in organizations.
        in: Dunnette M.D. Hough L.M. Handbook of industrial and organizational psychology. 2nd ed. Consulting Psychologist Press, Palo Alto, CA1992: 571-650
        • Konrad T.R.
        • Williams E.S.
        • Linzer M.
        • McMurray J.
        • Pathman D.E.
        • Gerrity M.
        • et al.
        Measuring physician job satisfaction in a changing workplace and a challenging environment.
        Medical Care. 1999; 37: 1174-1182
        • Kravitz R.L.
        • Leigh J.P.
        • Samuels S.J.
        • Schembri M.
        • Gilbert W.M.
        Tracking career satisfaction and perceptions of quality among US obstetricians and gynecologists.
        Obstetrics and Gynecology. 2003; 102 (463–370)
        • Landon B.E.
        • Aseltine Jr, R.
        • Shaul J.A.
        • Miller Y.
        • Auerbach B.A.
        • Cleary P.D.
        Evolving dissatisfaction among primary care physicians.
        American Journal of Managed Care. 2002; 8: 890-901
        • Landon B.E.
        • Reschovsky J.
        • Blumenthal D.
        Changes in career satisfaction among primary care and specialist physicians, 1997-2001.
        Journal of the American Medical Association. 2003; 289: 442-449
        • Landon B.E.
        • Reschovsky J.D.
        • Pham H.H.
        • Blumenthal D.
        Leaving medicine: The consequences of physician dissatisfaction.
        Medical Care. 2006; 44: 234-242
        • Larimore W.L.
        • Sapolsky B.S.
        Maternity care in family medicine: Economics and malpractice.
        Journal of Family Practice. 1995; 40: 153-160
        • Leigh J.P.
        • Kravitz R.L.
        • Schembri M.
        • Samuels S.J.
        • Mobley S.
        Physician career satisfaction across specialties.
        Archives of Internal Medicine. 2002; 162: 1577-1584
        • Linn L.S.
        • Brook R.H.
        • Clark V.A.
        • Davies A.R.
        • Fink A.
        • Kosecoff J.
        Physician and patient satisfaction as factors related to the organization of internal medicine group practices.
        Medical Care. 1985; 23: 1171-1178
        • Linzer M.
        • Konrad T.R.
        • Douglas J.
        • McMurray J.E.
        • Pathman D.E.
        • Williams E.S.
        • et al.
        Managed care, time pressure, and physician job satisfaction: Results from the physician worklife study.
        Journal of General Internal Medicine. 2000; 15: 441-450
        • Mechanic D.
        Physician discontent: Challenges and opportunities.
        Journal of the American Medical Association. 2003; 290: 941-946
        • Mello M.M.
        Medical malpractice: Impact of the crisis and effect of state tort reforms.
        Date: 2006
        (Accessed February 26, 2007)
        • Mello M.M.
        • Studdert D.M.
        • DesRoches C.M.
        • Peugh J.
        • Zapert K.
        • Brennan T.A.
        • et al.
        Caring for patients in a malpractice crisis: Physician satisfaction and quality of care.
        Health Affairs (Millwood). 2004; 23: 42-53
        • Melville A.
        Job satisfaction in general practice: implications for prescribing.
        Social Science & Medicine [Med Psychol Med Sociol]. 1980; 14A: 495-499
        • Pathman D.
        • Tropman S.
        Obstetrical practice among new rural family physicians.
        Journal of Family Practice. 1995; 40: 457-464
        • Pathman D.E.
        • Konrad T.R.
        • Williams E.S.
        • Scheckler W.E.
        • Linzer M.
        • Douglas J.
        Physician job satisfaction, dissatisfaction, and turnover.
        Journal of Family Practice. 2002; 51: 593
        • Perloff J.D.
        • Kletke P.
        • Fossett J.W.
        Which physicians limit their Medicaid participation, and why.
        Health Services Research. 1995; 30: 7-26
        • Rodwin M.A.
        • Chang H.J.
        • Clausen J.
        Malpractice premiums and physicians' income: Perceptions of a crisis conflict with empirical evidence.
        Health Affairs (Millwood). 2006; 25: 750-758
        • Studdert D.M.
        • Mello M.M.
        • Gawande A.A.
        • Gandhi T.K.
        • Kachalia A.
        • Yoon C.
        • et al.
        Claims, errors, and compensation payments in medical malpractice litigation.
        New England Journal of Medicine. 2006; 354: 2024-2033
        • Thommasen H.V.
        • Lavanchy M.
        • Connelly I.
        • Berkowitz J.
        • Grzybowski S.
        Mental health, job satisfaction, and intention to relocate.
        Canadian Family Physician. 2001; 47: 737-744
        • Viisainen K.
        The moral dangers of home birth: parents' perceptions of risks in home birth in Finland.
        Sociology of Health & Illness. 2000; 22: 792-814
        • Weeks W.B.
        • Wallace A.E.
        Time and money: A retrospective evaluation of the inputs, outputs, efficiency, and income of physicians.
        Archives of Internal Medicine. 2003; 163: 944-948
        • Williams E.S.
        • Konrad T.R.
        • Linzer M.
        • McMurray J.
        • Pathman D.E.
        • Gerrity M.
        • et al.
        Refining the measurement of physician job satisfaction: Results from the Physician Worklife Survey.
        Medical Care. 1999; 37: 1140-1154
        • Williams E.S.
        • Konrad T.R.
        • Scheckler W.E.
        • Pathman D.E.
        • Linzer M.
        • McMurray J.E.
        • et al.
        Understanding physicians' intentions to withdraw from practice: The role of job satisfaction, job stress, mental and physical health.
        Health Care Management Review. 2001; 26: 7-19
        • Zuger A.
        Dissatisfaction with medical practice.
        New England Journal of Medicine. 2004; 350: 69-75


      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.


      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.


      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.


      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.


      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.