The high cost of malpractice insurance for some medical specialties affects not only how many doctors are entering the field of obstetrics and gynecology, but also where they offer their widely needed obstetric, prenatal and gynecological care, according to new University of Michigan Health System research.
Their study, published in the June issue of the journal Obstetrics & Gynecology, gives a foreboding prognosis for the supply of doctors specializing in the field because of the rising costs of malpractice premiums.
"The high cost of malpractice premiums is beginning to lead providers to drop or reduce obstetrical services. Our study presented evidence that high malpractice premiums affect where new obstetricians are locating and it may affect the supply in the future," says Scott B. Ransom, D.O., M.B.A., M.P.H., associate professor of obstetrics and gynecology at the U-M Medical School and of health management and policy at the U-M School of Public Health, and the senior author of the paper.
"Our study shows that there is legitimate reason for concern about patients' access to obstetric care and prenatal care in the future," he says.
Some of the potential problem areas include states with the highest malpractice premiums, including Florida, Nevada, Michigan, New York, and the District of Columbia. Researchers also found signs for problematic future supply of obstetricians in several counties containing populous cities, such as Dade County, Fla., Wayne County, Mich., and Cook County, Ill., which all have high costs of malpractice insurance.
Ransom says he hopes that this study and others dealing with similar issues can inspire policy changes and tort reform that help reign in the cost of liability insurance for obstetrics/gynecology and other fields.
"Something has to be done about the skyrocketing cost of malpractice premiums in our field," says Ransom, also the director of women's health and gynecology at the Ann Arbor VA Healthcare Center and director of the U-M Program for Healthcare Improvement and Leadership Development. "We are going to lose some of the best and brightest young doctors who otherwise might enter this field, and we are going to face shortages in many areas of the country if something isn't done."
The researchers compared the rates of births per fellow and junior fellow members of the American College of Obstetricians and Gynecologists (ACOG) in states that have the highest cost of malpractice insurance and states at the other end of the spectrum.
They found that the rate of increase in births-per-junior fellow in the 10 highest-premium states was far greater (a median of 28.5 percent) than the rate of increase in the 10 lowest-premium states (a median of 5 percent) from 1995 to 2002. That indicates that the supply of obstetricians is not keeping up with the need for doctors in this specialty in the highest-premium states, says lead author Pamela Robinson, M.B.A., a student at the U-M Medical School.
The researchers also found that in general, most counties in the United States experienced decreases in the number of births per ob/gyn, indicating an improvement in the supply of doctors in the field. But they also found that the six highest-premium counties had a slightly lower rate of decrease in births per ob-gyn than the other counties in the nation. While not statistically significant, this result could hint at a worse situation in meeting the ob/gyn needs in these areas.
Malpractice insurance premiums vary widely from state to state. Florida is the highest-premium state, with an average 2004 premium of more than $195,000, followed by Nevada, Michigan, the District of Columbia, Ohio, Massachusetts, West Virginia, Connecticut, Illinois and New York.
The 10 lowest-premium states are Oklahoma, at about $17,000 on average, and Nebraska, South Dakota, Minnesota, Indiana, Idaho, North Dakota, Wisconsin, Arkansas and South Carolina.