"More than 63 percent of ob-gyns report making changes to their practice due to the risk or fear of liability claims or litigation; 60 percent have made changes to their practice because liability insurance is either unavailable or unaffordable," said ACOG in a press release about the survey results.
Because of the risk or the fear of being sued, ACOG said, 30 percent of ob/gyns have reduced the number of high-risk obstetric patients they take; 26 percent have stopped doing vaginal deliveries after a woman has had a caesarian section; 29 percent have increased the number of caesarians they do; 14 percent have decreased their overall number of deliveries; and 8 percent have dropped obstetrics from their practices. Of physicians who reported making changes to their gynecologic practice, 15 percent had decreased gyn surgical procedures and 2 percent had stopped doing any gyn surgery.
Ob/gyns have a good reason to be afraid. Malpractice claims have been filed against 91 percent of them at some point in their career. (The average is 2.69 claims per ob/gyn.) Of the total number of claims, 62 percent involved obstetrical work and the rest were related to gyn procedures. Just over half of those claims were dropped or settled without a payment by the ob/gyn.
The numbers in this survey, which covered the years 2006-2009, did not change markedly from the beginning to the end of the survey period. But Albert Strunk, deputy executive vice president of ACOG, noted that there has been a tremendous shift in ob/gyn practices over a longer period. "Forty-eight is now the median age when OB's stop doing deliveries," he told Fierce Healthcare. "That was previously about the midpoint of an OB's career. It's a tremendous loss of some of our best trained and most skilled people in terms of what they bring to the care of the mother and the fetus."
Medical liability has hardly been addressed in the healthcare reform legislation that's being debated in Congress. Yet it is still a crisis for many physicians, especially ob/gyns, who are so frequently targeted yet earn less than other at-risk specialists. According to Strunk, ob/gyns' liability insurance premiums average $200,000 a year, despite the fact that overall maternal and neonatal mortality has dropped markedly in recent years.
Tort reform, the longtime rallying cry of medical societies, has long been opposed by consumer and attorney groups. But ob/gyns need some relief, and we need ob/gyns-not only to deliver babies, but also to serve as primary-care physicians for the many women who depend on them. It's also worth noting that, partly because of the liability risk of ob/gyns, the caesarian section rate in this country is far higher than it is anywhere else. For this and other reasons, tort reform would be a good way to start reducing health costs.