OB/GYNs less willing to take on risky patients, procedures

If your hospital organization continues to experience a shortage of OB/GYNs willing to take on high-risk patients or procedures, you're not alone. According to a recent survey from the American College of Obstetricians and Gynecologists (ACOG), professional liability litigation and insurance costs continue to affect the medical practices of OB/GYNs across the country.

Discussed at a forum on patient safety and medical liability in Washington, D.C., last week, the survey found that nearly 63 percent of OB/GYNs have made one or more changes to their practice because of the fear of litigation. Just less than 60 percent reported that the cost of liability insurance forced them to make practice changes.

The findings show a continued trend of impact that makes it increasingly difficult for women in many areas of the country to access some obstetrical and gynecological services. Nearly one-third of obstetricians reported that they have decreased the number of high-risk obstetric patients in their practices. One-fourth reported that they have stopped performing vaginal deliveries after c-sections (VBAC). Almost 14 percent decreased the number of deliveries and 8 percent stopped deliveries altogether, according to the 2009 survey, which covers the period from January 1, 2006 to December 31, 2008.

"Forty-eight is now the median age when OB's stop doing deliveries," said Albert Strunk, ACOG's deputy executive vice president. "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."

What's driving these doctors to change their practices? The malpractice situation in this area of medicine. OB/GYNs are among the top three specialties in the rate of medical malpractice cases--of the top three, they have the lowest reimbursement rates from payers.

"More than 90 percent of the respondents have been sued at least once," said Strunk. "One-third have been sued four or more times, and the average number of suits in a professional lifetime is between two-and-a-half and three." Meanwhile, he said, reimbursement rates for most deliveries are stagnant or even declining, making it nearly impossible for some physicians to deliver enough babies to cover the costs of insurance. "It's no wonder the current system impacts us as it does," Strunk said.

Medical malpractice insurance for OBs runs close to $200,000 annually in most states, Strunk reported. For some subspecialties, the premiums run even higher--this despite that the overall maternal and neonatal mortality rates have gone down 95 percent and neonatal mortality is down 66 percent from the 1950s.

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