More ob-gyns changing practice because of liability insurance rates, fear of claims

Results are in from the 2006 ACOG Survey on Professional Liability, covering the period

2003 through 2005.  This latest survey reflects a continuing negative trend in practice changes in that almost 70% (69.8%) of ob-gyn survey respondents have made one or more changes to their practice as a result of the affordability and/or availability of professional liability insurance, and almost 65% (64.6%) have made one or more changes to their practice as a result of the risk or fear of professional liability claims or litigation.

National Summary

District I

District II

District III

District IV

District V

District VI

District VII

District VIII

District IX

Florida

Obstetric practice changes

Of the survey respondents who reported making changes to their obstetric practice as a result of the risk or fear of professional liability claims or litigation, 37.1% reported they increased the number of Cesarean deliveries, 33.1% decreased the number of high-risk obstetric patients, and 32.7% indicated they stopped performing or offering VBACs.  Additionally, 14.5% decreased the number of total deliveries, and 8.3% stopped practicing obstetrics altogether.

Gynecologic practice changes

Of all ob-gyns who reported making changes in their gynecologic practice due to the risk or fear of professional liability claims or litigation, 16.4% decreased gynecologic surgical procedures.  An additional 4.9% stopped performing major gynecologic surgery, and 2.1% stopped performing all surgery.

Business and finance changes

Relative to changes in business or finance, 20.4% of all ob-gyn respondents reported they had liquidated holdings, accessed savings, or secured a loan to fund liability insurance premium increases.

Claims experience

A total of 89.2% of respondents indicated they had at least one professional liability claim filed against them during their professional careers, or an average of 2.62 claims per ob-gyn.  Of these, 37.3% reported they experienced at least one professional liability claim filed against them as a result of care rendered during their residency training.

Top Ob allegations

• Neurologically-impaired infant  (30.8%)
• Stillbirth/neonatal death  (15.8%)
• Other infant injury - major  (10.0%)

Top Gyn allegations

• Delay-in or failure-to-diagnose  (28.8%)
• Patient injury-major  (22.8%)
• Patient injury-minor  (19.4%

Physician demographics

The majority of survey respondents were male (56.9%).   The average age of survey respondents was 48.5 years. 

2006 Survey

The 2006 Survey on Professional Liability is the ninth survey conducted by the American College of Obstetricians and Gynecologists since 1983 to assess the effects that professional liability litigation and related liability insurance issues are having on the practice of obstetrics and gynecology.  For the first time, the entire population of ACOG Fellows and Junior Fellows in practice in the 50 states, the District of Columbia, and Puerto Rico were surveyed using a combination of online and mailed questionnaires.  Junior Fellows still in residency, Founding Fellows, Life Fellows, members of the Armed Forces District and members living outside the 50 states, the District of Columbia, and Puerto Rico were excluded from the survey.

In total, 28,958 Fellows and Junior Fellows in practice were surveyed.  The final 10,659 completed surveys were coded and analyzed using Statistical Package for Social Sciences (SPSS).  Data analysis yielded frequency distributions and percentages for each of the survey questions.  The final data represents only those 10,659 ob-gyns who responded to the survey.

A full summary of the survey results is scheduled for publication in the March/April 2007 edition of ACOG Clinical Review.