Washington, DC -- As the negative state of the medical liability environment continues, ob-gyns across the US are forced to make changes to their practice that ultimately hurt patients, according to The American College of Obstetricians and Gynecologists' (ACOG) 2009 Survey on Professional Liability. More than 63% of ob-gyns report making changes to their practice due to the risk or fear of liability claims or litigation; 60% have made changes to their practice because liability insurance is either unavailable or unaffordable.

"This latest survey shows that the medical liability situation for ob-gyns remains a chronic crisis and continues to deprive women of all ages—especially pregnant women—of experienced ob-gyns," said Albert L. Strunk, JD, MD, ACOG deputy executive vice president. "Women's health care suffers as ob-gyns further decrease obstetric services, reduce gynecologic procedures, and are forced to practice defensive medicine.

"As the debate rages on about how best to institute health care reform, it's apparent that there is virtually no discussion addressing the need for medical liability reform. It is imperative that any changes to our current health system include meaningful federal medical liability reform," Dr. Strunk said. "The current medical liability legal system is out of control as evidenced by the fact that over half of all liability claims against ob-gyns are dropped or settled without payment on behalf of the ob-gyn."

This is the 10th liability survey conducted by ACOG since 1983. The entire membership of practicing ACOG Fellows and Junior Fellows (31,665) in all 50 states, the District of Columbia, and Puerto Rico were surveyed. For the first time, the survey questionnaire was available exclusively online.* The final data represent those 5,644 ob-gyns who responded to the survey. The survey covered respondents' practice over a three-year period, from Jan 1, 2006, through Dec 31, 2008.

According to the survey, ob-gyns continue to decrease their number of high-risk obstetric patients and decrease gynecologic surgical procedures. About 8% of survey respondents reported that they had stopped practicing obstetrics altogether.

Highlights from ACOG's 2009 Survey on Professional Liability

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, 30% decreased the number of high-risk obstetric patients that they accepted. In addition, 29% reported performing more cesarean deliveries, and 25.9% stopped offering/performing vaginal births after cesarean (VBACs). An additional 13.9% decreased the number of total deliveries.

		2006		2009
Decreased the number of high-risk obstetric patients		33%		30%
Stopped offering/performing VBACs		33%		26%
Increased the number of cesareans		37%		29%
Decreased the number of deliveries		15%		14%
No longer practicing obstetrics		8%		8%

Gynecologic practice changes
Of those ob-gyns who reported making changes to their gynecologic practice as a result of the risk or fear of professional liability claims or litigation, 15% decreased gynecologic surgical procedures. Furthermore, just over 5% stopped performing major gynecologic surgery, and 2% stopped performing all surgery.

		2006		2009
Decreased gynecologic surgical procedures performed		16%		15%
No longer doing major gynecologic surgery		5%		5%
Stopped performing all surgery		2%		2%

Claims experience
Nearly 91% of ob-gyns indicated they had experienced at least one liability claim filed against them during their professional careers, for an average of 2.69 claims per physician. Sixty-two percent of the total reported claims were for obstetric care, and 38% were for gynecologic care. Of those who reported claims at some point during their career, nearly 43% reported at least one claim filed against them was a result of care rendered during their residency training.

		2006		2009
At least one liability claim filed against them during their career		89%		91%
Percentage of total claims for obstetric care		62%		62%
Percentage of total claims for gynecologic care		38%		38%
Percentage of at least one claim filed against them during residency training		37%		43%

There were a total of 2,796 reported claims against survey respondents that were opened and/or closed during the 2006-08 time period. Of those ob-gyns reporting any claim against them, 45% had one or more claim against them; 29% had one claim; 12% had two claims; 3% had three claims; and 1% had four or more claims. Out of the total number of claims, 62% (1,736) involved obstetric care and 38% (1,060) were related to gynecologic care.

Ob Claims-Primary Allegations
		2006		2009
Neurologically impaired infant		31%		31%
Stillbirth/neonatal death		16%		16%
Delay in/failure to diagnose		14%		11%

Gyn Claims-Primary Allegations
		2006		2009
Major patient injury		23%		27%
Delay in/failure to diagnose		29%		24%
Minor patient injury		19%		17%

Claim Outcomes
Out of the 1,698 ob-gyn survey respondents who indicated how their claims were closed, just over half (53%) were reported dropped or settled without any payment on behalf of the ob-gyn. Of this 53%, 37% were dropped by the plaintiff, 12% were dismissed by the court, and 4% were settled without payment on behalf of the ob-gyn. Of the remaining 47% that did involve payment, 31% were settled in advance of trial or before verdict, 3% were settled through arbitration or other alternative dispute resolutions, and 13% were closed through a jury or court verdict.

Survey Respondent Demographics
Just over half of all survey respondents were male (53%). The average age of the survey respondents was 49.2 years. The majority of respondents were in group practice (52%), followed by solo practice (22%), hospital setting (12%), and teacher/faculty (10%). Of the total ob-gyns surveyed, 46% practiced in a suburban setting, 39% were in urban settings, and 15% were in rural settings. Nearly 3 out of 4 (74.3%) respondents provided both obstetric and gynecologic care. Ob-gyns that provided only gynecologic care represented 19% of respondents; 6% of ob-gyns provided only obstetric care.

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*Comparisons to results from ACOG's last survey in 2006 should be made with caution because that survey was available in both paper and electronic format.