title: Charges for obstetric liability insurance and discontinuation of obstetric practice in New York.
abstract: BACKGROUND
  The study objective was to determine whether New York physicians facing higher charges for obstetric liability insurance coverage are more likely to discontinue obstetric practice than physicians experiencing lower levels of increases in liability insurance charges.
  
  
  METHODS
  We performed a physician-level analysis of factors predicting discontinuation of hospital-based obstetric practice by 1989 for physicians active in obstetrics in 1980. We examined both physicians who became completely clinically inactive in New York between 1980 and 1989, and physicians who remained clinically active but restricted their hospital practice to areas other than obstetrics. Multiple logistic regression models were used to analyze predictors of discontinuation of obstetrics, including regional malpractice insurance charges, physician characteristics, and practice characteristics.
  
  
  RESULTS
  Although increases in malpractice insurance charges differed considerably among regions within New York State, there was no association between level of increase of charges for liability insurance and discontinuation of obstetric practice. A greater number of years since medical licensure was associated both with complete discontinuation of hospital practice in New York and selective discontinuation of obstetrical practice. Compared with obstetrician-gynecologists, family physicians were less likely to become completely clinically inactive. Among physicians who remained clinically active in hospital care, however, family physicians were less likely than obstetrician-gynecologists to continue to include obstetrics in their practice.
  
  
  CONCLUSIONS
  There is no relationship between the level of increase in liability insurance premiums and the likelihood of discontinuing obstetric practice in New York. Discontinuation of obstetric practice appears to mainly reflect trends in the physician's life cycle of practice activity and in the scope of family and general practice.
authors.affiliation: Primary Care Research Center, University of California, San Francisco 94143-1364, USA.
authors.forename: K
authors.initials: K
authors.lastname: Grumbach
authors.forename: K
authors.initials: K
authors.lastname: Vranizan
authors.forename: D
authors.initials: D
authors.lastname: Rennie
authors.forename: H S
authors.initials: HS
authors.lastname: Luft
mesh_terms: D003365:Costs and Cost Analysis; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005194:Family Practice; D005260:Female; D006176:Gynecology; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007351:Insurance, Liability / Q000191:economics*; D009518:New York; D009774:Obstetrics / Q000191:economics; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D000078329:Workforce