title: The changing face of access to family physician services in rural Florida.
abstract: OBJECTIVE
  This study's purpose was to determine whether access to services performed by Florida family physicians in rural areas is changing and whether the recent changes in the availability or cost of professional liability insurance may be influencing service provision.
  
  
  METHODS
  We conducted a survey of all family physicians in rural Florida, asking about changes in health care services and procedures provided, insurance coverage and premiums, satisfaction with practice, and plans for future practice.
  
  
  RESULTS
  Of the 204 respondents, 96 (49.5%) indicated that they have decreased or eliminated some health care services during the last year. Overall, 69.8% decreased or eliminated vaginal deliveries, 66.2% Cesarean sections, 56.6% endoscopies, 50.9% hospital-based surgeries, 50.7% emergency room coverage, 40.8% office-based surgeries, and 33.6% mental health services. Malpractice premiums increased a mean of 98.5%. Difficulty with finding or paying for insurance was listed as an important factor both by those reducing or eliminating services and by those planning to leave the community within the next 2 years.
  
  
  CONCLUSIONS
  Access to some services provided by family physicians in rural areas is decreasing and may be influenced by recent changes in professional liability insurance costs and other factors in Florida. Given the number of states currently experiencing similar insurance cost changes, access to health care in rural areas may be affected nationwide.
authors.affiliation: Division of Health Affairs, Florida State University, 1269 West Call Street, Tallahassee, FL 32306, USA. Nir.Menachemi@med.fsu.edu
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
authors.forename: Curtis
authors.initials: C
authors.lastname: Stine
authors.forename: Art
authors.initials: A
authors.lastname: Clawson
authors.forename: Robert G
authors.initials: RG
authors.lastname: Brooks
mesh_terms: D000328:Adult; D000368:Aged; D005194:Family Practice / Q000592:standards*; D005260:Female; D005431:Florida; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010821:Physicians, Family / Q000592:standards; D019035:Rural Health Services / Q000592:standards* / Q000706:statistics & numerical data; D013997:Time Factors