title: The impact of medical legal risk on obstetrician-gynecologist supply.
abstract: OBJECTIVE
  To evaluate the effects of medical legal risk on practice location of obstetrician-gynecologists.
  
  
  METHODS
  We used the American College of Obstetricians and Gynecologists (ACOG) Membership Record to determine the number of Fellows and Junior Fellows by state. We obtained state malpractice premiums from the Medical Liability Monitor and state birth rates from the National Center for Health Statistics. The American Medical Association (AMA) "Crisis" and ACOG "Red Alert" designations, as well as state malpractice premium levels, were used to approximate malpractice risk. We examined the changes in state births to obstetrician-gynecologist rates from 1995 to 2003 by using the Student t test and Mann-Whitney tests. Comparisons were made between states of different risk levels.
  
  
  RESULTS
  We found no significant difference in the percentage changes in births per Fellow or births per Junior Fellow between AMA "Crisis" and remaining states, nor between ACOG "Red Alert" and Safe states. The percentage changes in births per Fellow were similar in the 10 highest-premium states and the 10 lowest-premium states. The percentage increase in births per Junior Fellow in the 10 highest-premium states was significantly greater than the 10 lowest-premium states (median 28.5% versus 5.0%, P = .03).
  
  
  CONCLUSIONS
  Malpractice premiums appear to influence practice location of new obstetrician-gynecologists. Neither the AMA designation of "Crisis" nor the ACOG designation of "Red Alert" had supply implications in the analysis. More research on the interaction of malpractice rates and obstetrician-gynecologist supply is needed for informed decisions regarding malpractice premium management.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan 48109, USA. sransom@med.umich.edu
authors.forename: Pamela
authors.initials: P
authors.lastname: Robinson
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.forename: Kristie
authors.initials: K
authors.lastname: Keeton
authors.forename: Dee
authors.initials: D
authors.lastname: Fenner
authors.forename: Timothy R B
authors.initials: TR
authors.lastname: Johnson
authors.forename: Scott
authors.initials: S
authors.lastname: Ransom
mesh_terms: D001723:Birth Rate; D006176:Gynecology; D006801:Humans; D007231:Infant, Newborn; D007351:Insurance, Liability / Q000191:economics* / Q000706:statistics & numerical data*; D009774:Obstetrics; D014481:United States; D000078329:Workforce