title: Continuing decline in service delivery for family physicians: is the malpractice crisis playing a role?
abstract: OBJECTIVE
  This study was conducted to monitor trends in the reduction and elimination of services offered by family physicians. In addition, we examined whether the malpractice situation may be influencing these trends.
  
  
  METHODS
  We surveyed all family physicians in rural Florida and an equal number of randomly selected, urban, family physicians in the state. We examined changes in professional liability insurance (PLI) premiums, and changes in services offered, practice satisfaction, and future practice plans.
  
  
  RESULTS
  Overall, 308 (42.1%) family physicians responded. Results suggest that 60.3% of them reduced or eliminated services in the last year. Specifically, almost two thirds of respondents had eliminated hospital-based surgeries (65.2%) and vaginal deliveries (64.5%). Furthermore, endoscopies were decreased or eliminated by 69% of survey participants, and coverage of emergency departments and nursing homes was reduced or eliminated by 64.1% and 56.4% of respondents, respectively. Increases in the PLI averaged 78.2%. Overall increases in the PLI were significantly related to a decrease or elimination of services offered by family physicians. Dissatisfaction with practice was relatively high (36.8%) and was associated with both the reduction of services and an intention to leave practice within 2 years. No major differences in these trends were noted between rural and urban family physicians.
  
  
  CONCLUSIONS
  Access to care provided by rural and urban family physicians in Florida is being hampered by the malpractice situation and other factors. Policymakers may need to focus on these factors in an effort to relieve additional barriers to care for vulnerable populations.
authors.affiliation: Division of Health Affairs, College of Medicine, Florida State University, Tallahassee 32306, USA. Nir.menachemi@med.fsu.edu
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
authors.forename: Robert G
authors.initials: RG
authors.lastname: Brooks
authors.forename: Art
authors.initials: A
authors.lastname: Clawson
authors.forename: Curtis
authors.initials: C
authors.lastname: Stine
authors.forename: Les
authors.initials: L
authors.lastname: Beitsch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D005260:Female; D005431:Florida; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008318:Malpractice; D008875:Middle Aged; D010821:Physicians, Family; D012424:Rural Population