title: Professional liability issues and practice patterns of obstetric providers in Washington State.
abstract: OBJECTIVE
  To describe recent changes in obstetric practice patterns and liability insurance premium costs and their consequences to Washington State obstetric providers (obstetrician-gynecologists, family physicians, certified nurse midwives, licensed midwives).
  
  
  METHODS
  All obstetrician-gynecologists, rural family physicians, certified nurse midwives, licensed midwives, and a simple random sample of urban family physicians were surveyed about demographic and practice characteristics, liability insurance characteristics, practice changes and limitations due to liability insurance issues, obstetric practices, and obstetric practice environment changes.
  
  
  RESULTS
  Fewer family physicians provide obstetric services than obstetrician-gynecologists, certified nurse midwives, and licensed midwives. Mean liability insurance premiums for obstetric providers increased by 61% for obstetrician-gynecologists, 75% for family physicians, 84% for certified nurse midwives, and 34% for licensed midwives from 2002 to 2004. Providers' most common monetary responses to liability insurance issues were to reduce compensation and to raise cash through loans and liquidating assets. In the 2 years of markedly increased premiums, obstetrician-gynecologists reported increasing their cesarean rates, their obstetric consultation rates, and the number of deliveries. They reported decreasing high-risk obstetric procedures during that same period.
  
  
  CONCLUSIONS
  Liability insurance premiums rose dramatically from 2002 to 2004 for Washington's obstetric providers, leading many to make difficult financial decisions. Many obstetric providers reported a variety of practice changes during that interval. Although this study's results do not document an impending exodus of providers from obstetric practice, rural areas are most vulnerable because family physicians provide the majority of rural obstetric care and are less likely to practice obstetrics.
  
  
  METHODS
  III.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Benedetti
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
authors.forename: Susan M
authors.initials: SM
authors.lastname: Skillman
authors.forename: C Holly A
authors.initials: CH
authors.lastname: Andrilla
authors.forename: Elise
authors.initials: E
authors.lastname: Bowditch
authors.forename: Katherine Camacho
authors.initials: KC
authors.lastname: Carr
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Myers
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data; D005194:Family Practice / Q000191:economics; D005249:Fees and Charges / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007351:Insurance, Liability / Q000191:economics*; D008875:Middle Aged; D009721:Nurse Midwives / Q000191:economics; D009774:Obstetrics / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D019035:Rural Health Services / Q000191:economics; D014481:United States; D014861:Washington