Impact of deliveries on the office practice of family medicine.
BACKGROUND
To prospectively evaluate the frequency of late-night deliveries and the cost of lost office hours, physicians serving mainly uninsured and Medicaid patients in an urban area established databases tracking office demographics and detailed information on each delivery.


METHODS
Time needed in the hospital during routine office hours and late night was tabulated for each delivery. Complete calendar years 2000-2003 were tabulated separately and in total. Overhead and opportunity costs were calculated using historical norms and actual costs.


RESULTS
During the study, there were 490 deliveries, with 113 (23%) occurring late at night. Physicians retrospectively self-reported an average of 2.8 hours in the hospital for the average delivery, which included 105 (21%) Cesarean deliveries. There were an average of 9.5 prenatal visits with each delivery, and 23% of deliveries occurred late at night (11 p.m.-6 a.m.). The average delivery produced a net revenue of dollar 1,339. Deliveries caused physicians to be absent from the office for 371.5 hours over the four years. After deducting opportunity cost and continuing overhead, net revenue for the 48-month study period was dollar 646,858. Ancillary revenues were beyond the scope of the study design.


CONCLUSIONS
These data suggest that delivery services in this community of urban underserved minorities can be self-supporting. This is the first study in the medical literature to provide data describing the impact of deliveries on physician practices outside of residency. Loss of physician sleep and revenue lost secondary to time away from the office were successfully measured. These data suggest that common beliefs frequently overestimate lifestyle interruptions and underestimate the financial losses of failure to deliver babies in this region. Future studies are suggested.
Rodney
W MacMillan
WM
Department of Family and Community Medicine, Meharry-Vanderbilt Alliance, Memphis, TN 38119, USA. wmrodney@aol.com
Hardison
Damion
D
Rodney-Arnold
Kelly
K
McKenzie
Larry
L
D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data*; D005194:Family Practice / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D007231:Infant, Newborn; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D010824:Physicians' Offices / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy; D011446:Prospective Studies; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data