title: Malpractice burden, rural location, and discontinuation of obstetric care: a study of obstetric providers in Michigan.
abstract: BACKGROUND
  It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis.
  
  
  OBJECTIVE
  This study examined whether higher malpractice burden on obstetric providers was associated with an increased likelihood of discontinuing obstetric care and whether there were rural-urban differences in the relationship.
  
  
  METHODS
  Data on 500 obstetrician-gynecologists and family physicians who had provided obstetric care at some point in their career (either currently or previously) were obtained from a statewide survey in Michigan. Statistical tests and multivariate regression analyses were performed to examine the interrelationship among malpractice burden, rural location, and discontinuation of obstetric care.
  
  
  RESULTS
  After adjusting for other factors that might influence a physician's decision about whether to stop obstetric care, our results showed no significant impact of malpractice burden on physicians' likelihood to discontinue obstetric care. Rural-urban location of the practice did not modify the nature of this relationship. However, family physicians in rural Michigan had a nearly 4-fold higher likelihood of withdrawing obstetric care when compared with urban family physicians.
  
  
  CONCLUSIONS
  The higher likelihood of rural family physicians to discontinue obstetric care should be carefully weighed in future interventions to preserve obstetric care supply. More research is needed to better understand the practice environment of rural family physicians and the reasons for their withdrawal from obstetric care.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan 48109, USA. xiaox@med.umich.edu
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Siefert
authors.forename: Peter D
authors.initials: PD
authors.lastname: Jacobson
authors.forename: Jody R
authors.initials: JR
authors.lastname: Lori
authors.forename: Iana
authors.initials: I
authors.lastname: Gueorguieva
authors.forename: Scott B
authors.initials: SB
authors.lastname: Ransom
mesh_terms: D000328:Adult; D000368:Aged; D002322:Career Mobility; D005194:Family Practice / Q000191:economics / Q000331:legislation & jurisprudence*; D005260:Female; D006176:Gynecology / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D007351:Insurance, Liability; D016365:Liability, Legal / Q000191:economics*; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008824:Michigan; D008875:Middle Aged; D015999:Multivariate Analysis; D009774:Obstetrics / Q000191:economics / Q000331:legislation & jurisprudence*; D011216:Practice Management, Medical / Q000191:economics / Q000639:trends*; D011247:Pregnancy; D011365:Professional Practice Location / Q000191:economics / Q000331:legislation & jurisprudence; D012044:Regression Analysis; D012306:Risk; D019035:Rural Health Services / Q000600:supply & distribution; D019037:Urban Health Services / Q000600:supply & distribution; D000078329:Workforce