title: Change in Oregon maternity care workforce after malpractice premium subsidy implementation.
abstract: OBJECTIVE
  (1) To determine the proportion of maternity care providers who continue to deliver babies in Oregon; (2) to determine the important factors relating to the decision to discontinue maternity care services; and (3) to examine how the rural liability subsidy is affecting rural maternity care providers' ability to provide maternity care services.
  
  
  METHODS
  We surveyed all obstetrical care providers in Oregon in 2002 and 2006. Survey data, supplemented with state administrative data, were analyzed for changes in provision of maternity care, reasons for stopping maternity care, and effect of the malpractice premium subsidy on practice.
  
  
  RESULTS
  Only 36.6% of responding clinicians qualified to deliver babies were actually providing maternity care in Oregon in 2006, significantly lower than the proportion (47.8%) found in 2002. Cost of malpractice premiums remains the most frequently cited reason for stopping maternity care, followed by lifestyle issues. Receipt of the malpractice subsidy was not associated with continuing any maternity services.
  
  
  CONCLUSIONS
  Oregon continues to lose maternity care providers. A state program subsidizing the liability premiums of rural maternity care providers does not appear effective at keeping rural providers delivering babies. Other policies to encourage continuation of maternity care need to be considered.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239, USA. smitsa@ohsu.edu
authors.forename: Ariel K
authors.initials: AK
authors.lastname: Smits
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: King
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Rdesinski
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Dodson
authors.forename: John W
authors.initials: JW
authors.lastname: Saultz
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005380:Financing, Government; D019538:Health Care Surveys; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D007351:Insurance, Liability / Q000191:economics*; D008297:Male; D008318:Malpractice / Q000191:economics*; D008880:Midwifery / Q000191:economics / Q000706:statistics & numerical data; D009774:Obstetrics / Q000191:economics*; D009922:Oregon; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000191:economics; D000078329:Workforce