CHARGES FOR OBSTETRIC LIABILITY INSURANCE AND DISCONTINUATION OF OBSTETRIC PRACTICE IN NEW-YORK

BACKGROUND. The study objective was to determine whether New York phys icians facing higher charges for obstetric liability insurance coverag e are more likely to discontinue obstetric practice than physicians ex periencing lower levels of increases in liability insurance charges, M ETHODS. We performed a physician-level analysis of factors predicting discontinuation of hospital-based obstetric practice by 1989 for physi cians active in obstetrics in 1980, We examined both physicians who be came completely clinically inactive in New York between 1980 and 1989, and physicians who remained clinically active but restricted their ho spital practice to areas other than obstetrics, Multiple logistic regr ession models were used to analyze predictors of discontinuation of ob stetrics, including regional malpractice insurance charges, physician characteristics, and practice characteristics. RESULTS. Although incre ases in malpractice insurance charges differed considerably among regi ons within New York State, there was no association between level of i ncrease of charges for liability insurance and discontinuation of obst etric practice, A greater number of years since medical licensure was associated both with complete discontinuation of hospital practice in New York and selective discontinuation of obstetrical practice. Compar ed with obstetrician-gynecologists, family physicians were less likely to become completely clinically inactive, Among physicians who remain ed clinically active in hospital care, however, family physicians were less likely than obstetrician-gynecologists to continue to include ob stetrics in their practice. CONCLUSIONS. There is no relationship betw een the level of increase in liability insurance premiums and the like lihood of discontinuing obstetric practice in New York. Discontinuatio n of obstetric practice appears to mainly reflect trends in the physic ian's life cycle of practice activity and in the scope of family and g eneral practice.