Impact of physicians' perceptions of malpractice and adaptive changes on intention to cease obstetrical practice

Physicians who provide obstetrical care in rural areas face exposure to lia bility action and confront a critical decision-whether to continue to offer these services. This paper draws upon social-psychological and decision th eories to investigate this decision. Ninety-four percent of all obstetricia ns and family and general physicians practicing in the 12 nonmetropolitan c ounties of one state responded to it mail survey that asked about their int ention to continue or discontinue obstetrical practice, two dimensions of s ubjective risk (perceived likelihood of threats in the malpractice environm ent and perceived magnitude of negative consequences from being sued), and adaptive changes to protect against malpractice. The results suggest that ( a) perceived extent of negative consequences (but not perceived likelihood of malpractice threats) drives intention to leave obstetrics, (b) the profe ssional and reputational impacts of a suit-not the dollar amount of award o r settlement-predicts intention to stop practicing obstetrics, and (c) phys icians planning to continue providing obstetrical care in the future have m ade recent practice changes that may further exacerbate access problems.