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PubMedDate not supplied

Factors influencing cessation of pregnancy care in Oregon.

BACKGROUND AND OBJECTIVES: Anecdotal evidence suggests that many providers who previously delivered babies are no longer doing so, both in Oregon and nationally. This study determined the proportion of pregnancy care providers who have stopped or are planning to stop providing this care in Oregon and identified the important factors influencing such practice changes. METHODS: We mailed a survey in October and November 2002 to all obstetrician-gynecologists, family physicians, general practitioners, and certified nurse midwives practicing in Oregon. The survey inquired about whether they currently perform deliveries. If they did not do so, or if they did so but planned to stop, further questions were asked about reasons for not providing this care. RESULTS: A total of 2,158 surveys were mailed; 1,232 were returned (58% adjusted response rate), and 1,069 had sufficient information to be included in our analysis. Of respondents, 511 (47.8%) currently perform deliveries. Of these, 157 (30.7%) indicated that they planned to stop doing so in 1 to 5 years, with cost of professional liability insurance (59%) and fear of lawsuits (43%) most frequently cited as major reasons. A total of 367 (34%) respondents had previously stopped performing deliveries. Providers who stopped providing this care since 1999 were significantly more likely to cite cost of medical liability insurance and low reimbursement as major reasons, compared to providers who stopped earlier. CONCLUSIONS: Our study suggests that as many as half of clinicians who previously performed or currently perform deliveries in Oregon are planning to stop or have already stopped providing this service, raising concern about access to pregnancy care services for women in the state.

Cross-Sectional Studies↗
PubMed2004

Perianesthetic dental injuries: analysis of incident reports.

STUDY OBJECTIVE: To conduct a retrospective analysis of incident reports concerning dental injury, the most common cause for litigation against anesthesiologists, to determine specific risk factors that will help in formulating a risk reduction strategy for this clinical problem. DESIGN: Retrospective chart review of a large professional liability insurer. INTERVENTIONS: Of 40 hospitals that report to the MRM Co. as part of the professional liability insurance, during the years 1992-1999, 18 hospitals reported dental injury. A Maxillofacial surgeon (GN) and an anesthesiologist (ES), using a structured form, reviewed the reports. Evaluation of the cost of injury was determined from the patient's claims or from an evaluation of rehabilitation plan constructed by the maxillofacial surgery consultants to the company. MEASUREMENTS AND MAIN RESULTS: There were 203 incidents due to dental injury. The patients were most commonly in their 5(th) to 7(th) decade. Eighty six percent of the injured teeth were the upper incisors. Lower incisors were more likely to be injured during an urgent intubation, or due to airway manipulation other than intubation. (i.e., oral airway insertion) In only 38 (18.6%) cases was there a previous assessment of an expected difficult intubation. Dentition was judged to be pathological in 32% of the patients. CONCLUSIONS: In elective intubation, the teeth most likely to be injured are the upper incisors, in patients aged 50-70 years. In most cases dental injury is not associated with a pre-event prediction of difficult intubation.

Adolescent↗
PubMed2004

Professional liability and other career pressures: impact on obstetrician-gynecologists' career satisfaction.

OBJECTIVE: To investigate the impact of career pressures on career satisfaction and satisfaction with job-specific activities among obstetrician-gynecologists. METHODS: A questionnaire was sent to 1,500 member-Fellows of The American College of Obstetricians and Gynecologists in June 2001. The analyses were designed to examine the relationship between career pressures in 3 domains on clinicians' professional satisfaction. RESULTS: Overall career satisfaction and satisfaction with job-specific activities were both inversely related to the perceived impact of career pressures. The major impact reported was that liability insurance costs would shorten the duration of the members' careers. Managed care had less impact than liability, with moderate concern surrounding the limitation of diagnostic and treatment options. Obstetrician-gynecologists were less satisfied with their careers and job-specific activities if they believed the cost or time of obtaining continuing medical education requirements to be a burden. CONCLUSION: Career pressures produced by liability insurance costs have more negative impact on clinicians' satisfaction with their professional lives and job-specific activities than managed care and requirements for continuing medical education.

Adult↗
PubMedDate not supplied

Effect of perceived malpractice insurance costs on the family practice career goals of medical students.

A questionnaire regarding perceived training and practice goals was distributed to 185 consecutive medical students interviewing for a 1986-87 internship at a community hospital in Southern California. Students were asked to estimate the dollar cost of professional liability insurance for a hypothetical family physician in the first year in practice performing low-risk obstetrics in Southern California. Family physician applicants who planned to do obstetrics estimated an initial average yearly premium cost of $16,406, whereas those not planning to do obstetrics estimated costs of $25,710 per year. Non-OB directed family practice applicants had a statistically significant (P = .0018) higher estimate of professional liability insurance costs. Average premium costs were obtained from three separate professional liability insurance carriers. Cost estimates of mature rates were not necessarily unrealistic, but student ignorance of significantly lower initial rates was widespread. The broad ranges of estimates suggested that subsets of students may be dramatically overestimating these costs. The data and direct questioning of students suggest that perceived insurance costs may affect training goals and career choices of medical students.

California↗
PubMed1998

[Analysis of claims for damage in the gynaecological sector during 1997 based on data taken from the Professional Association of Gynaecologists' third-party liability group insurance].

This survey deals with claims for damages in the gynaecological sector during 1997 brought against gynaecologists covered under the professional association's third-party liability group insurance. These claims are typified and presented according to the tenor of the substantiations. The analysis shows that only in the case of a small percentage of the claims was incorrect treatment conclusively the cause of damage,thus resulting in prompt settlement. With regard to the other claims, the status of each dispute is listed as of June 30, 1998. In view of the difficulty that patients have in proving incorrect treatment and resultant damage (the burden of evidence lying with the patient), the focus of such disputes regularly shifts to allegations of inadequate prior information, since the physician has to prove due provision of the same, and to the assertion that documentation was incomplete, since deficient documentation can act in favour of the patient by alleviating the onus of furnishing proof, even to the extent of transferring such onus to the other party. Consequently, liability risk can be reduced by conscientious provision of prior explanatory information and precise documentation of this information and of the treatment.

Germany↗
PubMed2005

Defensive medicine among high-risk specialist physicians in a volatile malpractice environment.

CONTEXT: How often physicians alter their clinical behavior because of the threat of malpractice liability, termed defensive medicine, and the consequences of those changes, are central questions in the ongoing medical malpractice reform debate. OBJECTIVE: To study the prevalence and characteristics of defensive medicine among physicians practicing in high-liability specialties during a period of substantial instability in the malpractice environment. DESIGN, SETTING, AND PARTICIPANTS: Mail survey of physicians in 6 specialties at high risk of litigation (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) in Pennsylvania in May 2003. MAIN OUTCOME MEASURES: Number of physicians in each specialty reporting defensive medicine or changes in scope of practice and characteristics of defensive medicine (assurance and avoidance behavior). RESULTS: A total of 824 physicians (65%) completed the survey. Nearly all (93%) reported practicing defensive medicine. "Assurance behavior" such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents' lack of confidence in their liability insurance and perceived burden of insurance premiums. CONCLUSION: Defensive medicine is highly prevalent among physicians in Pennsylvania who pay the most for liability insurance, with potentially serious implications for cost, access, and both technical and interpersonal quality of care.

Defensive Medicine↗
PubMed1991

Obstetrical practice survey report. Healthy Futures Program, May 2, 1991.

Oklahoma physicians in three specialty areas (ob/gyn, family practice, and general practice) were surveyed in regard to their practice of obstetrics. The 611 physicians who responded included a representative sample in regard to county of practice, rural vs urban, age, degree (DO & MD), specialty, and type of practice. Respondents accounted for 51% of the total 1989 births in Oklahoma during calendar year 1989. The vast majority (greater than 90%) of respondents report that they normally provide delivery services and prenatal care in combination. Cesarean sections are performed by almost all ob/gyns (97.6%), more than half of the family practitioners (56.5%), and a very few general practitioners (18.9%). Half of all physicians responding have made changes in their obstetric practice in the last 3 years. The most common changes are: reducing care of medically high risk, uninsured, and/or Medicaid patients. The most important reasons for these changes are: fear of obstetric malpractice suits, inconvenience of obstetrics and excessive professional liability insurance premiums. Specific reasons for reducing care to medically high risk patients were reported to be: increased medical legal liability, belief that high risk patients should be cared for by specialists, and lack of Medicaid reimbursement for diagnostic services. Almost 90% of the physicians responding to the survey are required to carry a minimum amount of professional liability insurance by the hospital where they practice with the most frequently stated amount being $1,000,000. Current average "global fees" reported by the respondents were $1,202 for a spontaneous vaginal delivery and $1,543 for a cesarean delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Medical malpractice from the viewpoint of the insurer].

The task of the insurer for medical liability insurance is to care about the interests of the contract partner by defending unjustified claims, satisfying claims of compensation of harmed patients, and supporting the medical society in developing methods to prevent harm. The criminal law and the liability law are demonstrated.

Germany↗
PubMed1986

The insurance industry and the coverage of rehabilitation services.

Rehabilitation facilities are inescapably involved in the ongoing national debate over the financing and delivery of health care services. The relatively small portion of the debate involving our facilities does not involve questioning the need for rehabilitative medicine in serious trauma or illness, rather, the discussion revolves around how the services can best be delivered and the cost containment of the inherent costs. The recent interest evidenced by the government in DRG and related prospective payment plans is credited by some with effectively slowing the increase in health care costs. We believe that a careful look beyond just the numbers could demonstrate that cost "savings" are simply cost shifting to private payers. We believe that if DRG plans are strictly applied to rehabilitation facilities the results could be detrimental to both the facilities and their patients. Potential new markets are being explored such as the role our facilities can play in the area of treatment of catastrophic injury resulting from third party negligence. Liability litigation involving bodily injury is an area of enormous concern for the nation and its liability insurers, as is evidenced by the increased media attention given to the "liability insurance crisis" recently. The obvious long term cost containment effects of treatment in rehabilitation facilities is attracting the attention of the liability insurers as a potential vehicle by which liability exposures can be mitigated. The emergence of profit driven health care corporations and the enormous competition accompanying it is one of the most significant developments to be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed1997

Beyond tort reform.

Organized medicine has spent a great deal of time, energy, and money attempting to revise the legal tort system. Yet, change, if any, has been incredibly slow. There are many reasons for this. Tort law has been a part of American jurisprudence for hundreds of years. In addition, most state legislatures are populated with large numbers of attorneys. This paper explores the economic factors that underlie the litigation process in medical negligence/malpractice cases. It suggests that the current tort system is not as antimedicine as physicians commonly believe; rather, it is physician-friendly. Presented here is a more efficient and cost-effective method of addressing medical negligence/malpractice cases. An exclusive relationship between the liability insurance carrier and a defense law firm is proposed. Rather than using the old billable hours system to charge for its services, the defense law firm negotiates a yearly retainer based upon a percentage of the annual liability insurance premiums paid. How this relationship would result in a more efficient and cost-effective approach to the present tort system is examined.

Accounting↗
PubMed2001

[Complaints against dentists].

To get an impression of the claim-behaviour of patients of Dutch dentists, a qualitative survey was completed amongst eight out of the nine dental consultants of dental liability insurers in the Netherlands. After a literature-study and a test-interview, 11 questions were composed to get the information. It became apparent that the accused dentist is either the young, (too) enthusiastic dentist or the older one, who has lost interest in his job and follows no post academic education. Like in most western countries, according to literature, the most frequent topics patients complain about in the Netherlands are oral surgery, followed by fixed prosthetics, endodontology and recently periodontology. The main cause of the complaints is, according to the interviewed advisors, the lack of communication between the dentist and his patient. Moreover it became clear that dentists misuse their malpractice liability insurance as a second patient-insurance.

Adult↗
PubMed1993

Future legal issues in emergency medicine.

This article analyzes past legal trends in emergency medicine with an effort to project those trends and current developments into future legal issues that will confront emergency physicians and emergency departments. Special emphasis is placed on insurance trends and professional liability insurance developments along with medical malpractice claims past, present, and future. Also discussed in this article is the health care industry environment and ways that it might affect future legal challenges for emergency medicine.

Emergency Medicine↗
PubMed2005

Economic factors and the percentage of residency positions filled by United States medical graduates.

OBJECTIVE: To study the association between economic factors and the percentage of specialty residency positions filled by U.S. medical graduates. METHODS: Data from the 2004 National Resident Matching Program were used to estimate the percentage of residency positions filled by U.S. medical graduates in 15 major specialties. Data from the Medical Group Management Association, American Medical Association, and a major Massachusetts liability insurer were used to estimate the mean and median physician income, work hours, and the relative cost of professional liability insurance. RESULTS: The percentage of residency positions filled by United States medical graduates varied by specialty. In 2004, U.S. graduates filled more than 90% of the residency positions in orthopedics, plastic surgery, and neurosurgery. In contrast, U.S. graduates filled fewer than 60% of the residency positions in internal medicine and family medicine. A positive correlation between mean annual income and the percentage of residency positions filled by U.S. medical graduates (r = 0.78, P < .001) was observed across the 15 specialties studied. In a multivariate analysis, professional liability costs were not associated with the percentage of residency positions filled by U.S. graduates after controlling for annual income (P = .46). CONCLUSION: Economic factors are associated with the percentage of specialty positions filled by U.S. medical graduates. Procedure-based and hospital-based specialties with an above-average annual income are most likely to have their residency positions filled by U.S. medical graduates. LEVEL OF EVIDENCE: III.

Career Choice↗
PubMed2000

American Academy of Pediatrics. Committee on Medical Liability. Professional liability coverage for residents and fellows.

The American Academy of Pediatrics first developed a policy on professional liability coverage for pediatricians-in-training in 1989 and subsequently reaffirmed its basic position with slight modification in 1993. In this latest iteration of the statement, the original positions have been strengthened to address changes in the professional liability insurance industry, the structure and settings of residency training, and mandated reporting to health provider data banks. The new policy emphasizes the need to provide pediatricians in training with adequate professional liability insurance coverage and to educate residents and fellows on the importance of adequate and uninterrupted professional liability coverage-both during and after residency.

Humans↗