The expense of professional liability is a burden borne by not only physicians but also by patients because evidence suggests it affects clinical management decisions. Three in 4 practicing obstetricians-gynecologists have been named in a malpractice suit at some point during their career.
Liability suits have been associated with 22% of providers, decreasing their high-risk obstetric patient volume, 14% stopping obstetric practice altogether, 9% decreasing obstetric volume, and 1.1% of providers discontinuing the practice of trialing labor after a single cesarean delivery (CD).
To investigate the effect that professional liability concerns might have on the CD rate, we examined the state-to-state relationship between professional liability rates and mode of delivery, hypothesizing that higher liability insurance premiums would be associated with higher CD rates and lower operative vaginal delivery (OVD) rates.
Materials and Methods
Data were collected from the Centers for Disease Control and Prevention National Vital Statistics System for 2010, which included rates of mode of delivery, vaginal or cesarean deliveries, and OVD. Professional liability premiums for practicing obstetrician-gynecologist providers for 2010 representing each state were obtained from the 2011 Medical Liability Monitor Rate Survey. Additional information was obtained regarding obesity rates as well as average household income and percentage of urbanization within a state to evaluate for potential confounders of the relationship.
Using SAS 9.3 statistical software (SAS Institute, Cary, NC), linear regression modeling was performed to evaluate the relationship between medical malpractice insurance premiums and the rates of CD, vaginal delivery, and OVD either with vacuum assistance or forceps assistance. A linear regression analysis was performed defining statistical significance as a value of P < .05. The statewide obesity percentage, average household income, and percentage urbanization were included in the adjusted model.
Results
Results were available for all variables for all 50 states and the District of Columbia in 2010 and included in the analysis. Significant relationships ( P < .05) were observed between professional liability insurance premiums and either CD or OVD. Controlling for obesity, average household income, or percentage of urbanization did not change this relationship. Obesity was found to negatively confound the relationship, such that controlling for obesity only increased the significance of the relationship. Based on this analysis, higher professional liability insurance premiums correlate with higher cesarean rates and lower operative vaginal delivery rates ( Figure ).
