Present status of obstetrics in family practice and the effects of malpractice issues.

A survey of 800 active members of the American Academy of Family Physicians 1985-1987 membership directory was conducted for the purpose of determining the impact, over time, of malpractice issues upon the practice of obstetrics by family physicians. The survey response rate was 60.4 percent. Almost 20 percent of all respondents reported that they have never provided obstetric care of any type. Another 40 percent have provided obstetric care previously but have now discontinued this care, while the remaining 40 percent currently offer obstetric care to their patients. The proportion of respondents who discontinued the practice of obstetrics because of increased risk of malpractice litigation increased significantly over the years from 1947 to 1986 (P = .0084). The proportion of respondents who discontinued obstetric practice because of increased malpractice insurance costs also increased significantly from 1945 to 1986 (P = .0002). The proportion of those entering practice during the past five years who decided not to offer obstetric services because of malpractice risks was significantly greater than the proportion entering practice earlier (21.0 percent vs 2.0 percent, P = .0090). Although the current patterns of obstetric practice showed regional variation, the accelerating impact of malpractice risk and insurance cost on these patterns was similar throughout the nation.