• Xiao Xu, Kristine A Siefert, Peter D Jacobson, Jody R Lori, and Scott B Ransom.
• Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan 48109, USA. xiaox@med.umich.edu
• Womens Health Issues. 2008 Jul 1; 18 (4): 229-37.

BackgroundMedical services for pregnancy and childbirth are inherently risky and unpredictable. In many states, obstetrician-gynecologists (OB-GYNS) who attend the majority of childbirths in the United States and provide the most clinically complex obstetric procedures are struggling with increasing malpractice insurance premiums and litigation risk. Despite its significant implications for patient care, the potential impact of malpractice burden on OB-GYN physicians' career satisfaction has not been rigorously tested in previous research.MethodsDrawing on data from a statewide survey of obstetric providers in Michigan, this paper examined the association between medical liability burden and OB-GYNs' career satisfaction. Malpractice insurance premiums and malpractice claims experience were used as 2 objective measures for medical liability burden. Descriptive statistics were calculated and multivariable logistic regressions estimated for data analysis.ResultsAlthough most respondents reported satisfaction with their overall career in medicine, 43.7% had become less satisfied over the last 5 years and 34.0% would not recommend obstetrics/gynecology to students seeking career advice. Multivariable regression analysis showed that compared to coverage through an employer, paying > or =$50,000/year for liability insurance premium was associated with lower career satisfaction among OB-GYNs (odds ratio, 0.35; 95% confidence interval, 0.13-0.93). We found no significant impact of malpractice claims experience, including both recent malpractice claims (during the last 5 years [2001--2006]) and earlier malpractice claims (>5 years ago), on overall career satisfaction.ConclusionsThe findings of this study suggest that high malpractice premiums negatively affect OB-GYN physicians' career satisfaction. The impact of the current medical liability climate on quality of care for pregnant women warrants further investigation.

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