Living in Fear of Malpractice

In 1989, the results of a two-year study conducted by the Institute of Medicine, an affiliate of the National Academy of Sciences, was released on the nationwide effects of malpractice lawsuits against obstetricians. Obstetrician-gynecologists are more than twice as likely to be sued than other physicians, the report found, and claims against them tend to be two to three times higher than for other specialists.

The specter of malpractice litigation, according to the 15-member panel, “represents a serious threat to the delivery of obstetrical care in this nation.” Faced with the threat of being sued, an increasing number of obstetricians have left their practices. The report found that the number of obstetricians in rural areas fell 20% during the last five years. The number of ob/gyn residency graduates who start practices also has declined. In 1989, 30% of obstetric residents had not set up practices within three years of graduation; in 1990, that figure climbed to 50%.

The panel suggested several alternatives to the current legal system, including no-fault compensation for certain injuries to the newborn and privately negotiated contracts between patients and providers. To date, however, obstetricians say little has been done to change the litigious climate in which they work.