The effect of malpractice liability on the delivery of rural obstetrical care.

A telephone survey of all non-governmental obstetricians, family physicians, general practitioners, and osteopathic physicians in rural Arizona was undertaken to determine the effects of medical liability issues on the availability of rural obstetrical services. One hundred ninety-one (88.8%) responded, and after exclusion of those who had never provided obstetrical care, 126 physicians remained for evaluation. These included 32 obstetricians, 55 family physicians, 25 general practitioners, and 14 osteopaths. During the past three years, 26 (20.6%) had discontinued providing obstetrical service, citing liability issues as the reason. An additional 12 physicians (9.5%) planned to discontinue obstetrics upon expiration of their 1986 malpractice insurance policy. By the end of 1986, the number of obstetrical providers in rural Arizona will have decreased by 30.1 percent. Women in many rural areas already have pregnancy outcomes that are inferior to their urban counterparts. A further decrease in the availability of obstetrical providers may have additional adverse effect on pregnancy outcomes.