Are we sending the wrong message to future ob/gyns?

While we were discussing the impact of professional liability insurance premiums on practitioners in the state, I was asked how premiums have affected local recruitment of faculty and community physicians. I had to admit that I wasn't aware of any local practices that had been unable to attract new associates because of the liability climate, and it hadn't been a problem for our academic department either. (To be clear, our premiums definitely affect us in many ways, just not directly in faculty recruitment.)

But thinking further, there has been a more subtle but pernicious effect of the professional liability insurance crisis, and it's all about perception. Every rotation, I host third-year medical students at my home for an informal lecture over pizza. It's allegedly about operative vaginal delivery, but it's more about life in our profession. I always give them the opportunity to ask me open questions at the end of the evening.

These are third-year students. They are quite sophisti-cated. They've been sitting on our labor floor here at Yale-New Haven Hospital and at our community affiliate hospitals, absorbing a lot more than how to give oxytocin or when to start magnesium sulfate.

IThat's right, they're listening to you when you commiserate with your colleagues about your problems. I know about the crushing premiums charged in parts of Pennsylvania and New York, and about the physicians in Miami who put all their assets in a spouse's name and "go bare." There is no doubt that the practice of ob/gyn has been harmed by the capricious, unjust, and adversarial nature of the current tort system, particularly in states without payment caps and other meaningful reforms. All true, to a degree.

Data from 1 recent study paint a less-depressing picture.¹ Contrary to popular belief, we are not the most likely specialty to be sued. We are not even in the top 5. We now trail neurosurgery, cardiothoracic surgery, general surgery, orthopedics, plastic surgery, and gastroenterology for the percentage of physicians with a claim filed annually. And our payments are no longer the largest: We are now eighth in median claim payments, trailing pediatrics. Where we still lead is in "outlier payments," those over $1 million, although this has only occurred in about 1 in 1,000 physician-years of coverage.