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Physicians who deliver obstetric care in the US may be either obstetrician-gynecologists or general practitioners. However, some physicians have been leaving this area of specialization at a rapid rate in recent years. This is a consequence of the increase in malpractice claims against these doctors and the resulting increase in their insurance premiums. Many obstetricians who have not left their practices have chosen to raise their fees and accept lower risk patients. Family physicians, using a different approach, often simply eliminate that component of their practice. To learn more concerning the factors that could influence physicians' decisions regarding this issue, demographic variables for 1983 relevant to the physicians' practices, and patient characteristics, were investigated for obstetricians and family physicians in Washington State. Data were gathered from birth records and the 1983 American Medical Association Masterfile database. Counties were classified as urban, semiurban, semirural, or rural, based on US Census definitions. Births were designated as attended by either family or general practitioners, or by obstetrician-gynecologists. Matches were made between 45,540 births and 1,093 physicians, representing 67 percent of the total deliveries in Washington State in 1983. By far, the majority of obstetrician-gynecologists (the total number was 353) practiced in urban counties; none practiced in rural areas. However, 50 percent of the general and family physicians (the total number was 740) practiced obstetrics in semiurban, semirural, or rural counties; 16.4 percent practiced in semirural or rural areas. Although general and family physicians outnumbered the obstetrician-gynecologists, the latter group attended two and one half times the number of deliveries attended by the former. They also attended more medically high-risk patients, but general and family physicians attended more patients with other characteristics associated with high-risk, such as being a minority, single, or young. These differences were most marked in urban counties. Access to obstetric care is an important issue in Washington State, where 11 rural counties lack obstetric provider, according to 1989 data. The ongoing trend for physicians to stop performing obstetric services will only worsen the situation. (Consumer Summary produced by Reliance Medical Information, Inc.), Differences in the Obstetric Practices of Obstetricians and Family Physicians in Washington State In response to the obstetric malpractice crisis, both obstetrician-gynecologists and family physicians have raised their fees and [...]

* OBJECTIVE Our goal was to compare the quality of diabetic care received by patients in rural and urban communities. * STUDY DESIGN We performed a retrospective analysis of claims [...]

* BACKGROUND Federal legislation has recently been proposed to designate obstetrician-gynecologists OBGs) as primary care physicians. The Institute of Medicine identifies care unrestricted by problem or organ system as an [...]