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The article describes changes in obstetric practice patterns and liability insurance premium costs and their consequences to Washington State obstetric providers. From 2002-2004, mean liability insurance premiums for obstetric providers escalated by 61% for obstetrician-gynecologists, 75% for family physicians, 84% for certified nurse midwives, and 34% for licensed midwives. Providers' most common monetary responses were to cut compensation and to increase cash.

OBJECTIVE: To compare the practice productivity of female and male obstetrician-gynecologists in Washington State. METHODS: The primary data collection tool was a practice survey that accompanied each licensed practitioner's license renewal in 1998–1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births. RESULTS: Of the 541 obstetrician-gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits Per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits Per week (women 10.1 Per week, men 12.8 Per week, P ≤ .01) mad working 60 or more hours per week (women 22.1% versus men 31.5%, P ≤ .05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P < .01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30–39 through the 50–59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40–49 age group. CONCLUSION: Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician-gynecologists in Washington State. Changing demographics and behaviors of the obstetrician-gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States. [ABSTRACT FROM AUTHOR]