166: Maternal fetal medicine specialist density and state specific malpractice activity


      To determine if there is an association between Maternal-Fetal Medicine (MFM) specialist density and state specific malpractice activity.

      Study Design

      This was a cross-sectional, observational study of MFM specialist density and malpractice activity in the United States from 2000 to 2007. Individual state provider density data were obtained directly from the membership department of the Society for Maternal-Fetal Medicine. Fellows in training and honorary/affiliate members were not included in this analysis. State demographic data including population density and income was obtained from the US Census Bureau. State specific malpractice activity data was obtained from the National Practitioner Databank. Provider density was calculated for each state as MFM per 10,000 live births to control for differences in birthrate. Pearson correlations and multiple linear stepwise regression models were constructed for both absolute and relative changes in MFM density.


      The national MFM density in 2007 was 4.0 providers per 10,000 live-births. The median state MFM provider density is 3.9 / 10,000 live-births with a range of 0 to 9.1. Pearson correlations demonstrated that population density (p<.0001), mean income (p<.001), presence of a fellowship program (p<.005) are positively associated with MFM density while number of malpractice judgements (p<.02) and median malpractice payout amounts (p<.04) are negatively associated. A multi-variable stepwise linear regression including these variables explains a reasonable amount of the variability in the MFM density model (R = 0.68), however none of the variables reflecting malpractice activity retained their significance in the final model. Variables that retained their significance in the model are population density (p<.0001) and presence of a fellowship program (p<.01).


      The density of practicing MFM specialists does not appear to be associated with state specific malpractice activity. The strongest predictors of state MFM provider density are population density and the presence of a fellowship training program.