To the Editor The article by Dr Coutinho and colleagues1 found that graduating family medicine residents reported intentions to provide a broader scope of practice, including obstetric care, inpatient care, and prenatal care, than that reported by current family physicians.
The authors ascribed the differences to limited practice support, employer constraints, and other causes without mentioning malpractice liability. A number of studies have suggested that concerns about legal liability and malpractice fees significantly affect whether physicians stop practicing obstetrics.2- 4 Furthermore, in a report that examined medical students' and residents' awareness of the malpractice litigation environment and the reasons for choosing a specialty with high or low risk for malpractice lawsuits, the authors showed that students did not stop choosing high-risk specialties even if they perceived problems in the current litigation environment.5 In the current study, graduating family medicine residents who intended to provide a broader scope of practice may not have perceived a risk for malpractice lawsuits, whereas current family physicians may have been more concerned about legal liability, enough to stop practicing obstetrics.
Sugihara M. Intended vs Reported Scope of Practice. JAMA. 2016;315(20):2233-2234. doi:10.1001/jama.2016.1719