In Reply Dr Sugihara inquires how malpractice liability may be driving our findings. Malpractice liability costs vary widely,1 and the American Board of Family Medicine examination registration questionnaire did not include questions about malpractice insurance or the reasons why a specific type of care was or was not provided. Previous studies found that malpractice liability is a concern to practicing family physicians, specifically for the practice of obstetrics.2 An attempt to mitigate this concern by subsidizing malpractice insurance for family physicians and obstetricians2 showed that physicians who received the subsidy were not more likely to continue providing maternity care. Furthermore, among those planning to quit obstetrical care, subsidized physicians were more likely to cite liability cost as the reason compared with unsubsidized physicians. The authors postulated that unsubsidized physicians were more likely to have insurance paid for by their employer.
Coutinho AJ, Phillips RL, Peterson LE. Intended vs Reported Scope of Practice—Reply. JAMA. 2016;315(20):2234-2235. doi:10.1001/jama.2016.1727