摘要：Family physicians who wish to provide abortions have been subject to both denial of coverage by medical liability insurers and the imposition of large premium increases. These policy decisions by insurance companies raise questions about the role of family physicians in abortion care and about the autonomy of medical specialties in defining their scope of practice. We review the issues specific to abortion services in the primary care setting and examine the broader implications for the medical profession. Finally, we review how advocacy and improved regulation of the insurance industry could help to ensure that clinicians who are trained and willing to provide services to their patients are not limited by the decisions of medical liability insurers. IN 2004, A FAMILY PHYSICIAN in New York State decided that he would offer medication abortion with mifepristone and misoprostol to patients in his practice who desired early pregnancy termination. He received training in medication abortion and made arrangements for back-up surgical abortion coverage in the event of unsuccessful termination. He also wrote his medical liability carrier a letter to inform them of his plans. Although he was accustomed to prescribing medications with potential toxicity, such as sildenafil, warfarin, and oxycodone, without requesting clearance from his liability carrier, he decided that it would be prudent to notify the company of his plans to prescribe mifepristone. To his surprise, he received the following reply from the carrier: Our determination is that this procedure will be covered for OB/GYN physicians only. We do not believe this falls within the accepted scope of practice for a Family Physician, and therefore will not cover a family physician who provides Mifepristone in their [ sic ] practice. (R. Morrow, written communication, May 2006). The treatment of this physician—and many others like him—by liability insurance carriers raises questions that are specific to abortion care, as well as more fundamental questions about the autonomy of the medical profession. Here we explore the issues regarding liability insurance for family physicians providing abortions: Is abortion within the scope of practice for family physicians? Are there in fact legitimate concerns about the liability risk associated with abortion care performed by members of this specialty that justify limitations on women's access to pregnancy termination? In addressing these issues, we also draw attention to the more far-reaching questions: Who has the authority to define the scope of practice of physician specialties? Is it appropriate for insurers to make medication-by-medication decisions about coverage of the liability risk associated with prescribing drugs approved by the Food and Drug Administration? How are decisions about coverage of specific medical services made? Finally, what actions can be taken to ensure that restrictions on malpractice coverage do not inappropriately limit physicians’ ability to provide care to their patients?
