The relationship between physicians' qualifications and experience and the adequacy of prenatal care and low birthweight

Objectives. The purpose of this study was to examine the relationship between physicians' qualifications and experience and rates of completion of the recommended number of prenatal visits and delivery of a low-birthweight infant. Methods. All deliveries performed by a permanently licensed physician in Massachusetts in 1990 (n = 80 537) were examined. Qualification was measured by board certification. Experience was measured by both volume of deliveries and duration of practice. Results. Women cared for by a non- board-certified physician were less likely to receive the recommended number of prenatal visits (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.54, 0.85) and were more likely to have a low-birthweight infant (OR = 1.20, 95% CI = 1.00, 1.42). Physicians with a smaller volume of deliveries or a shorter duration of practice were more likely to deliver a low-birthweight infant. Conclusions. The data show an association of board certification with rates of the recommended number of prenatal visits and low birthweight. In addition, volume and duration of practice were significantly associated with low birthweight. Further research should examine whether these associations are related to differences in patient referral or to physicians' judgment and efficiency in provision of prenatal care.