In what could spell trouble for women’s healthcare, the United States is looking at a shortage of obstetrician/gynecologists.
A 2018 study by Doximity reinforces the growing threat of OB/GYN shortages in major U.S. cities in the face of escalating maternity workloads and anticipated retirements of current doctors.
Simply put: “You have too few people and too much work,” Peter Alperin, M.D., vice president of connectivity solutions at Doximity, a social network for doctors and other medical professionals, in an interview with Fierce Healthcare.
In a report released this week, Doximity said high maternity workloads that vary dramatically across major metro areas could leave some cities struggling to meet the demand for OB/GYNs. The top 5 cities most likely to suffer a shortage in the coming years are Las Vegas, Los Angeles, Miami, Orlando, Florida and Riverside California, the report said.
There is an insufficient number of young practicing OB/GYNs to fill the jobs held by doctors in the field who will soon retire. The study found that the average age of U.S. OB/GYNs is 51 years old. Most begin to retire at age 59, as doctors in the specialty tend to leave the field younger than most physicians due to the demanding nature of delivering babies.
For the first time, the report looked at correlations between sources of insurance and OB/GYN workloads, the study’s lead author Chris Whaley, Ph.D., adjunct assistant professor at the University of California, Berkeley School of Public Health, said in the interview. Nationally, around 50% of all births in the U.S. are covered by Medicaid programs, whose reimbursements are often lower than private insurers.
The study found that regions with the largest OB/GYN workloads also tended to have the highest number of women of child-bearing age covered by Medicaid or uninsured. Regions with fewer patients covered by Medicaid or uninsured tend to have lower workloads and a younger distribution of OB/GYNs.
“While it’s critically important that expecting women are provided appropriate pre-natal care services, regardless of income status, workload considerations imply that higher reimbursements for maternity services may be necessary in order to maintain a market equilibrium nationally,” the report said.
It’s possible that areas with a shortage of OB/GYNs will have to offer higher salaries to attract doctors since how much people are paid can influence where they decide to work, Alperin said.
While the study wasn’t designed to offer solutions to the shortage, Whaley said he hopes the report will bring attention to the issue so that stakeholders come up with solutions at the local and national level.
Some have suggested that midwives, used in other countries to oversee many expectant and new mothers, could help solve the problem in the U.S. However, thanks in part to opposition from doctors and hospitals, midwives are far less prevalent in the U.S. than in other affluent countries, attending around 10% of births, and the extent to which they can legally participate in patient care varies widely from one state to the next.
The shortage of OB/GYNs is part of a larger physician shortage, with the Association of American Medical Colleges estimating the country could see a shortage of up to 120,000 physicians by 2030.
There is also debate about the fact that fewer male doctors are entering the field of gynecology. Some 59% of OB-GYNs are women and the number of male doctors in the specialty is dropping.