Ob-Gyn Shortage Is Going to Get Worse (Op-Ed)

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Dr. Richard E. Anderson is chairman and chief executive officer of medical malpractice insurer The Doctors Companyand past chairman of the department of medicine at Scripps Memorial Hospital in La Jolla, Calif. He contributed this article to LiveScience's Expert Voices: Op-Ed & Insights.

Some of our most senior Americans can still remember a time when doctors used to make the trek to family homes to deliver newborns. That scenario may rarely happen these days, but could we ever have envisioned a point when women approaching childbirth might have trouble finding an obstetrician to deliver them?

Yet doctors who perform childbirth duties are becoming increasingly scarce. Data from the American College of Obstetricians and Gynecologists (ACOG) projects a shortfall of between 9,000 and 14,000 obstetrician-gynecologists (ob-gyns) in the next 20 years, and an ACOG survey found that 1 in 7 ob-gyns has stopped delivering babies. More than 20 states are now in "Red Alert" crisis mode — meaning the number of ob-gyns isn't sufficient to meet patients' needs.

Two compelling reasons exist for the shortage. The first, historically unchanged, is that as obstetricians age, their practice tends to age with them and a constant call schedule is hard to sustain for a small number of pregnant patients. The second cause is that the additional cost of malpractice insurance may not be sustainable for an obstetrician who is not performing a large number of deliveries. [9 Uncommon Conditions That Pregnancy May Bring]

On average, obstetricians pay the second-highest liability insurance premiums of any medical specialty, with only neurosurgeons paying more, and spend an average of nearly 15 percent of their careers fighting mostly fruitless or frivolous malpractice claims. Indeed, ob-gyns answering the ACOG survey blamed their decision to drop obstetrics on the twin burdens of insurance affordability and an outright fear of lawsuits. In many cases, ob-gyns can reduce their malpractice premiums in half by eliminating their obstetrical duties.

This distressing situation makes it easy to support a new opinion paper released by ACOG earlier this month. The paper essentially conveys that gynecologists who choose to forego late-pregnancy and delivery duties can still provide early pregnancy care without considering themselves obstetricians.

For example, a gynecologist whose patient develops an ectopic (or tubal) pregnancy may be the best-equipped physician to surgically treat the patient, even if that gynecologist doesn't usually treat pregnant women or deliver babies. This type of "gray zone" between the typical duties of gynecologists and those of obstetricians — who provide care throughout pregnancy and childbirth — is broached in the paper, which states that ACOG considers early pregnancy care to be within the scope of a gynecology-only practice. Accordingly, those physicians may choose not to carry liability insurance for obstetrics, ACOG says.

It's widely understood that the early weeks of gestation can be rife with complications, including bleeding, miscarriage and ectopic pregnancy. But it's also well-documented that few malpractice claims stem from treating those issues, while far more claims arise from problems during delivery or birth injuries to newborns. The average payment for claims involving neurologically impaired infants was $1.15 million, according to 2011 ACOG data.

Should malpractice insurers that underwrite gynecology-only practices provide coverage for treatment involving first-trimester and early second-trimester pregnancies and their complications? ACOG says yes, and I fully agree. It's perfectly reasonable for the college to draw attention to the fact that there needn't be a hard-and-fast rule or bright line separating gynecology and obstetrics when it comes to liability coverage. A doctor who is no longer delivering newborns, but still participating in early pregnancy care, may not have a significantly different risk profile than a gynecologist who does not provide that service. At The Doctors Company, we customize coverage and premium rates to our members' specific practice risk profiles, including factors like patient volume, on-call coverage and hospital privileges and we would have no problem providing coverage in the circumstances contemplated by ACOG.

At first glance, it's difficult to understand ACOG's context for issuing this brief opinion paper, since it doesn't appear to change doctors' choices or their potential malpractice coverage. Perhaps, like so many others in the medical field, ACOG is also casting a wary eye on the looming shortage of primary care physicians across America, a byproduct of health care reform. [Doctor Shortage Looms in Health Care Reform (Op-Ed)]

Combined with the lack of sufficient obstetricians to meet the needs of our population, the significant shortfall of primary care physicians will place more pressure on gynecologists to care for pregnant women. It does makes sense — the vast majority of gynecologists have training in obstetrics — but their malpractice insurance needs will naturally differ if they are, in fact, delivering babies. For our company, and I suspect for other malpractice insurers as well, the question of an additional premium for these physicians is not based on a political notion — it's based on a physician's overall liability profile.

Read Anderson's recent Op-Ed Who Shoulders the Blame for Misdiagnoses?

The views expressed are those of the author and do not necessarily reflect the views of the publisher. This article was originally published on LiveScience.com.

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