Dr. Leena Nathan, an assistant clinical professor at UCLA, almost always begins seeing patients at 7 a.m., even though she officially doesn’t begin work until 8. And she sees her last patient around 6 p.m., though her work day is supposed to end at 5 p.m. Nathan and the four other full-time ob-gyn doctors at the Los Angeles clinic are all fully booked for the next two months, but they receive daily requests to add patients and attempt to accommodate them where they can. She never takes a lunch break — instead eating between appointments — while also managing her administrative duties between caring for patients, when she’s home at night or on the weekends.
It’s a demanding and often chaotic schedule for Nathan and her ob-gyn colleagues in Los Angeles, a metro area that will see one of the most significant shortages of ob-gyns in the coming years, according to a new report from Doximity — the leading social network of physicians, which assessed the potential for ob-gyn shortages in each of the largest 50 U.S. metropolitan areas. The top three cities at greatest risk are Las Vegas, Orlando, and Los Angeles, which have all seen significant population growth in recent years. Miami; Riverside, Calif., Detroit; Memphis; Salt Lake City; St. Louis, and Buffalo, N.Y. were other cities in danger of ob-gyn shortages. The cities at least risk were found to be Portland, Ore., San Jose, Calif., and Birmingham, Ala.
The average age of an ob-gyn in the U.S. is 51, and experts say not enough young people are moving into the field to replace those who will retire. Most ob-gyns begin to retire at 59. Only 14 percent of all ob-gyns are 40 or younger, while 37 percent are 55 or older, according to the report.
Obstetrics and gynecology has the second-highest burnout rate of any medical specialty, which is likely because of increased workloads and competing administrative demands, says a study published in the journal Obstetrics & Gynecology.
“Moreover, delivering babies is physically demanding, with tough hours,” said Joel Davis, Doximity’s vice president of Strategic Analytics. “As such, ob-gyns tend to retire earlier from maternity care.” Obstetricians are the most frequently sued doctors after neurosurgeons, according to the National Institutes of Health. That fact, combined with high insurance premiums, appears to make medical school graduates reluctant to enter a field that has a burnout rate second only to emergency medicine — a field where you can be called at any time of the day or night to perform the demanding and sometimes arduous work of delivering a baby.
There are around 59,000 ob-gyns in the U.S., but nearly half of U.S. counties lack an ob-gyn, and The American Congress of Obstetrics and Gynecologists (ACOG) projects the U.S. could face a shortage of as many as 8,000 ob-gyns by 2020, and 22,000 by 2050.
“The current workforce in obstetrics and gynecology is aging, retiring early, and going part-time at an increasing pace, while the number of patients seeking care is exploding due to health care reform and population statistics,” said Valerie Anne Jones, M.D., a retired ob-gyn and member of Doximity’s Medical Advisory Board. “Access to maternity care and women’s health services is vitally important, and we need to have infrastructure to support the numbers or these women will have no ob-gyns to turn to despite having insurance.”
Dr. Esohe Faith Ohuoba of Memorial Hermann Medical Group in Texas became an ob-gyn because she felt it was a specialty that has the greatest potential to address health disparities among women — and build healthier communities by being on the frontline of women’s health care, from cancer prevention to contraceptive options and battling STDs.
“If you have healthy and strong women, you will have a healthy and strong community,” said Ohuoba.
When women don’t have adequate access to an ob-gyn, they will defer care until it becomes an emergency or use the emergency rooms as a source of primary care, explained Ohuoba, who said she is already seeing this happen. When she asks a patient about her primary care ob-gyn, some will say don’t have one or they are waiting to get an appointment because the earliest the doctors can see a new patient is in two or three months.
“I’ve even had patients travel from over one to two hours away to see me because they believe that they don’t have appropriate access to high-quality ob-gyn services within their community,” said Ohuoba. “I’ve seen patients in the ER who are in their third trimesters and have never seen a doctor. That’s a problem.” Not only does it put the mother and fetus in danger, but it adds another burden to an already overtaxed health care system.
Said Nathan, “Doctors need time to actually think about their patients, make good decisions and also have a balanced life with rest and relaxation included. This is all imperative for patient safety and doctor well-being, especially in a stressful field like ob-gyn.”
To prepare for the shortage of ob-gyns, medical groups have considered easing restrictions on nurse midwives to allow them to provide routine primary and gynecological care.
“Midwives and nurse practitioners or physician assistants can greatly help reduce the burden of normal exams in the office, both for obstetrics and gynecology,” said Nathan. “This will free the doctors’ time to address more complex issues, operate, deliver complicated patients, and deal with any issues as they arise.”
ACOG is evaluating training for residents and ob-gyn practices, and released guidance to help aid organizations implement methods of team-based care. Additionally, ACOG is working with government institutions and other leading medical organizations to improve the distribution of physicians to rural and underserved communities across the nation — a challenge numerous specialties face.
The shortage will likely worsen an already broken U.S. health care system, in which more women die of pregnancy-related complications than any other developed country in the world, according to an investigative report from NPR and ProPublica. According to a World Health Organization report published in 2015, the U.S. has seen a rise in maternal mortality, which has been declining in most of the rest of the world. Maternal death in the U.S. disproportionally strikes low-income women, women of color, and those living in rural communities. In the U.S., about half of those deaths are preventable, the same report says.
Republicans have long called for defunding of Planned Parenthood, and the Republican Congress keeps threatening to pass health care legislation that would diminish coverage of women’s health services, including access to contraception. Research shows that a lack of access to contraception would increase the rates of unplanned pregnancies and unsafe abortions.
“Access to women’s health care in this country needs to be perceived as very important to everyone’s well-being,” said Nathan. “After all, each of us has a mother, sister, wife, or other loved one who is female.”
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