Why Kitsap struggles to add needed women's care providers
In a matter of years, we are on track to lose access to obstetric and women’s care in Kitsap County. While this may sound like an exaggeration, according to the data it is not. And it is not just me saying it. The obstetrician who said it at the Kitsap County Health Board Meeting a few weeks ago is someone who I deeply admire, with whom, in fact, I once worked: Dr. Katherine Hebard. She told the board: “We’re standing on the edge of a precipice in terms of being able to offer our community care. Even as it stands, we’re a bit overwhelmed.” We need to heed the words of Dr. Hebard.
Obstetric care is unique in the medical profession. It is a niche that is part primary care, specialty care, and surgical care, all wrapped into one highly-trained professional. Obstetricians face urgent and emergent situations with their patients nearly every day. As a primary care physician, I have not taken overnight call in more than a decade. This has allowed me to find balance in my life as a spouse, mother, friend, and doctor. However, the lifestyle for an obstetrician is best summed up as many late nights, little sleep, and high stress, not the least of which involves the fact that the most dangerous experience of a woman’s life is childbirth.
Now, let’s talk numbers. Across the nation, the average number of obstetricians per 100,000 population is about 25-27. In Washington State, on average, there are 15 obstetricians per 100,000 people. Kitsap County has only three obstetricians per 100,000. That’s right, just three. Currently, there are four obstetricians working in a private practice group, Kitsap Obstetrics and Gynecology and three obstetricians working at the Doctors Clinic.
As of now, in Kitsap County, there are barely enough obstetricians to cover for each other in the event one or their family member faces an unexpected illness, injury, or other emergency. Obstetricians need vacations, too, which requires obstetricians to provide care to each other’s patients in their absence. While recruiting more obstetricians seems like an obvious solution, that is far more challenging than it seems.
Hebard summed it up best, “It’s a real challenge to practice in Kitsap County.” Here’s why.
Convincing physicians to work in underserved areas is already an uphill battle because many physicians are uncomfortable practicing in locales without the immediate support of specialists, something readily available in larger, metropolitan areas. In addition, having such a high percentage of patients with Medicaid and Medicare coverage in this community makes recruitment to our community nearly impossible.
The insurance payor mix in Kitsap County makes it difficult for a business to remain profitable in healthcare. As a fellow physician running a private practice, I know all too well the struggle of staying afloat. That is the reason so few clinics have remained independent. Hebard said, “We see a huge number of state insured pregnant patients, that’s the bulk of our patients in our county and frankly, it just doesn’t pay very much. So we have a hard time running our business.” She admitted the practice has lost money over the last several years. Negotiations for better payment rates with insurers have remained unsuccessful despite their efforts.
Dr. Hebard shared that her group has approached other consortium groups to help manage their business. Consortium groups are smaller practices that band together to negotiate better payment rates with insurers. All three groups her organization approached in the last three months have declined, mostly due to the payor mix or declining reimbursement numbers. Unfortunately, women’s health care can be a “loss leader,” so many consortium groups are reticent to incorporate women’s healthcare in their business model.
I cannot close this column without sharing what I know about Dr. Hebard, personally and professionally. She and I entered medical school at the University of Washington School of Medicine in 1995 and graduated together. With a class of 250, we did not always get to know our colleagues closely. However, Dr. Hebard and I did our internal medicine rotations together in Boise, Idaho at the VA hospital and lived across the hall from each other for three months. Working with her on the wards and studying with her in the evenings was both inspiring and humbling, at the same time.
Dr. Hebard is simply one of the most brilliant physicians of my generation. She is serious, committed to our community and conscientious. When she says that the number of obstetric providers “might decrease if we can’t continue to figure out how to keep our doors open,” she is sounding the alarm.
According to my calculations, the average age of the seven obstetricians in Kitsap County is 52.4. Two of the three obstetricians at the Doctors Clinic are over 60 and likely to retire in the next 5 years. Five obstetricians cannot meet the needs of a population of 350,000. If Dr. Hebard is sounding the alarm, our community would do well to listen.
Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular opinion column for the Kitsap Sun. Contact her at niranalagba@gmail.com.
This article originally appeared on Kitsap Sun: Niran Al-Agba: Kitsap County's struggle to recruit providers
