New research released this week from Doximity looked at how the upcoming Ob-gyn shortage will be affecting certain cities more than others. This really hits home for women who are planning families, currently pregnant, and wish to deliver in a hospital in one of those cities most at risk.
OB’s in these cities are likely feeling the pressure from the increased workload. Doximity compared number of deliveries in each city to number of practicing Ob-gyns.
Cities with the biggest workload per Ob-gyn:
St. Louis, MO
Las Vegas, NV
Oklahoma City, OK
San Antonio, TX
Los Angeles, CA
San Diego, CA
Please note that these are major metropolitan areas and not the rural locations we often think of when mentioning the coming “ob-gyn shortage”
Smallest Ob-gyn workload: (lowest birth to OB-GYN ratios)
San Jose, CA
San Francisco, CA
New York, NY
If you want concrete numbers, ratio of births to Ob-gyn is 248 in Riverside, CA compared to the low end of 58 births to Ob-gyn in Hartford, CT.
We know the higher workloads mean that those cities are hurting for more Ob-gyns.
Interestingly, the research also looked at percentage of Ob-gyns older than 55 in these cities as that is important when considering when these doctors will be retiring. In Las Vegas, a whopping 39% of Ob-gyns are older than 55. According to ACOG, average age of retirement for Ob-gyns 59-69.
What does this mean for cities like Las Vegas? They will be feeling this shortage intensely, and really soon.
The reality of the matter is that most Ob-gyns actually drop the OB part of their practice much earlier due to the physically demanding lifestyle an on call Obstetrician’s schedule entails. ACOG has reported the average age to stop doing obstetrics to be 48 years old. In addition, we are not seeing a big enough influx of younger ob-gyn’s to take their place.
There has been a dramatic increase in residents choosing to sub-specialize in Reproductive Endocrinology, gynecologic oncology, minimally invasive surgery, and pediatric gynecology. Most of these specialists do not deliver babies. In addition, we are even seeing less subspecialists in maternal fetal medicine (MFM) willing to do deliveries anymore.
So, here is the crux of the matter: Ob-gyns are aging, retiring early, and choosing sub specialization at increasing rates. However, the number of patients seeking care has exploded due to health care reform and population statistics.
Some possible ways to address this include:
1. Increase number of Ob-Gyn residency spots (perhaps even consider specifically increasing in areas at greatest risk of shortage). Often Ob-gyns continue to work in the area of their residency where connections are made and their lives have become settled.
2. Support currently practicing Ob-gyns and provide the infrastructure necessary to maintain this workforce. This can mean utilizing midwives or nurse practitioners/physician assistants to answer phone calls at night, triage patients in the ER and labor and delivery, and write admission notes and prescriptions. This leaves more time for the obstetrician to focus on the patient and provide the best possible care as needed for complex deliveries, cesarean sections or high risk patients that are increasingly at the doorstep.
3. Malpractice reform. Residents are choosing to go into a field where there are told to be prepared to get sued 2-3 times during their career (perhaps even without any negligence or merit to a suit). Are there bad doctors out there? Yes. Are they in the overwhelming minority? Yes. Should all ob-gyns practice medicine in an environment of fear with defensive medicine because of a few bad apples? NO. This current litigious system is not helpful to our patients or our practicing ob-gyns.
If you are an Ob-gyn, would you consider practicing in one of these locations? What are your thoughts on the coming Ob-gyn shortage?
Are you a resident who is subspecializing to avoid obstetrics?
Patients- are you feeling the shortage already? Is it hard to get an appointment or see a physician? Are you already seeing midwives or nurse practitioners? Do you live in one of these cities?
If you are interested in this topic, you can read more about it in recent news coverage: