Uncategorized

A Humbling Night at Taco Bell

This is a true story from my otherwise uneventful Monday night.

I was driving my 4 year old daughter home from swim lessons and planned to stop at Taco Bell, her current favorite, for dinner afterwards.

After I parked, I realized I forgot my wallet at home but luckily I did have my cell phone.  No problem, I thought. I have “apple pay” on my phone and could use that to pay for dinner as my credit card was uploaded.

My daughter and I waited in line as a large family in front of us completed their order.  The cashier was patiently compiling their customized order with a soft smile.  I noticed multiple tattoos on her arms as she was working the register, and wondered about the stories behind them. When it was our turn, I asked the cashier if they accepted apple pay as I didn’t have my wallet with me.  She wasn’t sure, but thought she had seen someone use it before and suggested we try.  So, after giving the order for myself and my daughter, we tried to pay.

However, it didn’t work.

Immediately, I felt very awkward and now had no way to pay for our dinner.  In my pockets I had about a dollar’s worth of change I found in the car.  The cashier noticed me checking my pockets.

Not a big deal, we would just go home to eat dinner.

I told my daughter, “sorry, we’ll have to come back another time”.  Immediately, the cashier jumped in and said she couldn’t let us leave without our dinner.

“I’ll pay for it”, she told me.

“No, no, absolutely not” I replied.  Then my 4 year old piped in with “what’s going on Mommy, I want to eat here”.  Before I could say anything else or leave the restaurant, the cashier was literally running to get her wallet and paid for our dinner with her credit card as she would not take “no” for an answer.

“I’ve been there too” she replied.  “You know, left my wallet at home”.

However, I am quite certain that’s not what she meant.  I thanked her profusely and felt strangely awful for accepting her money yet also completely humbled at her generosity.  I told her I would return to pay her back, but she just asked me to pay it forward.  At this point I didn’t know what to say to a woman who doesn’t know me or my situation, but just sees a mother and a daughter and wants to help.

I asked for her name- it is Christie- and she wrote it on the receipt for me.  My bill was $9.29.  As we sat quietly eating dinner, I was lost in thought.  I wondered how much minimum wage was.  I was also embarrassed by the fact that I didn’t know.  (I looked it up- ironically, it’s $9.25).

I thought about how quickly and selflessly the cashier paid for our dinner despite the fact it very well may have cost her an hour’s worth of work.

Her act of kindness stayed with me all night.  I couldn’t shake how profoundly this was affecting me.  I kept thinking how it must feel for mothers who truly don’t have the money to pay for a meal must feel.  Helpless?

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I thought about victims of domestic violence.  I have actually had discussions with patients and talked with them about developing a plan to leave an abusive partner.  They are often afraid to leave an abusive situation out of fear for how they will care for their families on their own.  In my ob-gyn practice, it was a standard question for new patients at their annual exam, “do you feel safe at home”? Unfortunately, pregnant women are at an increased risk for domestic abuse and I have seen this with more than one of my patients.

In the past, I have discussed with patients some practical measures such as hiding away a small amount of money so that they would have a way to care for themselves and children when first escaping the situation.  Often, these women have zero resources of their own.  I was wondering if this caring cashier thought perhaps I may have been in a similar situation.

The truth of the matter is that I have never been in this terrible situation, and can’t possibly understand what it is like for these women.

That night, I was wearing pretty typical clothes for a Monday night swim lesson- nice pair of jeans and a t shirt.  My daughter was in a cute matching Minnie mouse outfit. Definitely not the definition of needy but also not clearly one of wealth.

This cashier didn’t stop to question or judge our situation.

My plan is to go back next Monday night after swim lessons.  I have an envelope with Christie’s name on it that will pay her back many times over.  I also plan to talk with her manager about the kind of person they are lucky to have working the cashier. Most importantly, I want to tell Christie that her small gesture impacted me profoundly.   With stories of hate, mass shootings, and natural disasters filling our news lately, her kindness showed me that love and compassion for strangers is still present.

And, needless to say, I will also “just pay it forward” as she requested.

Uncategorized

Investing in the Stock Market? I Never Learned About This in Medical School!

How Can I Start Investing if I Don’t Even Know What the Terms Mean?

People have different opinions on how, when, and what to invest in.  A good rule of thumb is to SAVE (emergency fund and college funds for kids), PAY OFF DEBT, and INVEST all at the same time.  This means you do not have to wait until all debt is gone to start investing (you will have missed the potential for large profits during this time through compounding).  Most can consolidate medical student loan debt at reasonable rates.

However, in order to do all 3 of the above, you might have to cut back on spending and most likely live below your means. If you use the example of living off half your salary, or on the salary of one person (if married and both are working), you can do all 3.  However, the point of this article is not to preach about how you decide to manage your money but how to actually invest.

What even makes up the Stock Market?  What do these numbers mean?

If you pick up the Wall Street Journal, watch CNBC, or look to any source for information about the stock market you will find three things mentioned when tracking how things are going.  What if you don’t even know what these terms/numbers represent?

IMG_1628

S & P 500: Tracks the price of 500 large US stocks (account for more than 70% of total value of the market despite tens of thousands of stocks).  This is a broad representative index of large US stocks.

Dow Jones Industrial Average “the Dow”: Tracks 30 companies in US that are thought to represent the diversity of the economy of the US.  The stocks included change over time.

NASDAQ: This is an index focused on technology stocks

Why do you care about these indexes and why do they talk about them on the news every day?  It gives you a general idea overall how the stock market is doing (percentage gains or losses).  You can also compare your stock market investments to these indexes based on the types of stock you invest in.  If you own facebook (FB) or Google (GOOG) you may be interested in the NASDAQ numbers.

Mutual fund:

Contains many securities (stocks, bonds, etc) in one “investment portfolio” and is actively managed for you.

– automatically provides you with diversification (and therefore decreased risk) by owning many different stocks

– no time investment is needed for you to research stocks, determine which stocks to buy- but you should spend some time researching the actual mutual fund

-small fee associated (these fees have come down quite a bit in recent years and some mutual funds can have very low costs)

-may be a minimum amount necessary to invest

You can pull up your brokerage account website, select “mutual fund”, choose to invest in a diversified mutual fund yourself and call it a day.  Alternatively, you can have a financial advisor do it for you as well.  Just remember, you will not only be paying the fee for the mutual fund management but if you have an advisor you will also be paying a fee to them as well.   I’m not saying having an advisor is a bad thing- for some people really feeling overwhelmed, a good advisor can really get you on the right track.  However, I also think if you are motivated with just a little time commitment you can put money into a mutual fund and invest on your own too.

How do I pick a mutual fund?

You can google some top mutual funds; take a look at the performance over 10 years (including recent data too) and the fees with each.  Pick one.  If you are paralyzed by indecision, it may be worth your time to get an advisor.

Find a good finance app to help you look at these charts quickly and for brief summaries of the important info you need.

Download one today (they are free)- I use yahoo finance; Charles schwab, and cnbc.  You may need to try a few to find one that works well for you.

One particular mutual fund over different time frames (Vanguard 500 index Fund):

IMG_1631

3 months

IMG_1630

1 year

IMG_162910 years

Mutual funds (namely index funds comprised of stocks) are often more likely to mirror the overall stock market trend than an individual stock given its diversification.  Luckily, the overall trend in the market is typically UP.  Your mutual fund will not guarantee the typical 8% yearly return of the stock market, but may be closer than if you bought an individual stock.

Remember, I am not a financial advisor.  I have no crystal ball.  I don’t know which mutual fund will do better than another.  However, I do know that people who have invested long term in the stock market have done well and will continue to do well.  You can decrease your risk with diversification (owning more than one stock as in a mutual fund).  There is minimal time commitment (which is a plus for busy physicians).  You can build wealth if you invest in the stock market early in your career and leave the money alone.  Put the money in and let it grow for you over the years- no need to check back too frequently or you will just make yourself panic when the stock market dips down occasionally, as it always does.  Even if we hit a Bear market or serious downturn in the coming years, it will be important to keep invested as the market will eventually recover.

By this point, seasoned investors will be rolling their eyes at me for the basic nature of this post.  On the other hand, I am certain some readers will be feeling overwhelmed with information overload on pretty boring and dry topics.  It’s not as exciting as learning a medical procedure, as gratifying as building a lasting relationship with a patient, or as rewarding as delivering a baby.  However, you owe it to yourself and your family to develop a basic understanding of finances.  It’s not selfish to invest and maximize your potential earnings.  Doing so will provide you a future with more control over your life (when to retire), be able to handle an emergency (unexpected health bills, loss of job), and have the ability to give more generously through charity and donations.

Again, I am not endorsing any particular mutual fund.  Don’t make financial decisions from me, but your own research.  A mutual fund is a nice place to start, but if you are ready to try buying individual stocks stay tuned for the next article.

 

 

Investing

Getting into the Stock Market as a Physician? It’s not as Complicated as you Think.

As a young physician, I found that most of my colleagues were completely financially illiterate- myself included.  The simple fact is that we have dedicated our time and efforts to learning about medicine, not finances.  We also tend to find reading material on the subject dry and uninteresting.  However, with more and more physicians in debilitating debt from student loans, learning how to manage your finances has never been more important.

ANYONE can learn about investing (which I believe is the way to truly build real wealth in this country).  If you plan to save and retire off your income alone, you can do it but will need to continue working much longer than if you invest money from the very beginning in the stock market.  Make your money work for you.

I have found that there are several helpful financial websites out there for physicians such as White coat investor https://www.whitecoatinvestor.com/ and Physician on Fire https://www.physicianonfire.com/. I have referred many physicians to these sites.  However, in talking with my fellow physician friends (mostly women physicians), these websites are full of great information but can still feel overwhelming, especially when first starting out.

So, I will be starting a financial series and breaking it down from the beginning to help you get started.  No, I am not a financial advisor.  No, I am not backed by a financial institution.  I’m not really getting anything out of this other than maybe a few clicks to my website (but as other bloggers can attest, it barely adds up to anything).  Why am I doing this, then?  Well, I see a need.  I was in your position.  I have retired early thanks to wise investments and financial principles and now I have the time to help out those interested in the stock market but are afraid to jump in.  I do not claim to be an expert, but I don’t think you need to be in order to reach your financial goals (whatever they may be).   Hope you find it helpful.  We are starting with baby steps.

 

SET UP AN ACCOUNT FOR INVESTING

(This is separate from your 401K-make sure you have maxed that out first before investing in another account to receive the tax benefits of 401k).

You will need to pick a trading platform.  There are many companies for this.  They are all pretty similar and it ultimately doesn’t really matter which one you go with as long as you just start investing.  Back in the day, people used to use stock brokers and they would call on the telephone and urge you to invest in certain things.  Now, all you need is a computer and you can easily set up your account and start investing on your own.

I personally use Charles Schwab.  You could also pick Etrade, robinhood, Tdameritrade, etc.  Don’t get paralyzed by the choices, just pick one.

Here is the link to Charles Schwab to make it easy for you:

https://www.schwab.com/public/schwab/client_home

Click on “open an account

Type of account you want to open: “Brokerage”.

Then just follow prompts to open your account- will take less than 20 minutes.

You will need to transfer money into this account (you can link your bank account to make it easy or send in a check).  I recommend linking your account so that you can easily contribute in the future or set up automatic transfers each month.  Make it easy on yourself to keep investing!

 

Again, you can do this with any trading platform you wish- I happen to use this one, so I am sharing with you as I have found it easy to navigate, follow my stocks, and actively trade stocks.  I also like the interface of the app for my I phone.

Make it your goal to set up an investment account this week.

moneytree

Once your account is set up and money is transferred (make take a few days to have money accessible for you to invest), we will get started.

Expect my next post within the week.  It will go over the next step, which will be choosing what to invest in.  To delve into that further, we will have to get into some financial terminology but I plan to keep it simple, brief, and to the point.  We will talk about long term investing and mutual funds and how to do it.

Future Topics I plan to cover in the most basic way possible:

Investing- Mutual funds

Individual stocks

Saving for College: Setting up a 529 plan

Making a will/estate planning

I hope you follow along and share with any friends who may find this information useful as we work our way into investing.

hospital birth, Uncategorized

Rising Maternal Mortality in the US: Real or Just Hype?

The statistics are staggering.

The high maternal mortality rate in the US has been a matter of great interest and debate, spurring a reflective look into our healthcare system to determine why our country is on the wrong end of this statistic. The reasons and numbers vary across the country and notably in the state of Maryland, which has had a higher than average maternal mortality rate, the number of maternal deaths continues to increase at a rapid pace.

In a comparison of two study periods (2005–2009) to (2010–2014), while the maternal mortality rate increased by an astounding 32% nationwide, it increased by an even more astounding 51% in Maryland. https://www.acog.org/-/media/Sections/MD/Public/MarylandMMRposter2017.pdf?dmc=1&ts=20170927T1731113112

I must admit, as an obstetrician-gynecologist I was skeptical of the media hype regarding maternal mortality in the US (compared to other countries with less advanced technology and more limited access to medications and high quality medical care).

However, there is no denying the fact that the rate is indeed increasing. As I think about these statistics, it becomes clear to me that there are two major crises in the field of women’s health.

Maternal Mortality

The causes vary, but as discovered in the “Maryland Maternal Mortality Review Program” in 2014, the leading cause of death of pregnant women was substance abuse disorder – unintentional overdose. Meanwhile, the leading cause of death directly associated with pregnancy was hemorrhage.

Death by drug can be experienced by anyone, but death directly associated with pregnancy can only be experienced by the pregnant. This difference is important. 

On news outlets, social media, and magazines you have likely heard stories about the loss of a pregnant mother or postpartum patient under horrible circumstances of medical negligence or some preventable health cause. These stories are heartbreaking and infuriating and should not happen, especially in this country. These types of stories also bring ratings, clicks, followers, etc. and are unfortunately also a contributing cause for the growing distrust of physicians based on a very small minority picture of the problem at hand.

The important piece to consider is that a woman who overdoses while pregnant is also considered in overall pregnancy death statistics. Again, overdose was the #1 cause of pregnancy-associated death. The US is facing an opioid epidemic and pregnant women are not spared from this.

Substance abuse prevention and treatment programs during pregnancy will be paramount in reducing the number of maternal mortalities.

More research is needed to determine the complete impact drug use is having on our maternal mortality statistic.

Hemorrhage treatment is also an area where we can improve, and an effort has been made to have massive transfusion protocols and training in hospitals. This is a start.

Ob-Gyn Shortage

Is our country’s shortage of obstetricians linked to our high maternal mortality rate? I don’t think we have the evidence to support this notion. However, we may start to see concerns in the coming years as this shortage becomes more pressing.

The American Congress of Obstetricians and Gynecologists (ACOG) put together a workforce to assess the situation. https://www.acog.org/-/media/Departments/Government-Relations-and-Outreach/WF2011NV.pdf?dmc=1&ts=20170927T1856198056 Facts that emerged are as follows:

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In the state of Nevada there are 11 (out of 17) counties without a single practicing ob-gyn. Nevada’s female population is expected to increase by 64% by 2030, while the total US female population is expected to increase by 17%.

There are 2.08 ob-gyns per 10,000 women in this state.

By the year 2030, the US is expected to have an 18% (9000) shortage of ob-gyns.

These numbers are outrageous and it is obviously not limited to the state of Nevada, but a nationwide concern. What is causing this ob-gyn shortage, seen not only in Nevada but across the country? Well, the task force also noted an increase in the population of women in the US of 26% since 1980, but the number of ob-gyns trained has remained stagnant due to limited residency training spots (which are still filling each match day). Medical students still remain eager to enter the field of ob-gyn, although with some trepidation and concerns regarding lifestyle and malpractice premiums/lawsuits. The problem arises after they finish residency.

We are starting to see an aging ob-gyn workforce. In addition, physicians are working decreased hours and are retiring early from obstetrics. More recently, ob-gyn residents are opting to avoid obstetrics altogether and are choosing to sub-specialize at increasing rates in fields such as Minimally Invasive Gyn Surgery, Urogynecology, and Gynecologic Oncology. Work-life balance can be better in these fields and malpractice premiums are also much lower. Maintaining our current ob-gyn workforce should be top priority. This starts with supporting them by finally obtaining meaningful liability reform, sustainable working conditions, a positive PR campaign, and increasing the number of residency spots (especially in states such as Nevada with urgent needs).

If we don’t address the obstetrician shortage, we will burn out the ones still in the field. It is not good for our physicians, or more importantly, our patients to have a limited supply of medical knowledge and expertise. In our efforts to decrease the maternal mortality rate in the US, the ob-gyn shortage must also be addressed.

 

Maternity Leave, Parenting, Physician Training, Uncategorized

Best Time to Have a Baby as a Physician? It Depends.

Is there truly a best time to be pregnant, have a baby, and care for a newborn during a medical career? I’ve done the groundwork by having a baby in residency and two more as an attending. Here is what I found out along the way.

 

Is it even possible to have a baby during residency?

It was the end of a 24-hour call – I’m guessing similar to the ones most physicians in residency experience. Zero sleep, several high-intensity and stressful patient care situations, and a few graham crackers and ginger ale from patient waiting areas throughout the day to keep you going. When the call ended, the right thing to do was to lay down and get a few hours of sleep prior to driving home. However, your baby is waiting, and you haven’t seen her in 24 hours. You pumped milk in between admitting patients from the ER and a quick add-on surgery. You are desperate to get it home to see your child, so you rush out the hospital doors after carefully signing out to your oncoming resident.

 

Once home, you can’t wait to see your baby, your everything. Instantly, all stress evaporates and her belly laughs melt away the last 24 hours. Your husband gives you a quick kiss, hands off the baby that kept him up all night teething, and immediately heads out to the gym for an hour of his own much-needed downtime before starting his workday.

 

You lay on the floor to play with her and arrange pillows and toys surrounding her while you rest your head…just for a moment. The 24 hours of no sleep catches you and you realize you fell asleep on the floor next to your baby with no one else around. It scares you. Luckily, she hasn’t learned to crawl yet and is still content playing with toys. Exhaustion and exhilaration fill your days as a new parent/resident physician.

 

Time is lacking. Love is not. You will likely have to put your baby into childcare sooner than you would like. Six weeks maternity leave is pretty standard (but expect to use all of your vacation time for the year to cover it). You will also need to factor in additional calls before or after your baby is born to make up for the call you miss during leave. Your fellow residents will help by picking up the extra calls in your absence and will appreciate your reciprocity. As uncomfortable and painful as it is to take additional 24-hour calls while you’re pregnant, I highly recommend this instead of waiting until after the baby is born. Until maternity leave policies change in the US, this is what can be expected with having a baby during residency. More than six weeks off will likely involve adding time to your residency training. I actually agree with this as the high-yield information/learning obtained during residency will sustain your whole career; missing a large portion of it may put you at a disadvantage.

 

In the end, you will miss a few of the early milestones but will be reassured knowing that you will be available more in the future as an attending physician as your child grows older and is able to form memories of your time together. Plus, the days fly by as you are invigorated by your interesting days as a resident, while also knowing your life outside of the hospital is quite rich.

 

Your child will not suffer long-term consequences from you not being the one giving all the bottles during the day and tucking in for naps. You will be able to finish your training on time and have colleagues and program directors to help you cover the patients who need to be cared for in your absence.

 

The one person who may suffer a little bit is you. It’s hard to be away from your newborn while working 80 hours per week. So, why not wait until later to have a baby? Well, read on…

 

Yes, it is acceptable to plan your life and think about money

You may think this is backwards, but it actually makes more financial sense to have a child during residency than as an attending. I definitely don’t recommend finances to be the sole reason for having a baby during residency, but if you were thinking it didn’t make financial sense to do so, it may give you something to consider. We’re getting practical now. I personally didn’t factor in any of this when starting my family but realized the impact looking back.

 

You will be getting paid while on leave as a resident (covered through your accrued vacation time). You will have access to excellent health insurance coverage. It is not uncommon for your entire pregnancy and delivery to be covered by a $20 copay as a resident. Don’t expect this as an attending; if you aren’t seeing patients, you aren’t getting paid. It may also be difficult to find enough colleagues to help you cover your patients if you are in private practice. Most large employers will have some type of leave policy, but few will pay your salary while out.

 

As an attending I was able to take 12 weeks of leave, but it was unpaid. If you evaluate lost wages and earning potentials pragmatically, you actually come out far ahead by having a baby during residency. As an attending, you may be making 5x the amount of a resident, and 12 weeks unpaid leave is quite different than when a resident. When you don’t work as an attending, you don’t get paid. Why does this matter? Well, most of us right out of residency have six-figure medical school loans we need to repay as quickly as possible. Of course we don’t want money to be a factor in family planning, but sometimes it is, and it’s better to understand the consequences upfront.

 

The flip side to this is that, as an attending, you will have more income at your discretion. That income could provide a higher quality of childcare, and as mentioned earlier, help you enjoy more time with your newborn.

 

Why do we hate the term “advanced maternal age”?

 

time

Lastly, but perhaps most importantly, is age. In a recent discussion with other physician moms, more than half had gone through costly infertility treatments to complete their families. Some spend close to $100,000 for these treatments. Most of us in medicine are very driven people, who enjoy the rigors and challenges of our careers. We work diligently to make it through to the “light at the end of the tunnel” once the 8+ years of medical education is complete. However, once we can finally start to focus on family, children, and an existence outside of the hospital, we may have lost more than realized.

 

Far too many women may have missed out on their prime years of fertility by putting off childbearing. By the time medical school and residency is complete, most of us are approaching 30; add on a few years if fellowship is considered.

 

While 30 years old is likely not an age-related fertility concern for most, if you plan to have more than one child, it definitely could be. Around age 35, fertility starts to decline. In addition, if you do get pregnant, you are considered “advanced maternal age.” There is a higher risk for gestational diabetes, hypertension, chromosomal abnormalities, and miscarriage. Suddenly, you may find yourself longing for a second child, a sibling for your growing toddler, or a much-anticipated first child, but the answer may not come so easily. Physicians are fortunate to have stable incomes that allow us the opportunity to seek fertility treatments when needed. Ultimately, you will likely be able to complete your family, but it may be a long, financially, and emotionally exhausting journey through fertility treatments – and not the route you expected.

 

What really matters most?

Ultimately, the decision whether or not to have a child is very personal, and not every female physician desires this. However, the majority of female physicians do eventually become mothers. Our lives may become busier, but the dedication to medicine and our patients does not waver from the act of having a child. In some ways, I became a better physician after my own childbirth experiences.

 

The right time to have a child will be different based on personal values, support systems in place, and emotional readiness. But, perhaps we can help each other by being honest and open about what it is like to have children during a medical career. This way we can each determine the right time to expand our family, independent of pressures and expectations from outside influences.

hospital birth, retirement

Is your City on the list for the coming Ob-Gyn Shortage Crisis? Find out here…

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:
Riverside, CA
St. Louis, MO
Las Vegas, NV
Oklahoma City, OK
Phoenix, AZ
Houston, TX
San Antonio, TX
Los Angeles, CA
Dallas, TX
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)
Hartford, CT
Richmond, VA
Louisville, KY
San Jose, CA
Birmingham, AL
Boston, MA
Portland, OR
San Francisco, CA
New York, NY
Providence, RI

 
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.

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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:

https://www.yahoo.com/news/growing-shortage-ob-gyn-doctors-threatens-womens-health-150842816.html

https://www.statnews.com/2017/07/20/ob-gyn-shortages/