hpv, OB GYN, Parenting, vaccine

This Mom (and OB/GYN Doctor) Sounds Off on Whether Your Daughter Should Get the HPV Vaccine

My young daughter will be entering middle school in another year. However, she still likes coloring books. If she watches a scary movie, I have to lay with her in bed until she falls asleep.

She is still just a kid. Should I really be worried about HPV? Is this something you should consider for your daughter?

Most people know that the HPV virus is sexually transmitted. However, most people don’t think it could happen to their daughter. Unfortunately, more than 80% of the population has been exposed to the HPV virus during their lifetime. How is that possible?

Well, let’s assume your daughter has 1 lifetime sexual partner. Let’s pretend her future husband only had 1 girlfriend prior to meeting your daughter. However, maybe his previous girlfriend had 5 partners- and who knows how many exposures those 5 partners had.

Now it’s easy to see that you don’t have to be sexually promiscuous to be exposed to HPV. It could happen to anyone and often does. HPV is silent (there are often NO symptoms), and people don’t know they have it and therefore pass it on to others unknowingly.

As an ob-gyn doctor, I know about the HPV virus and have seen so many patients affected by this virus that can cause cervical cancer if left untreated. I have seen women die from cervical cancer caused by this virus. I have seen pregnant women who are newly diagnosed with cervical cancer have to decide whether to delay treatment or potentially risk their pregnancy by treating the disease.

Luckily, most of the time we can monitor the HPV virus through pap smears/hpv testing and never have to intervene as the body will often clear the virus on its own. Occasionally, treatment in the form of excisional procedures on the cervix are necessary to prevent progression to cervical cancer. If you have never seen a LEEP procedure done in the office, trust me, you want to spare your daughter from this if at all possible.

By the time a girl visits her ob-gyn’s office she may have already been exposed to HPV and we potentially missed an important opportunity to give the vaccine. This is due to the fact that we typically don’t see teens in the office unless they are having a problem, and we don’t start pap smear screening until age 21 (appropriately so).

vaccination-2722937_1920

Pediatricians (and family practitioners) do a fantastic job of making sure our young girls are getting the vaccine when indicated. Currently, the vaccine can be given to girls between the ages of 9-26 years old. Most girls are vaccinated with the series at age 11 or 12. Remember, the point is to vaccinate far PRIOR to sexual activity. We don’t expect your 11 year old daughter to be sexually active.

On the other hand, I have had to do numerous procedures on patients in their 20’s who have precancerous lesions from the HPV virus. Most are shocked and terrified and don’t understand how this could have happened to them.

As a mother, I am just like any other parent who would do anything to prevent my child from suffering. I worry about risks and benefits of treatments (even preventative) and how they will affect my daughter. I feel lucky to have had the opportunity to truly understand the research and risks behind this vaccine through extensive training in obstetrics and gynecology.

It is empowering to have access to a vaccine that can actually prevent cancer.

So, while the physician in me appreciates and understands the research and clinical implications this vaccine portends, when I counsel patients I find the mother in me also weighing in.

Since I do have a young daughter who I would do anything to protect, I can assuredly say that she will be getting her HPV vaccine when she turns 11. I want to know that I did my job as her mother to protect her when she can’t yet understand how this may impact her life down the road.

 

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.

images

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/