The United States is expected to see a shortage of up to nine thousand OBGYNs by 2020, despite the fact that the number of women and number of babies being born is still growing. What does the upcoming OBGYN shortage mean for expectant mothers? We’ll address the factors driving the problem, ways people are trying to adapt and a few potential solutions.
The Numbers
The American Congress of Obstetricians and Gynecologists estimates that there will be between six and nine thousand fewer OBGYNs than are needed to serve the population in 2020. If trends continue, the shortage could reach 22,000 by 2050.
Almost half of the counties in the United States do not have an obstetrician/gynecologist. More than half don’t have a nurse midwife. This is causing women to have to drive hours to see an OBGYN. The delays in receiving care or difficulty in receiving it may be a factor in the relatively higher maternal death rate in the United States.
Ease Restrictions to Increase Alternative Caregiving Options
One possibility is reducing the restrictions on nurse midwives so that they can provide more care and services. For example, there is a bill in the California legislature that would remove the requirement that nurse midwives work under the supervision of a doctor.
A trend already underway is the growth in “laborists”, OBGYNs and nurse midwives who only focus on labor and delivery. This leaves other OBGYNs more time to focus on other issues. It is also thought to reduce burnout for OBGYNs since they aren’t up at all hours tending to patients in labor. More than two hundred hospitals have laborists on staff.
Another option is seeking care abroad. A lack of care at home is pushing more women to go overseas and many services are already offering air medical transport to this demand.
Introduce Financial Incentives
There are proposals to offer financial incentives to get more medical professionals to specialize in maternal health. The ACOG is pushing Congress to provide financial incentives for medical students to go into obstetrics and gynecology.
This would be expected to raise the number of OBGYN residents from current levels that have been steady since 1980 despite the population growing exponentially in the intervening years. That supply has been constrained even further by those who study obstetrics and gynecology but go into reproductive endocrinology, infertility, or gynecologic oncology.
In 2000, less than 10% of residents entered a sub-specialty. The rate was nearly 20% by 2012. Physicians groups are trying to offset this by seeking to increase the number of medical residencies by 15,000 with half of those dedicated to specialties in short supply, including OBGYNs. Note that the federal government currently funds about 30,000 residency positions each year. This change would greatly increase the supply of young OBGYNs.
Other plans would incentivize them relocating to areas without these services, especially rural areas. The ACOG has backed a proposal that would let the federal government designate areas with critical shortages and make both nurse midwives and OBGYNs eligible for financial help with their school loans. At least one school is sending willing students to rural residencies, knowing that around half of all residents stay in the place where they complete their residency.
The United States is expected to see an uptick in the number of babies born each year. We need to make changes to ensure that some sort of qualified medical professional is there to greet them upon arrival.
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