Why being an OB-GYN is challenging compared to other medical fields
The Sacramento region is suffering a shortage of women’s health providers, local OB-GYNs warn. Experts say those shortages extend nationwide and are projected to get worse in the coming years.
A study released earlier this year by Doximity, the nation’s largest online network for health care providers, ranked Sacramento ninth in a list of the top 10 metropolitan areas in the nation with the highest risk of an OB-GYN shortage.
The online network uses a score system to assess the severity of the lack of providers in 50 of the nation’s metropolitan areas, taking into consideration the age of practicing providers and the ratio of births to OB-GYNs.
“In the metropolitan areas with older OB-GYNs and higher workloads, we expect that they have a greater risk of shortages,” said Dr. Peter Alperin, vice president of connectivity solutions at Doximity.
California’s capital also has an aging workforce. Sacramento ranked seventh out of 15 for metropolitan areas nationwide with the lowest percentage of OB-GYNs younger than 40.
Sacramento’s percentage of providers under 40 is 4.29 percent, compared to the national average of 16 percent, according to Doximity.
“I think almost every group in town is trying to hire,” said Dr. William Gilbert, medical director of Sutter Women’s Services in the Sutter Health Valley Area and a high-risk maternity OB-GYN.
Gilbert said he thinks the local shortage is due partly to population growth in the region but also to the higher wages elsewhere in the nation for the same position and the high cost of living in the area.
Although the number of trained OB-GYNs has remained virtually unchanged since 1980, the U.S. has seen a 26 percent growth in the population of women. By 2020, the American College of Obstetricians and Gynecologists projects a shortage of 8,800 OB-GYNs and a shortage of as many as 22,000 by 2050.
The group says “the strain to the OB-GYN workforce could be crippling.”
In addition to providing routine and preventive care to women of all ages, OB-GYNs provide essential care to pregnant women before and during childbirth. The field is the fourth-largest physician workforce and the largest adult specialty aside from family and internal medicine, according to ACOG.
The ramifications of an insufficient number of women’s health care providers can be dire.
“Women get suboptimal care and die,” said Dr. Amy (Meg) Autry, a professor and the director of graduate medical education in the Department of Obstetrics, Gynecology and Reproductive Sciences at UC San Francisco.
According to Doximity, OB-GYNs have “the highest burnout rate of all medical specialties,” next to emergency room doctors.
“I’m burned out all the time,” Gilbert said. “You have to be ever vigilant ... because everyone expects a good outcome. If you get a bad outcome — and that’s going to happen — you’re set up for a major lawsuit.”
Gilbert attributes the earlier retirement age of OB-GYNs to the fear of a malpractice suit. Although it’s less money, Gilbert said, sometimes it’s easier just to walk away from the practice.
“At least you can sleep at night,” he said.
ACOG associates high malpractice premiums with a decrease in providers practicing obstetrics — the field of care for pregnant women before, after and during childbirth. Because this field of care delivers babies, the job requires providers to work at unpredictable hours.
“Our after-hours work is challenging,” said Dr. Laurie Gregg, an OB-GYN and medical director for patient safety and quality for women’s services at Sutter Medical Center in Sacramento. “Those babies and emergencies rarely come between 8 and 5, and many OB-GYNs have nights without sleep.”
The next generation of physicians also wants a more balanced life. ACOG reports female OB-GYNs are younger overall and “more likely to work part-time schedules and balance career-building with child-rearing.”
A large part of the ongoing shortage in the workforce has to do with factors associated with residency programs.
The number of accredited first-year residency programs has, essentially, remained unchanged since 1980. Meanwhile, ACOG reports the number of graduates from residency programs has decreased in relation to an increase in the U.S. population.
Gilbert, who has worked as an OB-GYN for almost 30 years, has become involved with efforts to recruit people into the profession.
“Almost all qualified candidates are qualified women,” Gilbert said, explaining this is because women want to work in the field. Patients also often prefer female providers.
In 2017, 58.7 percent of OB-GYN providers in practice were women. ACOG projects this number will increase to 66 percent in the next decade.
The ongoing trend of women entering the workforce has become more apparent to local providers like Gregg, who has been in practice in the region since 1998.
“When I started in Sacramento, I had three male partners and no female partners,” she said. “Now I have four female partners and one male partner. In 2018 nationwide, 57 percent of all OB-GYNs are female. If you look at the newly trained OB-GYNs — in the first three years after graduation — 83 percent are female.”
Gilbert noted a concern within the profession: Fields where women are overrepresented, like pediatrics and OB-GYNs, “tend to be underfunded.”
Health professionals also have identified stagnant funding for training as an acute problem to explain the OB-GYN shortage. Most of the funding for residency slots comes from Medicare, and the Balanced Budget Act of 1997 put a cap on those payments.
“While medical schools have increased enrollment by nearly 30 percent since 2002, the 1997 cap on Medicare support for graduate medical education has stymied the necessary commensurate increases in residency training,” explains the Association of American Medical Colleges. This has led to “a bottleneck for the physician workforce.”
Health care professionals identified immigrants who are trained physicians as a critical and needed labor supply.
“Congress needs to understand that there is a huge physician shortage,” Gilbert said. “One of our best supply of physicians was immigrants.”
Health care professionals predict an increase in the number of midwives and those jobs referred to as “physician extenders” or “enhanced providers.”
“Medical needs of the U.S. adult female population during the next decade cannot be met by OB-GYNs, family physicians and general internists alone,” the 2017 ACOG report states. “More collaborative team-based care would improve access to health care. The addition of qualified nonphysician health care professionals ... should help meet those needs while potentially reducing the cost of care and the need for additional health care professionals.”
Professionals hope new models of care will be effective in improving the shortage.
“The problems are real, the solutions are difficult, but they’re there,” Gilbert said. “If we don’t start early to take care of our pregnant mothers, we’re setting ourselves up for failure.”