Why Some Ob/Gyns Are Walking Away

When Donna Adams-Pickett, PhD, MD, graduated from medical school 25 years ago, she never dreamed she’d 1 day stop offering OB services to her patients.

This was an especially difficult decision for Adams-Pickett because her choice of specialty was both personal and heartbreaking.

“I lost my paternal grandmother in childbirth, so I wanted to fulfill this dream of delivering women in a safe, cared-for environment,” Adams-Pickett, a solo practitioner who runs the Augusta Women’s Health & Wellness Center in Augusta, Georgia, told Medscape Medical News. “I wanted to treat women from underserved populations, and these were patients who were traveling upward of an hour and a half for their appointments since the closest OB care is 85 miles in either direction.”

Unfortunately, soaring malpractice premiums and restrictive reproductive legislation in her state rendered the OB part of her practice unaffordable — and risky from a litigation perspective.

“There is no way for me to sugarcoat it,” she said. “It was devastating for me to stop delivering babies.”

The Shortage Tracks to Medical School Graduates

Adams-Pickett’s story is, unfortunately, all too common. While some Ob/Gyns are eliminating obstetrics, others are leaving the field entirely either to retire or switch specialties. In states with stricter abortion bans, the number of providers has dropped, and there’s been a marked decrease in medical students interested in pursuing residencies in those states, according to research conducted by the Association of American Medical Colleges.

The numbers are glaring: By 2050, predictions show that there will be a shortage of up to 22,000 Ob/Gyns with a significant gap of 3000 women’s health specialists in the next 5 years, according to a report from the Department of Health and Human Services.

The problem, frankly, starts when medical students are deciding on their subspecialty, Adams-Pickett said. This is the moment when the realization of how difficult this specialty is comes into play — as are the concerns about the threat of litigation.

“When medical students choose a subspecialty, they are looking at our lifestyle, and they’re trying to prioritize their mental well-being and health,” she said. “If they think, ‘I’ll never be home with my family,’ and there is significant probability they’re going to be involved in multiple pieces of litigation over their careers, that’s not attractive to them.”

In addition, the graying of the profession and concern about practicing in states where Ob/Gyns feel their licenses or personal freedom could be at stake by caring for their patients contribute to shortages.

“I think it’s a combination of burnout, retirement, and a feeling that the current practice environment feels hostile to women’s health professionals,” said Barbara Levy, MD, chief medical officer at Visana Health, a virtual women’s health clinic in Minneapolis. “When there’s clear medical evidence to support care pathways and laws or regulations that prohibit optimal care for our patients, women’s health practitioners face moral conflict, which is difficult to live with.”

Despite This, Change Is Possible

When you ask Ob/Gyns what should be done about these issues, they’re quick to offer some clear ideas that could reverse current trends.

“The easiest fix is to improve the lifestyle issues affecting us,” said Adams-Pickett. “This could include creating models where physicians can sign out a patient in the evening to a hospitalist so the Ob/Gyn can go home at a regular hour and then return in time for delivery.”

A team approach to support obstetrics that includes nurse practitioners and physicians’ assistants would also be instrumental in reducing stress. That’s what Fatima Naqvi, MD, an Ob/Gyn and the medical director of Women’s Health at Atlantic Medical Group in New Jersey, has already begun to address. At her practice, this means adding more midwifery to the OB team.

“Midwives have been known to decrease C-section rates and increase breastfeeding,” Naqvi said. “We are championing Family Connects NJ, a program that offers new mothers free at-home nursing care, and we’re working with more doulas to provide critical postpartum care, legislation that Tammy Murphy, the wife of New Jersey’s governor, advocated for.”

In addition, malpractice policy reform would be hugely helpful, adds Lisa Bukovac, DO, an Ob/Gyn and senior vice president of clinical operations at Ob Hospitalist Group, the nation’s largest and only dedicated hospitalist provider. “I’m not saying there isn’t medical malpractice and that it isn’t valuable, but it’s abused in this country,” she said. “I’d opt for more arbitration and less litigation.”

Giving residents the option to either specialize in obstetrics or gynecology and gynecologic surgery — and making sure residents are given the latitude to focus on more intensive training in either field — could be a solution to shortages as well.

“If you go back 25 years ago when work hour restrictions were put into place for residencies, it was the right thing to do; there were fewer errors and patients were safer, but we didn’t lengthen the residencies for the time lost,” Bukovac said. “Residents were coming out of programs with skillsets that weren’t as robust. One way we could combat that and give residents more tools to provide care would be to separate Ob/Gyn and make them two different specialties.”

Bolstering maternity care in places where there are maternal deserts — over 35% of US counties are deserts, which affect 2.3 million women, according to research by the March of Dimes — would be an improvement, too.

“We see more and more maternal deserts every year because hospitals are saying they can’t afford to keep their labor and delivery units open,” said Bukovac. “When these units close, the care moves further away from women who don’t have the resources to travel another 30 miles to the next OB or the next hospital.”

Improving access to care via telehealth could also go a long way to improving health outcomes.

“We need to go to where our patients are since 40% of births in this country are patients on Medicaid,” Naqvi said. “For this reason, we’re trying to improve remote patient monitoring. We want to be in constant communication with our patients, make their lives a little easier, and provide continuity of care, which is essential, especially during pregnancy.”

Lambeth Hochwald is a New York City–based journalist who covers health, relationships, trends, and issues of importance to women. She’s also a longtime professor at NYU’s Arthur L. Carter Journalism Institute.