As the national physician shortage worsens, areas of the country with aging OB-GYN clinicians and high OB-GYN workloads are expected to face a high risk for physician shortfalls.
The stakes for women's health are high, according to Amit Phull, MD, vice president of strategy and Insights at San Francisco-based Doximity, which conducted the research.
"We're facing a national physician shortage in the years to come. OB-GYNs are one of the top specialties at risk and are central to women's healthcare in the U.S. The emergence of a significant shortage in this specialty could be terribly problematic from a women's health standpoint," Phull said in a prepared statement.
The American Congress of Obstetricians and Gynecologists (ACOG) estimates there will be a shortage of up to 8,800 OB-GYNs by 2020, with the shortfall approaching 22,000 by 2050.
The Doximity study includes data from the Centers for Medicare & Medicaid Services, board certifications, and self-reported information from about 43,000 OB-GYN clinicians. The research, 2018 OB-GYN Workforce Study, focused on the largest 50 U.S. metropolitan statistical areas by population.
One of the key features of the Doximity study is a risk index designed to identify which cities could feel the brunt of the OB-GYN shortage first. The risk index has two factors: the average age of the local OB-GYN workforce and the workload they carry based on births per OB-GYN per year.
"In the metropolitan areas with older OB-GYNs and higher workloads, we expect that they have a greater risk of shortages. In the metropolitan areas with younger OB-GYNs and lower workloads, we expect that they have a lower risk of shortages," the Doximity researchers wrote.
The Top 5 cities considered at high risk for an OB-GYN shortage are Las Vegas; Los Angeles; Miami; Orlando; and Riverside, California.
The Top 5 cities considered at low-risk for a shortage are Ann Arbor, Michigan; Birmingham; Portland, Oregon; San Jose; and Baltimore.
The Doximity study features several other key findings:
- In the study's 50 metropolitan areas, the number of OB-GYNs was compared to the number of annual births. St. Louis posted the highest workload, with 247 births per OB-GYN. Ann Arbor had the lowest workload at 32 births per OB-GYN. With service-volume capacity, low-workload areas should be resistant to physician shortages.
- Retirements are a key driver of the OB-GYN shortage. The average age of OB-GYNs was 51, with Pittsburg posting the oldest age at 52.32 and Houston posting the youngest at 48.38. The median retirement age for OB-GYNs is 64, according to ACOG.
- More than a third of OB-GYNs were 55 or older. In 32 out of the 50 metropolitan areas in the study, at least one third of the OB-GYNs were 55 or older.
- Only 16 percent of OB-GYNs were 40 or younger. In 12 of the metropolitan areas, less than 15% of OB-GYNs were 40 or younger.
- Metropolitan areas with large OB-GYN workloads also tended to have the highest number of women who were uninsured or covered by Medicaid. With Medicaid reimbursement trailing private insurance, these areas have downward pressure on OB-GYN compensation.
Christopher Cheney is the senior clinical care editor at HealthLeaders.