Confronting the projected OB shortage

Everyone is familiar with the classic television line when a woman unexpectedly goes into labor: “Is there a doctor in the house?”

But if you’re delivering a baby in the next few decades, the answer may well be no.

A recent report by Doximity warned of a looming OB/GYN shortage, noting that the current trajectory of decline in OBs would result in an 8,000-person OB gap by 2020, and a shortage of 22,000 providers by 2050.

While the report identified several factors behind the pending shortage, the authors noted that the age of retirement is a significant factor. Most OB-GYNs begin to retire at age 59, six years before the median retirement of their fellow physicians.

The reason, according to Doximity: OB-GYNs tend to retire younger due to the demanding nature of obstetrics.

While this shortage will impact many regions, two of the regions that I oversee as Medical Director of Operations for Ob Hospitalist Group are in the “top ten” of areas most likely to suffer shortages: Los Angeles and Riverside, California. In effect, that means pregnant women in some of the most populous regions of California – as well as many other parts of the country -- risk being medically underserved.

Regional shortages represent real patient risk. Research suggests that the farther a woman must travel to receive OB/GYN care increases her risk for pregnancy complication and an adverse outcome. In many areas, especially across rural America, women must travel up to six hours to see an obstetrician or reach a healthcare facility that still offers labor and delivery services.

Shortages also represents organizational risk. Consumers are increasingly sophisticated about their healthcare choices, including hospitals and health systems. To remain competitive in an industry with tight margins, hospitals know they need to solidify customer loyalty – and as The Advisory Board notes, “Because many patients’ first contact with a hospital is through labor and delivery, an OB program provides an opportunity to develop loyalty for other hospital services among community residents.”

Here are four actions that may help hospital and health system administrators protect their organizations from the projected exodus:

Leverage technology to supplement gaps. With Amazon’s foray into healthcare, it’s clear that technological disruption is not just a trend, but a certainty. Hospital administrators should explore using technologies such as wearable sensors to transmit fetal and maternal vitals such as fetal heart rate and uterine contractions. Similarly, artificial intelligence (AI) offers the potential to identify problems at an early point via intelligent algorithms that can be tailored by facility, clinician, and even patient. These technologies can alert OBs if there is a change in fetal or maternal status, triaging and prioritizing OB time for clinical needs.

Tackle burnout by designing programs with built-in balance. OBs retire earlier than their peers because the demands of the job can be extensive – the pressures of maintaining a community practice as well as being responsive to the needs of laboring patients at any time, day or night.

OB hospitalist programs can help by relieving some of the pressure on community OBs to drop everything and rush to the hospital. Having a clinician onsite 24/7 allows the community OB to travel to the hospital at the right time, knowing his/her patient is being carefully monitored by an obstetrician.

Help community OBs maximize reimbursement. OB hospitalist programs can also provide value with Medicaid-funded births. For some hospitals, Medicaid-funded births are associated with lower reimbursement, as well as increased liabilities as Medicaid-funded births represent a higher incidence of complications due to lack of prenatal care. For many community OBs practicing in high Medicaid regions, the combination’s impact on compensation may be a disincentive to maintaining a long-term regional practice. But the right OB hospitalist program can provide care for all unassigned and uninsured presenting patients if necessary, relieving some of the financial impact on community OBs.

Leverage staffing options to create the right clinical balance -- for the right patient, in the right setting. A physician is not necessary for every single aspect of the laboring process. Nurses and Certified Nurse Midwives (CNMs) can also fill a need when appropriate. According to the American Midwifery Certification Board, as of August 2017, there were 11,826 CNMs in the United States, and almost 95 percent of CNM-certified midwife–attended births took place in hospitals. Slotting the best member of the clinical team to handle the right tasks may help hospitals for which regional shortages become profound.

Healthcare executives who are proactive in their workaround strategies will be best prepared if – or in the worst case, when – OB shortages threaten local organizations.

Donald U. Toatley, MD, MBA, FACHE, is Medical Director of Operations for Ob Hospitalist Group (OBHG), which provides in-house, highly skilled OB/GYN clinician support, including obstetricians, nurse practitioners, and Certified Nurse Midwives (CNMs), to partner hospitals 24 hours a day, 365 days a year.

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