The Looming Shortage of OB/GYNs

A perfect storm is brewing in the area of OB/GYN, likely to create a shortage of OB/GYN practitioners in its wake, suggested experts during the 2010 annual meeting of the American Congress of Obstetricians and Gynecologists (ACOG) at a session titled, “The Future OB/GYN Workforce: Will We Have the Right Number, Distribution, and Skills?”

The demand for physicians in the coming years is projected to exceed the supply, and this challenge will also be faced by OB/GYNs, said Edward Salsberg, Director, Center for Workforce Studies, Association of American Medical Colleges, Washington, DC. A major contributor to this much-anticipated storm is the increasing demand for physicians. “There is a gale force wind on the demand side,” Mr Salsberg said.

The most obvious factor leading to the increase in demand comes from the continuing growth of the US population— about 25 million people per decade. The aging US population is another factor: the number of citizens aged >65 years is slated to double between 2000 and 2030, and many baby boomers will be reaching age 65 next year, Mr Salsberg added. The increase in older individuals translates to a rise in chronic illnesses, resulting in more visits to physicians overall. In addition, physician office visits by those aged >45 years continue to increase, he said.

Improved survival rates, and the impact of decades of increasing obesity rates and poor lifestyle, will also help fuel the physician shortage, along with the need for addressing existing disparities in care.

Healthcare Reform
Healthcare reform will also play a huge role in demand, with 30 million new patients being added to the system, said William Rayburn, MD, MBA, Seligman Professor and Chair, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque. “As our population gets older and with increasing patients from healthcare reform…. OB/GYNs are going to have to do more primary care, whether we want to or not, because it’s needed,” Dr Rayburn noted.

Healthcare reform brings both good and bad news for OB/GYNs, according to Mr Salsberg. The good news is that the principles of healthcare reform align themselves nicely with those that are important to OB/GYN—access, continuity, collaborative practice, and bundled payments. The bad news is that healthcare reform provides extensive support for primary care, but OB/GYN is not considered primary care.

Regarding the care being provided, there is some “schizophrenia or confusion” within the field, said Erin Tracy, MD, MPH, Assistant Professor, Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Massachusetts General Hospital, Boston. A survey of 139 OB/GYNs revealed that 64% do not wish to provide primary care in their practices, whereas 62% feel they already provide primary care, she said.

In response to Mr Salsberg’s question whether OB/GYNs should “jump on the bandwagon” of the reform-born patientcentered medical home, Douglas Laube, MD, MEd, Professor, Obstetrics and Gynecology, University of Wisconsin-Madison, said he sees a place for OB/GYNs in the medical home. “I hope we can at least rent a room in the home and carve a place for ourselves in…primary care,” Dr Laube said.

The Aging of OB/GYNs
There is “no rescue in sight on the supply side,” Mr Salsberg said. Baby boomers reaching retirement age will also have an impact on practitioners; he predicted that retirement among physicians will spike over the next 3 to 5 years, because many put it off as a result of the depressed economy.

In addition, 39% of all active OB/GYNs are older than 55 years. Although the number of OB/GYNs entering the workforce is growing slowly but steadily, the number reaching retirement age is about the same. Also, he said “there is some frustration” among OB/GYNs in general, which may lead to early retirement.

The Gender Gap
Gender also comes into play. The predominance of women OB/GYNs is significant from a workforce planning perspective, because male physicians work longer hours than females, and both sexes work fewer hours after reaching age 65. Among physicians of both sexes who have children younger than 5 years, males work more hours than their female counterparts, Mr Salsberg said.

“Female physicians do twice as much work at home,” compared with their male counterparts, Dr Tracy said, attributing the discrepancy to cultural expectations of women. She added that 20% of OB/GYNs have worked parttime at some point in their careers, and data have shown that part-time physicians are more productive. Overall in the United States, 8% of men and 21% of women work part-time. “If you are looking to hire a female partner, you cannot assume she wants to work parttime,” she pointed out.

In addition, the number of American women is projected to increase by 15% between 2010 and 2025, with the number of childbearing-aged women expected to grow by 10% during that time, which will also have an impact on the OB/GYN profession, Mr Salsberg said.

“We’re going to have a shift of more women ACOG fellows taking over the workforce,” Dr Rayburn said, citing the 10-year age differential between men and women gynecologists. The average age of a male ACOG fellow is 54 years, and the average age of a female OB/GYN is 45 years.

Weathering the Storm
In light of these projections, the question of what will happen in the event of an OB/GYN shortage looms large. “Our system responds to shortages,” Mr Salsberg said.

On the supply, or practitioner, end of the equation, a shortage would bring the following changes:

• Practitioners work longer hours
• Increased use of nurse practitioners and other support staff
• Extended time between visits
• More phone/e-mail contact with patients (if reimbursed?)
• Innovations.

On the demand, or consumer, side, changes would include:

• Longer waits for appointments
• Increased emergency department use
• Traveling farther for care
• Seeing different types of providers
• Some patients do not get necessary care.

How things play out will depend largely on how OB/GYNs respond to the predicted shortage. “How can we use teams better? How can we delegate better? Regardless of the number of physicians, how we use those physicians determines a lot,” Mr Salsberg said. “These changes are a challenge, but really an opportunity.”