Story at a glance
- The United States is projected to experience a shortage of 5,000 OB-GYNs by 2030.
- This is expected to cause already overworked doctors to further struggle to meet demand and continue widening maternal and infant health disparities.
- An aging workforce, an aging population, high rates of burnout and abortion restrictions are all contributing to the shortage.
The United States is facing a shortage of obstetrician-gynecologists that is only expected to worsen moving forward.
There were about 50,800 OB-GYNs practicing in the U.S. in 2018, already too few to meet the country’s rising demand.
Roughly 3,000 fewer OB-GYNs will be practicing in the country by 2030, while the need for those doctors will continue to increase, federal officials projected in a 2021 report from the Department of Health and Human Services.
Some of the reasons for this shortage, like an aging physician workforce, are similar to those causing the nation’s overall healthcare worker shortage. But some, like the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, are unique to the specialty.
The number of doctors is in part falling short of demand because older physicians are retiring and leaving the workforce more quickly than younger doctors can replace them.
Almost half of the country’s working physicians are 55 years old and older, according to the American Medical Association. And a sizeable portion — 35 percent — will reach retirement age in the next five years.
Older doctors aren’t working for as many years as they used to, said Stella Dantas, president-elect of the American College of Obstetricians and Gynecologists.
“My mom is a physician seeing patients well into her 70s,” she told The Hill. “That’s just not the generation now.” Instead, Dantas added, physicians are more likely to retire in their mid-60s.
High rates of burnout among doctors are also fueling the country’s physician shortage, and OB-GYNS are no exception.
The increase in doctors’ administrative duties compared to past generations is in part contributing to this issue.
“There’s a lot of regulatory things that we need to do during our workday that are not necessarily within our scope,” Dantas said.
All physicians, OB-GYNS included, now spend their days not only seeing patients, diagnosing conditions or delivering babies, but also filling out, signing off and sending mountains of paperwork.
This, when coupled with struggles to get reimbursement for services from health insurance providers like Medicare and Medicaid, makes for a perfect environment for burnout.
On top of this, OB-GYNS also deal with the added stress of lawsuits and rising malpractice insurance.
OB-GYNS are the second most frequently sued class of physicians in the country, resulting in exorbitantly high malpractice insurance rates, according to a Medscape “Physicians and Malpractice Report” published last year.
In states like Florida, Illinois and New York, OB-GYNS pay upwards of $170,000 a year in malpractice insurance premiums alone, according to NerdWallet.
“Obstetrics comes with its challenges of hours and liability issues, so we see people dropping the obstetrics part of their practice a little earlier and then doing what is called GYN-only practice,” said Dantas.
In other words, doctors are opting to not treat pregnant people or help with deliveries.
Another factor contributing to the OB-GYN shortage is the changing legislative landscape, which shifted significantly as a result of the Supreme Court overturning federal protections for abortion in its 2022 Dobbs decision, according to Dantas.
Most OB-GYNs did not provide abortion services prior to the ruling, and that has remained true in the years since, according to a KFF 2023 National OBGYN Survey.
Before 2022, about 20 percent of OB-GYNs offered any type of abortion service in office. That number dropped to 18 percent last year.
But the Supreme Court’s decision appears to be having an impact on medical students’ interest in entering the specialty. Data from the National Resident Match Program shows about 2 percent fewer senior medical students studying to be doctors of medicine or doctors of osteopathic medicine applied for an OB-GYN residency in 2023 compared to 2022.
Applications to OB-GYN residency programs dropped far more significantly in the 13 states that enacted complete abortion bans after the Dobbs ruling, according to American Medical Association research.
Research also shows that abortion restrictions are influencing where medical students are choosing to do their residency programs.
About 77 percent of third-year and fourth-year medical students included in a 2023 study said that the Dobbs decision would impact where they would consider applying for residency.
This is because many medical students fear they would not get an adequate reproductive healthcare education in a residency program in a state where abortion is banned, according to Ariana Traub, co-author of the study and medical student at the Emory University School of Medicine.
“The thought of practicing in a state where the law against evidence-based medical care is a challenging pill to swallow so early in your career,” said Traub in an email to The Hill.
Traub added that many of the states that have passed full abortion bans also have the highest maternal and infant mortality rates and major gaps in access to reproductive healthcare.
“With increasing restrictions and the potential for further departures of OBGYNS to states with fewer restrictions, this gap has the potential to widen even further, leaving those most vulnerable even further behind,” Traub said.
— Updated April 15 at 11:35 a.m.
Published on Apr 14,2024