Adrienne DeMarais Zertuche, MD, MPH
Georgia has 10.9 obstetrician/gynecologists per 100,000 residents, a number which falls significantly short of the national average of 14.1. Population growth and provider exodus continue to exacerbate this shortage, and the problem disproportionately affects rural areas.
The obstetric situation is especially grave. Georgia received March of Dimes “F” and “D” ratings for preterm delivery in 2010 and 2011, and it has the tenth highest infant mortality in the United States (8.1 per 1,000 live births). Of the 82 Georgia primary care service areas1 (PCSAs) outside metropolitan Atlanta, 52% have an overburdening or complete absence of obstetric providers. That is, 36% of the PCSAs outside of Atlanta have no delivering obstetricians, and 16% have a shortage. If Georgia fails to recruit additional providers over the next 10 years, the number of PCSAs with a deficit will double. By 2020, 75% of the PCSAs outside Atlanta will lack sufficient obstetric services.
Provider age and sex play an important role in this grim picture, as they contribute to earlier retirement from obstetric services. On average, male OBGyns stop practicing obstetrics at age 52 and females at age 44. In 44% of the PCSAs outside Atlanta with delivering providers, more than half of the obstetricians are female, and in 67% the average obstetrician age is ≥45 years.
Georgia obstetricians indicate that more and more OBGyns are eliminating the obstetric portion of their practice due to:
- overwhelming schedules, worsened by the retirement of other local obstetricians;
- high malpractice risk, exacerbated by the lack of tort reform; and
- invariably low Medicaid reimbursement rates, which pay for approximately 60 percent of the state’s deliveries (and up to 80 percent in rural areas).
These findings are the results of recent work by the Georgia Maternal and Infant Health Research Group (GMIHRG), which consists of thirteen graduate students from the Emory University Schools of Medicine, Nursing, and Public Health.2 GMIHRG was established in May 2010 to investigate the current status of obstetric care in Georgia and to explore the reasons for and the consequences of the provider shortage and maldistribution.
Our members conducted a piloted phone survey of the obstetric nurse managers at all 63 Georgia birthing facilities in the 82 PCSAs outside metropolitan Atlanta (response rate >90%); at each facility, we inquired about the obstetric provider workforce3 and each provider’s age, sex, and sustainability. We also interviewed four physicians that recently stopped providing obstetric services to Georgia women.
In order to make the GMIHRG findings easily accessible for healthcare providers, patient advocates, and Georgia legislators, the results were mapped and individualized “report cards” by counties and PCSAs were created. To review and print information related to your local area, please visit the Georgia OBGyn Society website (http://gaobgyn.com/resources/category/ob-shortage-study). We hope that you can use our materials to educate yourself and others about the obstetric care issues facing your region and the state as a whole.
Now that GMIHRG has delineated and publicized Georgia’s OB shortage areas, we plan to investigate potential solutions to this problem. Our next project will examine the characteristics and attitudes of the state’s OBGyn residents and midwifery students. We hope to identify traits that may predict delivery of obstetric services in rural Georgia upon completion of training. Please contact Adrienne DeMarais Zertuche at firstname.lastname@example.org if you have any questions, or if you want to get involved.
2 Brittany Argotsinger, MPH*; Danika Barry, MPH*; Nikita Boston, CHES, MPH*; Ansley Howe (MSN/MPH Candidate)*; Sylvie Hua, MPH*; Kayla Lavilla, MPH*; Hilary Moshman, MPH; Bridget Spelke (MD/MPH Candidate)*; Dena Vander Tuig, MD, MPH; Audra Williams (MD/MPH Candidate); Abby Yandell (MD/MPH Candidate)*; Brittany Young (MD/MPH Candidate); Adrienne DeMarais Zertuche, MD, MPH.*
* Denotes direct involvement in project.
3 Based on ideal annual delivery rates (155 deliveries per obstetrician, 100 per certified nurse midwife, and 70 per family practitioner), we converted all providers into “obstetrician equivalents.” Using these equivalents and facility birth data, we calculated the average annual deliveries per provider (AADP) within each PCSA, labeling the workforce as “adequate” if AADP166.