There's a shortage of OB-GYNs and midwives. Here's what's being done about it.

50 percent of U.S. counties lack an OB-GYN, and 56 percent don't have a nurse midwife, ACNM says

Facing a national OB-GYN shortage, lawmakers and health care professionals are strategizing on how to bolster the ranks of maternal health care providers, Michael Ollove writes for Stateline.

U.S. faces looming shortage of reproductive care providers

There are about 11,200 nurse midwives and 20,000 OB-GYNs in the United States. But about 50 percent of U.S. counties lack an OB-GYN, and 56 percent don't have a nurse midwife, according to the American College of Nurse-Midwives (ACNM). And the American Congress of Obstetricians and Gynecologists (ACOG) projects that the United States could face a shortage of 6,000 to 8,000 OB-GYNs by 2020 and a shortage of 22,000 by 2050.

Multiple factors could be contributing to the shortage. While males make up the majority of OB-GYNs, the majority of those ages 44 and younger are females. And female OB-GYNs, according to ACOG President Thomas Gellhaus, are more likely to retire earlier and opt for part-time positions than their male counterparts. Moreover, both male and female OB-GYNs are increasingly trying to balance work and personal lives, meaning they tend to be less available than their predecessors were in earlier years.

Providers also are choosing more specific subspecialties within maternal care, such as infertility or gynecologic oncology, which reduces the number of OB-GYNs available for routine maternal services. According to ACNM, the percentage of OB-GYNS with a subspecialty increased from 7 percent in 2000 to 19.5 percent in 2012.

Meanwhile, the country's female population is expected to increase by about 18 percent between 2010 and 2030. In turn, CDC projects the number of births will increase as well, from 3.9 million as of 2014 to an estimated 4.2 million per year by 2030.

"It's very simple," said William Rayburn, a professor of obstetrics and gynecology at the University of New Mexico. "Our population is continuing to grow faster than we are producing OB-GYNs."

Eugene Declercq, a professor of community health sciences at Boston University, said the shortage of reproductive health care providers can be harmful to women's health and might partly explain the United States' comparatively high rate of pregnancy-related deaths.

Shortage requires aggressive action, stakeholders say

State officials, medical organizations, and other stakeholders say aggressive action is needed to stem the potential gap in women's health care needs.

Several states, including California and North Carolina, either have adopted or are considering legislation to ease scope-of-practice restrictions on nurse midwives, enabling them to practice without the supervision of a physician. In turn, more people are becoming nurse midwives, Ollove writes. According to the Bureau of Labor Statistics, the number of nurse midwives has increased by about 30 percent since 2012. 

But overall numbers remain low, so stakeholders are considering other changes.

For example, ACOG is backing federal legislation that would incentivize medical students to specialize in maternal health care and to work in areas bearing the brunt of the shortage, especially rural regions. Since 1980, the number of medical students going into OB-GYN residency programs has remained static at about 1,205 per year, according to Gellhaus.

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One ACOG-backed measure would increase the number of medical residencies by 15,000 positions over five-year period, half of which would be allocated for specialties facing shortages, such as OB-GYNs. Currently, the government funds about 30,000 medical residencies per year.

Another measure would direct the federal government to designate shortage areas for obstetrics and gynecology, just as it does for primary care, mental health, and dental care. Doing so would enable the National Health Service Corps to help OB-GYNs and nurse midwives with their education-related debt (Ollove, Stateline/Columbus Dispatch, 8/28).

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