The Future of the Ob-Gyn Workforce

Workforce issues in women’s healthcare continue to be a primary concern for ACOG.

A recent survey of 20,088 physicians conducted by the Physicians Foundation, a non-profit research organization, found that increasing workloads, regulatory requirements, and other changes in the healthcare system are prompting physicians to make career changes. It found that 81% of physicians described themselves as either overextended or at full capacity. Although these findings are not specific to our specialty of obstetrics and gynecology, it can be assumed that many ACOG Fellows have similar opinions.

One-third of currently practicing obstetricians and gynecologists are over 55 years of age. According to the Physicians Foundation survey, 39% of physicians are planning to accelerate their retirement plans. If that is not frightening enough, within the next three years, approximately 18% of physicians plan to reduce their work hours, 10% plan to seek a non-clinical job, and 9% will retire. We cannot afford to precipitously lose the work efforts of comparable percentages of highly productive, busy obstetricians and gynecologists and expect to be able to continue to meet the healthcare needs of women. The numbers of ob-gyn residents coming out of our training programs have not substantially increased in the past twenty years. Consequently, we do not have the immediate ability to replenish this potential loss of productivity. This prompts the question “What is ACOG doing about this looming crisis?”

In May 2014, as part of my presidential initiatives, I appointed an Executive Board Working Group on Practice Transformations to provide decision-making help for ACOG Fellows who are considering change in their practice. This group is working hard to make certain that ACOG serves as a primary resource for information on ob-gyn practice alternatives. In addition, our Collaborative Practice Task Force and the Working Group on Team Leadership are exploring methods for obstetricians and gynecologists to expand access for women’s healthcare through efficient, multidisciplinary teams.

ACOG’s Council of Resident Education in Obstetrics and Gynecology (CREOG) is working to revise our educational curriculum to reflect anticipated changes in practice modalities. In cooperation with the Society for Maternal/Fetal Medicine, ACOG is defining levels of maternity care with the intent of improving and promoting regionalized, integrated systems of maternity care.

It is my hope that these and other ACOG efforts will have a significant and certain impact on continuing access to high-quality, high-value care for the women of our country.

This entry was posted in Women's Health and tagged , , by John C. Jennings, MD. Bookmark the permalink.

About John C. Jennings, MD

John C. Jennings, MD is the president of ACOG through April 2015. He is professor of ob-gyn at the Texas Tech University Health Sciences Center at the Permian Basin. Dr. Jennings was in private practice in San Angelo, TX, for 12 years before entering academic medicine. He has served as head of gynecology and program director of ob-gyn at Wake Forest University in Winston-Salem, NC; professor and program director of ob-gyn at the University of Texas Medical Branch in Galveston; chair and program director of ob-gyn at TTUHSC at Amarillo; and regional dean of the school of medicine at TTUHSC at the Permian Basin.

15 thoughts on “The Future of the Ob-Gyn Workforce

  1. I think that it is important for all doctors to pace themselves. Even though this may not happen due to what field they are in or what patients they treat. Even those that are Ob-Gyn doctors need their rest too. Perhaps if more people decided to be Ob-Gyn doctors, this would help those that need the rest?

  2. Thanks for the insight. Recently my wife and I had our second daughter. We have been very fortunate for the caring doctors that my wife has had each time. Without them I have no idea what pregnancy would be like for our family. They have been very patient and gracious to answer our questions and work through fears with us. I hope that we will continue to see more doctors like this taking care of the families across America. It is definitely something that we should try to protect.

  3. It’s interesting to read up on the current status of the OBGYN field, as it seems to normally take a back seat to other stories. I also did not know that there was such a high majority of those in the work force who felt overextended or at full capacity. Interesting read and I appreciate the detail and information presented.

  4. This is a small random sample of apparently general ob/gyn and while not really the size of a random sample the points made are worth reviewing:
    1. Women have had an effect and it appears it is towards working lower hours
    2.High risk( and you define) should be relegated to MFM
    3. Reimbursement at all levels of caring for the low risk as supervisor and comanaged should be increased
    4.Normal deliveries may or may not require mid-level providers to compensate for the “shortage.”
    5. Computerization is slowing the face to face process and overall care.
    6. Lawsuits create an adverse reaction to caring for the “high risk”
    7. Others feel the midlevels take care of the normal and generalists take care of the high risk.
    8,Laborist may be a solution, but how do we pay for the increased cost.
    9. The demand is now High and reimbursement low.

    These issues all reflect the decades long ongoing change in this profession Change is complex, uncomfortable, and takes time to anticipate the changes and make preemptive favorable solutions.This did not occur.
    Commodisation of medicine left the station years ago. Subspecialization created silos which seem to be merging as they feel the coming real economic crunch. We need efficiency and effectiveness with implementation. Try to find the root cause analysis. Use business models to attain these goals and the process and outcome will not be appreciated by many.
    Pregnancy is a physiological event. Low risk will be cared for by a combination of ob and midlevel providers (hopefully to reduce intervention even though we have increasing comorbidities).Inductions and c/sections must be reduced.
    Technology has driven the cost and insurers lowered reimbursement.This is business and most obs are employees of institutions ( unless really creative) who are involved in decreasing reimbursement and surging in merger and acquisition to increase profit margins.
    So solutions are mixed and some should be implemented now as beta tests. In the meantime we strive to improve quality. The evidence as how to treat is generally not strong and our need for standardization has yielded some sucess over the past decade.
    We can anticipate consolidation on all levels of care and continuing lower reimbursement. The gold standard as yet to be established, but the future will be bleak unless we accept the disruptive forces are here to stay and we must provide caring and quality care through models dependent on efficiency and effectiveness.The new graduates will grow up in this new environment without regrets based on history.
    I work in rural america where only 6.4% of obs practice…here is a real shortage.

  5. In my twenty five years of practice, I have watched our specialty suffer the hardest, both financially as well as professionally. We have gone from one of the highest paid specialties to mid bottom. We have pioneered revolutionary techniques to reduce morbidity and hospital costs and while we struggle to perform complicated surgeries through smaller incisions, we see the reimbursement shrink proportionately to the length of the incision. I have watched PHARMA, AHA and durables lobby hard to claim financial positions and profits.
    Now you tell me that we are in high demand and facing shortages and economic principles of supply and demand economics is not entertained. These same principals of supply and demand economics have been used against us for the past twenty years. Most of us will altruistically do the right thing but what I see is our reimbursements continuing to shrink despite the fact that our patients will become increasingly complicated. My colleagues suggest use of mid level providers to perform the low risk procedures which means that we will be working harder , with higher risks, stress and demands from our patients as well as overseeing the complications of the midlevel lower risk cases. This will also increase our exposure to liability.
    I would ask that ACOG consider working with AMA, MEDI-MEDI and RBRVS on reflecting these changes and increasing demands through our compensation and relative value. In addition, it is time that all facets of health care realize the changing financial landscape, not just the professionals
    I have left private practice to pursue corporate medicine as a result of these changes but see that ALL institutions, ACO’s etc will be impacted by these forthcoming revisions, restructuring and constant penalties.

  6. Timely comments indeed! Another issue looming that will directly affect the OBGYN workforce is the issue of our pediatric colleagues choosing to exit from hospital work; in our community hospital in Western NC, we are facing an immediate crisis. Without competent providers to attend to newborns there may be NO Obstetrical services!

  7. I believe that the increase in paperwork, charting requirements, ease of frivolous lawsuits, and loss of independence and overall respect due to employed status contributes greatly to the problem. There is also uncertainty with regard to compensation in the future. Physicians are smart and talented people who will only put up with the hours, even if they love the field, until they approach burn-out then use their talents in a way that allows a better lifestyle with equivalent or even improved income.

  8. another major problem is that the overwhelming new doctors are females. These are smart women who marry successfull men. The women now have to run a practice, take call and raise a family. Fortunately there spouses make a good living. The result is that female ob/gyn work less hours than their male counterparts. We therefore need many more ob/gyn”s in the future because of the decreased volume that the women ob will be able to handle.

  9. Finding appropriate care for high-risk gravidas is NOT something that can easily be changed – at least not with our current system of global payments and financial incentives . There is a tremendous shortage of MFMs, and everyone ( CNM, OBG and FP ) are competing aggressively for the same pool of low risk, well insured women in popular urban/suburban locations. There is also a tremendous shortage of experienced mid career OBGs willing to continue to make themselves available to care for high risk patients due to rising overhead, medmal pressures, poor reimbursement without compensation for the extra time and risk these patients these patients incur, and just general night call burden. Burnout and fatigue lead many skilled Obstetricians to flee to gynecology only or outpatient care as soon as they can.
    Until the financial incentives favor adequate reimbursement for call hours, compensation for availabilty to ” back up” teams of CNM or FP doing low risk deliveries who need an experience OB on hand for problems and CS, and improved reimbursement for the time devoted to the high risk patient the problem will only get worse.

  10. The only solution to the workforce problem in my opinion is more in house L&D coverage. The drive towards retirement is mostly driven by taking call and the impact it has on lives, lifestyles, health, family life and it’s economic impact on our practices. Most physicians in our community take call in groups and take a post call day or half day off further diminishing access to outpatient care. With viable laborist or hospitalist models, the outpatient physicians can continue to work and maintain their patient base to the referral hospitals they work with. The problem is how to pay the laborist/hospitalist in a world of reimbursement cuts and all parties looking to save cost. This prospect is career lengthening for the outpatient provider. I appreciate the statistics on the severity of this problem that is fast approaching. We need solutions on this immediately. Please contact me for further discussion. I am passionate about this topic and want to find a nation wide solution. I am happy to participate on a committee or phone call to discuss further. I agree with other posts that the solution lies not just in how much we are paid, but how we are paid.

  11. what you are describing makes sense, but not in our malpractice system.
    Who wants to take most difficult cases, face horrendous risk and to be sued all the time… All for the same reimbursements…

  12. Nurses, both at the basic and advanced practice level are sorely underutizlized. Whats needed is a more efficient division of labor and there need be no crisis.
    Obstetricians would then be free to focus on high risk cases. currently high risk women have the longest waits and the most difficulty finding an appropriate provider and that is something that can easily be changed.
    Routine prenatal, and gyencological visits can easily be managed by advanced practice nurses, and basic level nurses could perform at least some of the routine prenatal assessments for low risk women without reducing quality of care and in fact enhancing it. In the labor unit as well, nurse midwives could be utilized far more than they are today.

    • Some of the solutions proposed may help with the workforce shortage. However in my years of general OB practice I LOVED going in for routine deliveries. I LOVED the continuity of care, including delivering the 2nd and 3rd children of the same family. And after taking care of some patients for more than 30 years I LOVE being a part of the 2nd generation of babies and life stages. If someone suggested at the start of my career that I would be turning over all my deliveries to a laborist or all my low risk but “great-fun-to-be-with” patients to a NP, I might have thought twice about choosing the specialty. These “solutions” might be expeditious but maybe that’s what the practice of obstetrics have come down to. Tsk.

    • Not all obstetricians want to deal with high risk patients. High risk patients should be managed by MFM not generalists. The reimbursement isn’t sufficient enough for the lawsuits associated with treating high risk patients. I dislike when we are told to relegate low risk patients to advance nurse practitioners. Some of us want to school to treat healthy woman and not ONLY sick patients. Thanks

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