Shifting focus in Women’s health. No More Obstetrics
After having graduated from my first OBGYN residency in 1997, I dived into women’s health with passion.
Ever since my foray into medicine, I have taken care of thousands of women, guided them through their pregnancies, coached them during their deliveries and helped them navigate the post partum undulations. Staying up on countless nights seemed like a small price to pay for the precious moments I witnessed as a new life came flying (or not) into this world. The joyous cries of new parents combined with the howling of the newborn were all worthwhile. I never turned away any woman who needed me. High risk or not! I took on every challenge and went overboard to ensure the safest and healthiest outcome.
Since my graduation, I have worked in three countries. Having undergone various forms of training while traversing different institutions, I have thrived everywhere, flourishing with the affection emanating from a foundation of deep trust!
Sadly, some 18 years later, I have decided to stop Obstetrics because of the changing direction of health care. With the rising malpractice insurance rates and low reimbursements I have been forced to be pragmatic.
I had been choosing to be oblivious to the perils of practicing obstetrics despite of glaring factual evidence. Not delivering my patients was akin to abandonment in my mind. Now, however, I am left with little choice. I have reached this difficult decision. Either, I let myself be swallowed by a big health care system and become a cog in a corporate wheel or I close my doors to a very expensive service.
The current average annual malpractice insurance premium for an OBGYN( Obstetrician and Gynecologist) starts at $180,000 in New York. To sustain that expense, a physician needs to be a baby-producing factory running a patient mill just to stay afloat. Do I have enough patients to do that? Of course! Am I physically able to take good care of everyone personally and sustain great quality and safety? No!
The following statistics reveal the painful travails of a practicing OBGYN physician in a non-tort reform state.
The current annual premiums for professional liability insurance range from $ 18,154 in Wisconsin to $ 201,808 in Florida. The highest average base rate premiums are in NY, Connecticut, District of Columbia and Florida. In these states, some premiums for Maternal Fetal medicine doctors (doctors taking care of high risk pregnancies) go up to 300K making it extremely prohibitive to practice.
As per ACOG (American College of Obstetrician and Gynecologists), NY OBGYN work force survey 2014, New York has 2,624 ob-gyn physicians serving a population of 8,315,058 women.
- There are only 3.16 ob-gyns per 10,000 women.
- 9 of New York’s 62 counties do not have any ob-gyns.
There has been essentially no increase in the number of ob-gyns trained since 1980, while the population of women in the United States has increased by 26% since that time, and will increase another 36% by 2050. The Affordable Care Act gives 30 million women access to new or increased preventive and primary care
The number of ob-gyns retiring will soon equal the number of resident graduates. The anticipated shortage of ob-gyn physicians will be 18% (9,000) by 2030 and 25% (15,723) by 2050.
The CDC data from National Vital Statistics System Statistics from 2014 showed a national total of 3,988,076 births of which NY alone had 238,773 births. The rate was up 1% as compared to the prior year.
The ACOG professional liability survey results from 2015 provide an interesting insight into changing practice patterns in different parts of the country and highlight the negative impact of rising litigation and malpractice premiums.
The survey interval was from Jan 2012 till Dec 2014. New York exhibited highest percentage of physicians leaving obstetrics. 22.5% OBGYNs reduced performing high-risk deliveries, and 6.6 % stopped practicing obstetrics all together. In contrast, in California, which is one of the few states where there is tort reform in practice (there is a cap on the malpractice premium), only 3.3% of OBGYN stopped obstetrics all together.
Innumerable OBGYN physicians in NY are either retiring or taking on hospitalist administrative jobs. The traditional private doctor’s office where women felt at home and had a sense of belonging is becoming obsolete.
In the past few months, I have been making painful phone calls to my patients telling them that I can no longer take care of them due to a “personal” situation. I have had patients say, “Please, just deliver me!” or “ Can’t you wait for me?” or “How can you do this to me?”
Some just burst into tears!
I get a painful tug in my heart every time. I feel like I am breaking up with them or that I am letting them down. I am not ready to quit OB at the age of 42. I have loved doing it all these years. The battle of striving to provide compassionate care to women safely is now proven to be a losing one. Only recently, the painful realization dawned on me that I am not a magician.
So, why am I trying to hide behind a farce that I am leaving OB due to a “personal situation”? Women in need of my care need to be aware of the facts. It seems like, we OBGYN’s in NY are working 36 hours a day to pay our malpractice so that we can protect ourselves from being sued anyone who can! Is that the reward for the numerous vigilant nights spent in labor and delivery suites? Do we really deserve this after dedicating our youth and most of our adult lives in training to be great caregivers?
I had a patient tell me today, “Please don’t leave me. Finding a good GYN has been like a series of bad dates. I feel safe with you. I promise you I won’t sue you!”
Defensive medicine is not what medical school or multiple residencies ever prepared me for! All I knew was how to make sure my patients get the best possible outcome in the all possible scenarios. I excelled in that! Yet, now I feel like I am some how failing them?
Bottom line is that total number of providers delivering Obstetrical care in NY is shrinking. My day to day interaction with the patients who I have to now refer out to another Obstetrician to render prenatal care and follow through until delivery has revealed how hard it is for a patient to find such a provider. Within the last 3 months, 2 of the 6 obstetricians who I had worked with in my coverage group are stopping OB this summer and 2 are not accepting new OB patients. My patients call me back asking for suggestions. My only suggestion is to go the big hospital based practices where they are sure to get prenatal care. The future of Obstetrics looks like an assembly line of pregnant women and providers passing through the mill of labor and delivery units staffed by hospitalists who have not taken care of these women during their pregnancies.
Unless meaningful liability reform comes to New York and the entire country, this decline in OBGYN providers heralds the beginning of the end of compassionate care for soon to be mothers.
I stopped Obstetrics as of November 1st, 2015. I apologize to all my pregnant ladies who I have let down. I have not lost the battle though, at least I hope!
Changing gears, I will still be doing what I love, changing women’s lives for the better, helping them deal with the myriad of other health problems that they deal with. I will be focusing on preventative; adolescent and menopausal care with special focus on Sexual health issues with a holistic twist.
So! We, at womenshealthmantra.com will still be “Helping women live healthy lives”! May be, just not during their pregnancies!
Adeeti Gupta MD, FACOG
Walk IN GYN Care
* This post has been published on Huffington Post at: http://www.huffingtonpost.com/entry/the-cost-of-being-pregnant-in-new-york-why-obstetricians_us_57963bd1e4b0e339c23f5045