By: Dr. Adeeti Gupta
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 coached women through their pregnancies and helped them navigate the post partum undulations. Staying up on countless nights was 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 with the howling of the newborn were all worthwhile. I took on every challenge and went overboard to ensure a happy and healthy family.
Sadly, some 18 years since starting my career, I have decided to stop Obstetrics because of the changing direction of health care. With the rising malpractice premiums and declining reimbursements, I have been forced to be pragmatic.
I had turned a blind eye to factual evidence, and was choosing to be oblivious to the perils of practicing obstetrics. Now, I am at crossroads. 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 malpractice premium for an Ob-gyn starts at $180,000/ yr. in New York. To sustain that expense, a physician needs to be a baby-producing factory. 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!
Statistics from the Ob-gyn facts and figures, 2011 reveal the painful travails of a practicing physician in a non-tort reform state.
The current annual premiums for professional liability range from $18,154 in Wisconsin to $201,808 in Florida. The highest premiums are in New York, Connecticut, District of Columbia and Florida. In these states, some premiums for Maternal Fetal medicine doctors (high risk pregnancies) go up to 300K making it extremely prohibitive to practice.
According to the American College of Obstetrician and Gynecologists, Ob-gyn 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 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 (HANYS physician advocacy)
The number of ob-gyns retiring will soon equal the number of graduates. The anticipated shortage of ob-gyns 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 New York 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.
Between January 2012 and December 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, (there is a cap on the malpractice premium), only 3.3% of OBGYN stopped obstetrics.
Innumerable physicians in New York are either retiring or taking on hospitalist jobs. The traditional private doctor’s office where women had a sense of belonging is 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. I have had patients say, “Please, can you just do this one?” Some just burst into tears.
I get a painful tug every time. I am not ready to quit at the age of 42. I have loved it. I am losing the battle of striving for compassionate care for women. The painful realization has finally dawned that I am not a magician.
Women in need of care need to be aware of the facts. It seems that we Ob-gyn’s are working 36 hours a day to pay our malpractice so that we can protect ourselves from being sued. 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?
Defensive medicine is not what my training ever prepared me for. The goal always was for my patients to have the best possible outcome, which I prided myself for. Yet, now I feel trapped.
Bottom line is that the number of physicians doing Obstetrics is shrinking. My daily interaction with the pregnant patients looking for someone to render prenatal care has revealed the challenge. Within the last 3 months, 2 of the 6 obstetricians who I had worked with in my coverage group are quitting and others are not taking on anyone new. The future of Obstetrics looks like an assembly line of pregnant women passing through the mill of labor and delivery units staffed by hospitalists who are unknown to them.
[Related: Women’s Fertility Game Changer: Egg Freezing]
Unless meaningful liability reform is implemented universally, this decline in OBGYN providers heralds the beginning of the end of compassionate care for “soon to be” mothers.
I stopped Obstetrics recently. I apologize to all my pregnant ladies who I have let down. Changing gears, I hope to continue changing women’s lives for the better by helping them deal with the myriad of other health problems (menopausal, sexual and preventative) that inflict upon them.
The future babies and pregnant mothers deserve a caring path to the most important day of their lives. So, something needs to give!
Dr. Adeeti Gupta is the Founder and Director of both Walk In GYN Care and Fusion Gyn. She is also President at Women’s Health Mantra, and attending physician for the department of OBGYN in Lenox Hill Hospital, clinical instructor at Stonybrook University Medical Center, and an assistant professor at AUC School of Medicine.
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