Obstetric Provider Maldistribution: Georgia, USA, 2011
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Objectives In 2010, Georgia had the nation’s highest maternal mortality rate, sixteenth highest infant mortality rate, and a waning obstetrician/gynecologist (ob/gyn) workforce. Statewide ob/gyn workforce data, however, masked obstetric-specific care shortages and regional variation in obstetric services. The Georgia Maternal and Infant Health Research Group thereby assessed each Georgia region’s obstetric provider workforce to identify service-deficient areas. Methods We identified 63 birthing facilities in the 82 Primary Care Service Areas (PCSAs) outside metropolitan Atlanta and interviewed nurse managers and others to assess the age, sex, and expected departure year of each delivering professional. Using accepted annual delivery rates of 155 per obstetrician (OB), 100 per certified nurse midwife (CNM), and 70 per family medicine physician (FP) we converted obstetric providers into “OB equivalents” to standardize obstetric services available in any given area. Using facility births and computed OB equivalents (contemporary and 2020 estimates), we calculated current and projected average annual births per provider (AABP) for each PCSA, categorizing its obstetric provider workforce as “adequate” (AABP < 144), “at risk” (144 ≤ AABP ≤ 166), or “deficient” (AABP > 166). We mapped results using ArcGIS. Results Of 82 surveyed PCSAs, 52 % (43) were deficient in obstetric care; 16 % (13) had a shortage and 37 % (30) lacked obstetric providers entirely. There were no delivering FPs in 89 % (73) of PCSAs and no CNMs in 70 % (56). If Georgia fails to recruit delivering providers, 72 % (58/77) of PCSAs will have deficient or no obstetric care by 2020. Conclusions Obstetric provider shortages in Georgia hinder access to prenatal and delivery services. Care-deficient areas will expand if recruitment and retention of delivering professionals does not improve.
KeywordsGeorgia Workforce shortages Rural health Obstetrics Maternal health
The Georgia Maternal and Infant Health Research Group is a collaboration of the Georgia Obstetrical and Gynecological Society and Emory University Schools of Public Health, Medicine, and Nursing. We are indebted to the many students who have worked with us over the past 3 years. This study was funded in part by the Georgia Obstetrical and Gynecological Society, the March of Dimes (Georgia Chapter), and the Georgia Department of Public Health. We are grateful for their support. GMIHRG would also like to thank the Georgia Board for Physician Workforce for their partnership throughout this project.
- 1.American Congress of Obstetricians and Gynecologists (ACOG). (1988). Professional liability and its effects: Report of a 1987 survey of ACOG’s Membership, March 1988. Washington, DC.Google Scholar
- 2.American Congress of Obstetricians and Gynecologists (ACOG). (1990). Professional liability and its effects: Report of a 1990 survey of ACOG’s membership, September 1990. Washington, DC.Google Scholar
- 3.American Congress of Obstetricians and Gynecologists (ACOG). (1999). Professional liability survey 1999. Washington, DC.Google Scholar
- 4.American Congress of Obstetricians and Gynecologists (ACOG). (2003a). Socioeconomic impact survey of fellows: Profile of ob–gyn practice, 1991–2003. http://www.acog.org/About-ACOG/ACOG-Departments/Practice-Management-and-Managed-Care/ACOG-2003-Economic-Survey-Results. Accessed January 13, 2015.
- 5.American Congress of Obstetricians and Gynecologists (ACOG). (2003b). Professional liability survey 2003. Washington, DC.Google Scholar
- 6.American Congress of Obstetricians and Gynecologists (ACOG). (2011). Georgia workforce Fact Sheet, 2011. www.acog.org/-/media/departments/government-relations-and-outreach/wf2011GA.pdf. Accessed January 13, 2015.
- 7.American Congress of Obstetricians and Gynecologists (ACOG). (2012). Professional liability survey 2012. http://www.acog.org/About-ACOG/ACOG-Departments/Professional-Liability/2012-Survey-Results. Accessed January 12, 2015.
- 8.Amnesty International. (2010). Deadly delivery: The maternal health care crisis in the USA. www.amnestyusa.org/sites/default/files/pdfs/deadlydelivery.pdf. Accessed January 12, 2014.
- 9.Dresden, G. M., Baldwin, L. M., Andrilla, C. H. A., Skillman, S. M., & Benedetti, T. J. (2008). Influence of obstetric practice on workload and practice patterns of family physicians and obstetrician–gynecologists. Annals of Family Medicine, 6(Suppl 1), S5–S11. doi: 10.1370/afm.737.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Georgia Board for Physician Workforce (GBPW). (2010). Physician workforce core specialties, 2010. http://gbpw.georgia.gov/sites/gbpw.georgia.gov/files/related_files/site_page/Physician%20Workforce%20Primary%20Care%20Core%20Specialties%202010.pdf. Accessed January 12, 2014.
- 11.Georgia Board for Physician Workforce (GBPW). (2015). Report information: Geography specific terms. http://gbpw.georgia.gov/report-information. Accessed January 13, 2015.
- 12.Henry J. Kaiser Family Foundation. (2010). State health facts, infant mortality rate. www.kff.org/other/state-indicator/infant-death-rate. Accessed March 13, 2015.
- 14.March of Dimes. (2010). 2010 Premature Birth Report Cards: Georgia. http://www.marchofdimes.org/materials/premature-birth-report-card-georgia.pdf. Accessed August 10, 2011.
- 15.Miller, A. (2011). A doctor who couldn’t afford to stay in Georgia. Georgia Health News, July 22, 2011. http://www.georgiahealthnews.com/2011/07/doctor-couldn’t-afford-stay-georgia. Accessed August 13, 2011.
- 16.Rayburn, W. F. (2011). The obstetrician–gynecologist workforce in the United States: Facts, figures, and implications, 2011. American Congress of Obstetricians and Gynecologists (ACOG). http://www.acog.org/Resources%20And%20Publications/The%20Ob%20Gyn%20Workforce/The%20Obstetrician%20Gynecologist%20Workforce%20in%20the%20United%20States.aspx. Accessed January 13, 2015.
- 17.Smulian, E. A., Zahedi, L., Hurvitz, J., Talbot, A., Williams, A., Julian, Z., et al. (2016). Obstetric provider trainees in Georgia: Characteristics and attitudes about practice in obstetric provider shortage areas. Maternal and Child Health Journal. doi: 10.1007/s10995-016-1998-9.PubMedGoogle Scholar
- 19.Xu, X., Siefert, K. A., Jacobson, P. D., Lori, J. R., Gueorguieva, I., & Ransom, S. B. (2009). Malpractice burden, rural location, and discontinuation of obstetric care: A study of obstetric providers in Michigan. The Journal of Rural Health, 25, 33–42. doi: 10.1111/j.1748-0361.2009.00196.x.CrossRefPubMedPubMedCentralGoogle Scholar