Rural residency offers tool to address ob.gyn. shortages

As of 2010, the national ratio of ob.gyns. per 10,000 women was 2.1, but that ratio decreases from 2.9 in metropolitan counties to 0.7 in rural counties.

William F. Rayburn, MD, distinguished professor and emeritus chair of obstetrics and gynecology at the University of New Mexico, Albuquerque, is working on an update to the workforce report, expected to be released in May 2017 at ACOG’s annual scientific meeting in San Diego.

The maldistribution trend is likely to continue over the next decade for several reasons, said Dr. Rayburn, associate dean for continuing medical education and professional development at the university.

At the top of the list is the stagnant number of residency training slots across the country. While medical schools in the United States and abroad are graduating more students, the number of first-year ob.gyn. residency positions has remained at about 1,200 since 1980. In 2017, there were 1,288 positions offered in the Main Residency Match.

Gender is another factor. Ob.gyn. is now a majority female specialty and by 2025 women will make up about two-thirds of the workforce, Dr. Rayburn said. While women are just as productive as men, they don’t work as many hours and they tend to drop obstetrics from their practices earlier, he added.

In addition, research indicates that women ob.gyns. are more likely to stay in urban areas after training.

“The movement, generally speaking, when people relocate is often to urban areas, from one urban area to another or from a rural area to a more urban area,” Dr. Rayburn said.

There is growing demand for health care from a population of adult women that is increasing at a greater rate than the number of ob.gyn. residents, he said.

The rural residency option being explored in Wisconsin is a great idea, Dr. Rayburn said, provided the trainees receive enough experience in the rural environment to prepare them for the change in practice. “The more you can get people to train in more rural areas, the more likely they are to eventually go there. But that’s far from a guarantee,” he said.

Going forward Dr. Rayburn said he expects to see loan repayment used to draw physicians to underserved areas.

“The problem is that the rural areas tend to have less of a good payer mix,” he said. “In other words, there are more poor people in rural areas. And the health care delivery is more limited in terms of resources, types of surgical equipment, and being able to take care of complicated pregnancies.”
 

GME funding cap

The Association of American Medical Colleges is focused on easing physician shortages by getting lawmakers to lift the cap on federal funding for graduate medical education (GME) positions that was put in place as part of the Balanced Budget Act of 1997.

“The population is getting larger and aging, which increases the need for more physicians and thus we have to work with Congress to lift the cap,” said Janis Orlowski, MD, Chief Health Care Officer at the Association of American Medical Colleges.

Specifically, the association is calling for funding to train at least 3,000 more physicians each year. In the last Congress, lawmakers introduced bills that would have provided those positions, with one of those bills directing that a portion of those new positions be dedicated to specialties with physician shortages.

Dr. Orlowski said bipartisan support still exists for lifting the cap, though new legislation probably won’t be introduced until after the summer recess when Congress won’t be bogged down with efforts to repeal and replace the Affordable Care Act.

Getting the GME cap lifted is mostly about coming up with the funding, she said. But some lawmakers have expressed concerns about how to ensure that increases go to the specialties with the greatest needs or that physicians trained in these spots will ultimately practice in the areas where care is needed, such as rural America.

“Those are issues that we need to continue to work on and address,” she said.

ACOG supports efforts to lift the GME funding cap and is pushing federal legislation that would establish maternity care health professionals shortage areas, allowing the National Health Service Corps to offer scholarships and loan repayment benefits to providers who work in those areas. Similar programs are already in place for primary care, and dental and mental health. Like the GME funding bill, legislation on this topic was introduced in the last session of Congress but will need to be reintroduced in the current Congress.

“We have to work on the workforce,” Dr. Gellhaus said. “It’s going to be a concern.”