The Senate Women’s Adequate Healthcare Study Committee met on October 26, 2015 at the Tift Regional Health Center in Tifton, GA to discuss women’s access to healthcare in rural Georgia. Dr. Paul Browne and Dr. Chadburn Ray of Medical College of Georgia and Dr. Adrienne Zertuche of the Georgia Obstetrical and Gynecological Society presented information on how the OBGYN shortage affects women in rural counties along with suggestions for attracting more practitioners to the state and specialty.
When you get outside the Metro Atlanta area, the “biggest barrier to [obstetric] care is geography,” says Dr. Paul Browne. Rural hospitals have closed, or at least closed their obstetric services, because they cannot stay in business while sustaining heavy losses treating predominantly Medicaid covered patients plus the uninsured. As a result, 83 percent of women must travel outside of their county to deliver their babies. Long travel times also translate into unhealthy outcomes for mothers and babies as women who have to drive farther for medical care are more likely to deliver preterm.
There are many factors driving the shortage of OBGYNs in our state. In rural Georgia the malpractice insurance rates doctors must pay coupled with Medicaid reimbursement rates that are about one-fifth the rates of private insurance companies make it very hard for a doctor to make ends meet in a rural practice. In Georgia as a whole, Medicaid covers the obstetric costs in 40-60 percent of births depending on the year. In rural areas, that percentage is much higher.
The obstetrics specialty has not seen a substantial increase in OBGYN residents in more that 20 years, and as a chunk of the current workforce gets ready to retire, we may see even fewer doctors available to treat Georgia women. Georgia needs to take steps now to support re-entry programs for OBs who want to return to practice after a break, expand our Certified Nurse Midwife programs, and encourage Family Practice physicians to gain obstetric experience.