The Georgia Senate Women’s Adequate Healthcare Study Committee met on November 9, 2015 at the State Capitol. Again they heard from state experts on women’s access to healthcare in Georgia, but this time the presenters focused on women’s healthcare providers and ways to improve access to care for women in rural areas of the state.
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.
The Georgia Senate Women’s Adequate Healthcare Study Committee met at Augusta University in Augusta, GA on October 6, 2015. The Study Committee heard from experts about the top health concerns affecting women in the state, including breast cancer and cervical cancer, aging issues such as Alzheimer’s disease and osteoporosis, and cardiovascular disease. Information was presented by Dr. Sharad Ghamande, Dr. Carlos Isales, and Dr. Lucy Marion of Augusta University, Nancy Paris and Angie Patterson of Georgia CORE, Dr. Stephen Goggans of the Georgia Department of Public Health, Dr. Pascha Shafer, and the Alzheimer’s Association.
Breast cancer is the most common cancer diagnosis in women followed by cervical cancer. A family history of breast cancer is the most significant predictor of risk, and genetic screening for BRCA 1/2 can reduce the incidence of breast cancer and ovarian cancer by 80-95 percent. While cervical cancer is the second leading cause of cancer death in women in the United States, the Pap smear screening test reduced the death rate from cervical cancer by 74 percent from 1955-1992.
Georgians are living longer, and an aging population brings its own health challenges. The study committee heard presentations on aging covering such topics and osteoporosis and Alzheimer’s Disease, both of which disproportionately affect women.
Cardiovascular disease is the number one killer of women in the United States. Each day, eleven women die in Georgia from heart disease. Obesity, which affects over one-third of the population in our state, increases the risk of cardiovascular disease by a factor of four, and diabetes, another risk factor, is increasing in prevalence as well. Smoking tobacco products is associated with half of heart disease events in women, and the risk drops quickly when women stop smoking. In fact, the risk is mostly gone in 2-3 years.
The next Senate Women’s Adequate Healthcare Study Committee will meet on Monday, November 9, 2015 from 2:00-5:00 pm in room 450 of the State Capitol.
The Georgia Senate Women’s Adequate Healthcare Study Committee met for the first time on Monday, September 14, 2015 at the State Capitol and focused on the availability of OB/GYN services and chronic disease management services in Georgia. The committee heard from Dr. Brenda Fitzgerald, Commissioner and State Health Officer for the Georgia Department of Public Health, Ms. Melanie McNeal, Long-term Care Ombudsman with the Department of Human Services, and Dr. Catherine Bonk, President of the Georgia OBGYN Society.
Dr. Fitzgerald led with the most shocking statistic of the day—Georgia ranks 50th in maternal mortality in the U.S. We lose new moms at a higher rate than any other state in the nation. The Georgia Department of Public Health in partnership with OB/GYNs in the state is conducting more extensive studies to understand better the underlying causes. They have also worked with state coroners to gather better cause of death data on death certificates to help them in their research.
Our infant mortality rate is high, but falling. In 2012, Georgia was ranked 44th in the U.S., and by 2014, we had fallen to 31st. Part of the success can be attributed to a public/private partnership to reduce early elective deliveries in the state. Between 2012 and 2014, the early elective delivery rate dropped from 8 percent of births to 1 percent of births, and as of October 1, 2013, Medicaid no longer pays for early elective deliveries in Georgia.
The leading cause of death for Georgia women is cardiovascular disease. In fact, every day twenty-nine women die in Georgia from cardiovascular disease. The state is fighting this disease on three fronts. They are working to reduce obesity rates. Almost a third of Georgians are obese, up from 10 percent in 1990, and two-thirds of Georgians would be classified as overweight or obese. There are on-going education efforts to teach better eating habits and encourage exercise. Diabetes is also a driver in the rates of cardiovascular disease in the state. Women are diagnosed more than men are, and there is a push to increase the number of Diabetes Self-Management Education sites in the state. The third front is reducing tobacco use in the state through programs like the Georgia Tobacco Quit Line at 1-877-270-STOP. Dr. Fitzgerald also discussed cancer and Alzheimer’s disease.
Ms. Melanie McNeal, Long-term Care Ombudsman with the Georgia Department of Human Services, talked about the challenges faced by older women in the state. Learning to manage chronic disease is vitally important to our aging population, particularly diseases like diabetes. Preventing falls is another focus for our seniors, and local community groups are offering programs like A Matter of Balance and Tai Chi to help improve balance and reduce falls. Access to care issues from a lack of geriatricians to limits in transportation are also affecting Georgia seniors.
Dr. Catherine Bonk, president of the Georgia OBGYN Society, talked about the challenges of being an OB/GYN and ways the state can improve access to care in Georgia. It takes twelve years of education to become an OB/GYN—four years in college, four years in medical school, and four years of residency training in OB/GYN. Most of these doctors leave school with an average debt of $250,000. Of the twenty-three OB/GYNs who graduate from Georgia medical schools each year, only half stay in the state. An increase in residency slots as well as incentives for graduates to stay in the state would go a long way to increasing the number of OB/GYNs in Georgia.
A common thread that ran through all the presentations was concern for access to OB/GYN care and support programs for chronic disease in rural areas of Georgia. Forty counties have no obstetrical care of any kind—no OB/GYN, no family physician doing OB, no midwife—and more than 70 counties have no OB/GYN physician. Twenty-four percent of pregnant women in Georgia have to drive 45 minutes or more for obstetrical care.
There were possible solutions offered as well. Telemedicine is one way to deliver services in rural areas and is already in use in Georgia. However, it needs to be expanded. Programs encouraging OB/GYNs to stay in the state and incentives for working in rural areas would help close up some of the access gap. More certified nurse midwife programs would also expand care. As always, public education is vital to encourage women to use the programs available to them.
The Senate Women’s Adequate Healthcare Study Committee will meet three more times. Those dates and times are:
October 6, 2015, 9:00 am to 12:00 noon, at Georgia Regents University, Augusta
Topics will cover diseases that most affect women—cancer, cardiovascular disease, osteoporosis
October 26, 2015, 9:00 am to 12:00 noon, at Tift Regional Health Centers, Tifton
Topics will cover rural healthcare, access to obstetrical care, and telemedicine.
November 9, 2015, 2:00 pm to 5:00 pm, at the State Capitol Room 450
Topics will cover the socio-economic status of women and domestic violence
All committee meetings are open to the public.
Karla Jacobs is a member of the Georgia Commission on Women. She lives in Marietta with her husband, two kids, a dog, and some fish.