Fredericksburg Parent

www.FredericksburgParent.NET 33 The OB/GYN category in our family favorites contest has gone through dramatic changes in the last 10 years. What was once our largest, most competitive category has now shrunk down to under 10 candidates. Here is a look at what is happening to the OB/GYN healthcare sector, researched and reported by our sister publication, the FXBG Advance. We do not have enough doctors to do all the doctoring In Planning District 16—which is comprised of Fredericksburg City and the counties of Stafford, Spotsylvania, Caroline, and King George, and has a popula- tion of 320,000—there are seven obstetrics and gynecology practices. Together, according to their websites, these prac- tices employ a total of 22 doctors—physicians with either an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) degree. In order to practice obstetrics or gynecology, physicians must have gone through a residency in the specialty and taken a specialty exam within five years of receiving training, says Ami Keatts, a practicing OB-GYN in the Shenandoah Valley and chair of the Virginia chapter of the American College of Obstetricians and Gynecologists (ACOG). OB-GYN physicians are the only providers who can per- form surgical management of gynecological conditions and obstetrics, Keatts says. "Midwives and nurse practitioners can do a ton of stuff, but if let's say someone has a pregnancy failure and needs a D&E [surgical management of a miscarriage]—that would require a surgeon," Keatts says. "Only OB-GYN doctors do that procedure. No other specialty can do that." Other surgical procedures that only OB-GYN physicians can provide are endometrial ablations for treatment of unusually heavy menstrual bleeding, and laparoscopy, which is used either to diagnose potentially debilitating conditions such as endometriosis or fibroids or to perform treatments such as cyst removal or hysterectomy. Across Virginia and the country, Keatts says, "We do not have enough [OB-GYN] doctors to do all the doctoring." In her practice area, which covers Augusta, Allegheny, Highland, and Bath counties, "Patients really want to see a physician and it often takes a month or so to get in." It can take up to two months for new patients to be seen at most practices in the Fredericksburg area. At Pratt Medical Group, it could take five months, unless the patient is cur- rently pregnant. Some aren't accepting new patients. What's causing the shortage? The Fredericksburg area is not alone in experiencing a shortage of OB-GYNS. There were about 50,800 OB-GYNs practicing in the United States in 2018, according to a 2021 report from the U.S. Department of Health and Human Services' Health Resources and Services Administration. This number is expected to decrease by 3,300 providers by 2030, while demand is expected to increase by 7%. Physicians are retiring or cutting back their hours, Keatts says, and while the number of medical students going into the specialty hasn't changed, there are not enough facilities offering residencies in OB-GYN for those students. "The potential deficit is 5,000 OB-GYN physicians by 2030 all over the country," Keatts says. "Now those numbers come from 2018, so personally, I would expect it to be even worse, because with the pandemic, we saw peo- ple retiring a little bit earlier than expected." The cost of malpractice insurance is also driving the shortage. OB-GYNs in Virginia cannot practice without malpractice insurance, Keatts says. The cost of malpractice insurance is "the biggest reason most [OB-GYN] physicians are working for hospitals and large healthcare systems," she says. Virginia places a cap on the amount of compensation a patient can receive in a medical malpractice case. The cap is set to increase each year through 2031, when it will reach $3 million. "That will be a huge problem, because it will increase the cost [of malpractice insurance] for OB-GYN physicians in Virginia and will lead to more doctors leaving the workforce," Keatts says. What can be done? The General Assembly this legislative session took steps toward increasing the supply of OB-GYN physicians by funding five new residency programs in fiscal year 2025. "We hope that this will help lead to more providers in maternity care shortage areas," says Nicole Lawter, a lobbyist for ACOG. This, along with not removing the cap on medical malpractice compensation and not restricting access to abortion can help alleviate—or at least not worsen—the OB-GYN shortage in Virginia, Keatts says. "Restricting access to abortion and criminalizing the providing of birth control will drive OB-GYN providers out of the state," she says. There's a Shortage of OB-GYNS Locally, Statewide, and Nationally WRITTEN BY ADELE UPHAUS For more ar cles on the healthcare landscape in FXBG go to fxbgadvance.com

• Cover