It’s no secret that the shortage of ob/gyns relative to need in the U.S. isn’t what it should be. There simply aren’t enough doctors in the field, and certainly not enough willing to do deliveries and high-risk procedures to meet even the current demand. But the bigger questions are, 1.) will this trend continue? and, 2.) will it spread to other fields? Unfortunately, the answer looks likely to be yes.
So, why the shortage? Well, there are lots of reasons that all seem to be coming together at the same time. Here are just a few of the more prominent ones:
- The cost of medical malpractice insurance. While the cost of malpractice insurance has come down some over the past few years and seems to have largely leveled off, there’s no denying that it is still very substantial. And for ob/gyns, it’s especially so. Due to risk factors and the frequency of lawsuits against these doctors, ob/gyns pay the second highest malpractice insurance premiums of any specialty, exceeded only by surgeons.
- Fear of malpractice lawsuits. The second biggest concern doctors and students cite as keeping them from going into the obstetrics and gynecology fields is the fear of malpractice lawsuits. Even though insurance theoretically protects them from most of the financial burdens of being sued it can’t take away the stress and anxiety caused by the fear of being accused. And such fears aren’t unfounded. The average ob/gyn will be sued approximately three times in the course of a career. Upwards of 90% of all ob/gyns are sued at some point prior to retirement. And while the numbers are better for most other fields, they are still higher than most doctors think reasonable.
- The cost of education. In addition to malpractice concerns, the cost of education is a serious deterrent. The average debt of a student coming out of medical school is around $175k, and the average pay is only about $220k for ob/gyns, and only about $150k for general practitioners. Those salaries might not sound small, but when you consider the time and financial investment required for medical school and residency, the hours required, the chance of being sued, etc. it’s easy to see why other opportunities—opportunities that often require far less schooling and thus far less debt—might look better to bright, ambitious young people.
- Increasing number of patients. Part of the reason for the shortage of doctors (not only ob/gyns but also general practicioners and others) is simply the result of an increasing number of patients. With an aging population of baby boomers, a large number of doctors retiring, and healthcare reform projected to add something like an additional 32 million people to the ranks of the insured by 2016 it’s no wonder there is a shortage. We don’t just need to keep adding doctors at the rate we have in the past, we need even more!
- Lower payments and fear of the unknown. The medical environment today is in flux. It’s yet to be determined what healthcare reform will look like practically as it is changed, amended, and implemented. One thing that’s likely though is that a good number of those additional 32 million insureds will be getting their coverage through state run exchanges or Medicare/Medicaid. That means lower payments to doctors and hospitals and ultimately lower income. More patients, more work, more red tape, and less to show for it isn’t exactly an enticing prospect—especially when, as we mentioned, the price to pay for such a career is growing steeply.
So, with all that said, is there any hope? Not only do we have a laundry list of reasons why we’re being faced with a shortage of ob/gyns but more alarmingly still, on a moment’s reflection it’s clear that many of the reasons cited above aren’t unique to ob/gyns. They’re just the first to feel them, and tend to feel them more acutely, but many of these concerns will apply to general practitioners and even other specialist if they don’t already.
That said, yes there is some hope, but it will require creativity, commitment, and the expertise of professionals, like brokers, legal advocates, and forward thinking medical specialists who make it their business to help doctors do what they do without the added burdens of worrying about liability and profit loss. (The cost of education is a piece of the puzzle that would require more than we can get into here.)
- Legal reforms that seek to do things like put caps on non-economic damages need to be pursued vigorously in order to lower the threat to doctors of financial ruin, as well as to lower the cost of malpractice insurance by creating a less risky environment for insurance companies.
- Of course, one solution we’ve already seen developing is the designating of more responsibility to nurse practitioners and physician’s assistants. This is almost certainly going to continue to be a necessary component in a broader solution but of course it has its limits. There are only so many things an RN or PA can do without having the full medical training that a physician has.
- Hospitals can think creatively about hiring practices and division of labor (no pun intended). For instance, hiring a laborist may be a way to bring greater efficiency as well as reduced overall risk to a hospital’s practice. Likewise, while not always feasible some gynecologists may choose to treat only first and early second trimester pregnant women under their gynecology insurance and avoid paying for the riskier and more expensive coverage associated with obstetrics. This is of course dependent on your provider’s willingness to allow such a practice, which leads to a final suggestion.
- A broker that is more than a mere middleman between doctors and insurers is becoming a growing necessity. A good broker can do things like work with insurers to make certain that you are getting the proper, specifically tailored, coverage you need for your particular practice. This means things like negotiating to see whether certain pregnancy related treatments can be covered under gynecology insurance, making sure that part time insurance is taken advantage of whenever possible, helping you get the lowest rates possible, and even assisting your practice in navigating the issues involved with remaining compliant with changing legal and regulatory issues being rolled out on a seemingly endless basis.
Hopefully this and the shortage of ob/gyns hasn’t left you too gloomy, but the future of medicine is rife with change right now, and it will require creativity and boldness to meet the growing needs of an aging population and a growing number of patients. Thankfully there are those out there who have made it their business to try to help doctors continue to serve the needs of people and to do so without seeing profits dry up.
For more information on the specifics of finding medical malpractice insurance for ob/gyns download our whitepaper here. For help with anything pertaining to medical malpractice insurance in any field, contact one of our eQuoteMD staff members here, or get a quote here.