To Dr. Mark Simon, chief medical officer at Ob Hospitalist Group, an OB-GYN hospitalist provider operating in 36 states, the reduced interest in the specialty is not surprising.
“When you go into a residency, you want to learn full scope for your specialty, whatever that is, and for OB-GYN that includes abortion care,” Simon said. “The other component of that is, who really wants to go to a location where they could potentially be subject to civil or criminal penalties for doing their job?”
Since most doctors practice medicine where they complete their residency, Simon said he is concerned about what the shift could mean for the medical workforce in restrictive states. “It is a challenge for those states because it's going to create even more difficulty for them in recruiting obstetricians or obstetrical clinicians who would provide that care to the population,” he said.
The U.S. is already experiencing a shortage of maternity healthcare professionals and is last among the developed countries when it comes to maternal mortality, said Dr. Marcus Schabacker, president and CEO of ECRI, a nonprofit patient safety organization.
“Creating uncertainty and a very politically charged environment is certainly not helping,” Schabacker said. “The decreased numbers of people interested in and willing to specialize in OB-GYN is worsening the situation.”
Nationwide, obstetrics units in hospitals are shutting down as a result of economic challenges and staffing shortages. More than 89 obstetric units closed in rural hospitals between 2015 and 2019, according to the American Hospital Association.
Nearly 20 rural communities have lost access to obstetrics services over the course of the pandemic, the Chartis Group found in a recent study.
In March, Bonner General Health in Standpoint, Idaho, announced it was closing its obstetrical services, largely due to the state’s legal and political climate. Last year, Idaho enacted a near-total ban on abortions, meaning doctors in the state could spend up to five years in prison for performing the procedure, with the exception of cases involving rape, incest or maternal health concerns. The threat has prompted some physicians to leave the state and made it difficult to recruit others.
Central Maine Healthcare’s Rumford Hospital in Rumford, Maine, closed its maternity unit at the end of March, citing a declining birth rate, shortage of obstetricians and inconsistencies surrounding how to provide women’s healthcare. The health system said the closure would not result in job cuts.
In December, Astria Toppenish Hospital in Toppenish, Washington, ended its labor and delivery services, citing economic constraints, labor challenges and a reduction in Medicaid reimbursement. The Astria Health hospital said it dedicated resources to sustain its labor and delivery services, but lost $3.2 million over the previous year.
Delays and denials of treatment due to lack of access and complicated legal frameworks remain major threats to patient safety, Schabacker said. He called on state legislatures and health system administrators to give clear guidance to clinicians on what is legal and admissible before a moment of crisis arises and a decision needs to be made, he said.
“Educate your workforce, create a safe environment, have feedback loops, have a learning system and educate your patients and the community you're operating in on what they can expect when they come to the clinic,” Schabacker said.