Access to obstetric care waning in some areas

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A national shortfall of obstetrician-gynecologists is expected to grow in the coming decades, and while there is data to suggest Maryland remains well-positioned compared to other states, some doctors and hospital officials remain concerned about access to obstetric care in the Free State.

The number of OB-GYNs nationwide has stayed virtually stagnant since 1980, while the population of women has increased 26 percent, according to the American College of Obstetricians and Gynecologists.

By 2030, ACOG expects a shortage of 9,000 OB-GYN physicians, a number that will grow to more than 15,700 by 2050.

In 2014, Maryland had 867 ob-gyns serving 2.46 million women, which works out to 3.52 OB-GYNs per 10,000 women and 7.27 per 10,000 women between the ages of 15 and 45 — higher than the national average of 2.65 and 5.42, respectively, according to ACOG.

But numbers don’t tell the whole story, according to Carmela Coyle, president and CEO of the Maryland Hospital Association.

There are any number of ob-gyns that don’t actually deliver babies and must refer their pregnant patients to doctors who will, Coyle said.

Trying to determine that number — which isn’t reflected in the total number of doctors — is one of the goals of a state-commissioned workgroup on access to obstetric care being led by MHA. The workgroup is scheduled to deliver a report on its findings, including recommendations for incentives that would increase availability of care, in December.

“What we’re trying to understand is the fragility and vulnerability of access to obstetric care,” Coyle said.

The proximity of doctors to patients is one concern. Three Maryland counties – Garrett, Caroline and Somerset – do not have any OB-GYNs, according to a 2014 ACOG report on the state’s workforce, and three Maryland hospitals have closed or will soon close their obstetric departments.

Maryland General Hospital, now the University of Maryland Medical Center Midtown Campus, moved its obstetric services about 1 mile away to the main UMMC campus in 2013 after seeing a 50 percent decline in deliveries from 2007 to 2012, according to a hospital spokeswoman.

Chester River Hospital Center, now the University of Maryland Shore Medical Center at Chestertown, closed its obstetric unit in 2012 after the two obstetricians who delivered there opted to move their delivery services to Anne Arundel County. The population of Kent County is aging, and rebuilding the unit after the obstetricians left did not make financial sense, said Patti Willis, regional senior vice president of strategy and communications for UM Shore Regional Health.

The Laurel Regional Hospital Center will close its maternity ward in October as the hospital transitions to an ambulatory care center after years of declining admissions. The department has been averaging about two births per day, a spokeswoman said.

Doctors and hospitals are also concerned the medical liability climate in the state — demonstrated by several large judgments in birth-related malpractice cases — which they say could push more obstetricians out of the baby-delivering business.

The high cost of insurance premiums threaten doctors as well as hospitals, which then have less money to put into new equipment and improvements to patient care, said Dr. Robert Atlas, chair of the department of obstetrics and gynecology at Mercy Medical Center in Baltimore.

Maryland had one of the highest total payouts for malpractice claims of any state in 2014 with more than $135 million, according to Deiderich Healthcare, which provides malpractice insurance.

One solution advocated by Atlas and the hospital association is the creation of a no-fault birth injury fund, financed by hospitals and doctors, which would provide compensation for claims of birth injuries to infants as long as no lawsuit was brought by the victims.

“Hospitals support making sure families are taken care of,” Coyle said, explaining that part of the fund’s intent is to prevent malpractice suits from being drawn out in court and making families wait for awards.

But such a fund is not the “silver bullet” that proponents say it is, said George S. Tolley III of the Maryland Association for Justice, formerly known as the Maryland Trial Lawyers Association. Only two states — Virginia and Florida — have adopted such funds, said Tolley, who is also a member of the MHA-led work group.

A December 2014 report from a state Department of Health and Mental Hygiene work group on obstetrical care access found that malpractice premiums across Florida remained among the highest in the nation, Virginia’s program has faced funding challenges, and both states have pursued tort reforms since creating the funds.

Maryland Sen. Catherine Pugh of Baltimore city, who has sponsored unsuccessful legislation to create the fund, said she was waiting to see what the workgroup recommended before deciding whether she would introduce the bill again in 2016.