In mid-February, Dakota Richardson went to the emergency
room at Stafford Hospital for abdominal pain. Ultrasound imaging revealed a
large cyst on one of her ovaries.
“They told me they were not going to remove it right away
because it wasn’t an emergency yet,” Richardson says. “But they said, we want
you to go to your gynecologist.”
She did, and a follow-up ultrasound showed that the cyst was
still there. She and her doctor decided to move forward with surgery at Mary
Washington Hospital to remove it. But after two months, Richardson was still
waiting for a surgery appointment.
“[My doctor] told me he’s been reaching out to the
scheduling department, and he can’t even hear back from them,” Richardson says.
“Me as a patient, I can’t get ahold of them. Apparently, some of their own
doctors can’t get ahold of anyone to schedule a surgery.”
By mid-April, the pain from the cyst had become disruptive
to her life and she’d taken unpaid leave from her job as a delivery driver at
Domino’s. She wasn’t sure if the store would have a job for her when she was
ready to go back.
On April 18, Richardson turned to the Facebook group
Fredericksburg Talk for advice.
“Any recommendations on a [gynecologist] who doesn’t go
through Mary Washington who can get me into surgery asap? Must take Medicaid,”
she wrote.
In the 75 responses, women urged Richardson either to go to
the emergency room or seek care in the Richmond area.
“There’s a shortage of [gynecologists] in Fredericksburg,” one
person wrote. “No one is getting in quickly. Maybe call VCU [Medical Center].”
“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 population of 320,000—there are seven obstetrics and gynecology
practices. Together, according to their websites, these practices 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 perform
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 currently 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 people 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.
