The average age of ob.gyns. is rising across the country, signaling physician shortages that are projected to worsen over the next several decades. The pinch may be felt especially in areas with high birth rates and few younger ob.gyns., according to a report from Doximity.
Doximity’s geographic projections paint a fine-grained picture in agreement with the American College of Obstetricians and Gynecologists’ projections of a national shortfall of up to 8,800 ob.gyns. by 2020, with the deficit of ob.gyns. potentially climbing to 22,000 by 2050.
Pittsburgh and Bridgeport, Conn. top the list of metropolitan areas with the oldest average age of practicing ob.gyns., with average ages of 52.32 and 52.12 years, respectively. Las Vegas, Detroit, Miami, Los Angeles, New York, Boston, and Chicago all also made the top 15 cities in this list.
Because ob.gyns. start to leave the work force at age 59 years and retire at a median age of 64 years, this aging physician population could affect access to women’s health services within the decade, said Dr. Whaley. The fact that the burnout rate for ob.gyns. is only topped by emergency room physicians represents another area for concern, said Dr. Whaley of the University of California, Berkeley.
The report drew on data from the Centers for Medicare and Medicaid Services and board certification data. Doximity’s self-reported information from about 43,000 full-time board-certified ob.gyns. was also factored in. The top metropolitan areas were determined by 2010 census data and birth statistics came from federal databases.
With the data sliced another way, Pittsburgh also had the highest percentage of ob.gyns. aged 55 years or older, with 41.92% falling into this age group. Of the 50 metropolitan areas included in the Doximity report, 32 have an ob.gyn. workforce with at least one-third aged 55 years and up.
And there are many metropolitan areas where there’s a paucity of young ob.gyns., signaling future serious shortages, according to Doximity. In 12 of the metropolitan areas studied, less than 15% of the ob.gyn. workforce is aged 40 years or younger. Some of the cities with a potential “double hit” of older ob.gyns. and few younger physicians entering the profession include Las Vegas, Miami, Los Angeles, New York, and Chicago.
The Doximity methodology also took into account the average workload, in terms of the number of live births per physician per year, for ob.gyns. in the various metropolitan areas. There was a large variation in workload calculated this way: St. Louis has 247 live births per ob.gyn per year, while Louisville, Ky., has just 64, according to the report.
Factoring in workload information as well, the report gives a “shortage risk index” listing. Here, Las Vegas, Los Angeles, and Miami top the list. Cities considered at lowest risk for shortages according to this methodology include Baltimore, Denver, Portland, Ore., and Cleveland.
According to a 2017 ACOG workforce report, though women make up nearly half of those entering medical school, over four in five physicians entering ob.gyn. residencies (82.3% in 2016) are women. Further, women made up 58.7% of the ob.gyns. in active practice in 2017, outstripping all other surgical and medical specialties save pediatrics. Within 10 years, two-thirds of all ob.gyns. will be female, according to ACOG.
“While this study cannot determine causation for the variation in workloads, compensation, or shortages across metropolitan areas, we hope it will continue to serve as a baseline for the size of the challenge and prove helpful to health care employers, policymakers, patient advocates, and others interested in further study of this topic,” wrote Dr. Whaley and the report’s coauthors. “This information may also be helpful for ob.gyns. looking to live in areas with an increasing need for their expertise,” they said.
Dr. Whaley has received consulting fees from Castlight Health, Crossover Health, Doximity, Livongo, and Norwest Venture Partners. Doximity funded the production of the report.