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Maternal care shortage hits rural Del. women hardest

Katie Tabeling
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With a nationwide exodus of obstetricians and gynecologists continuing at significant rates, women in Delaware’s rural communities are facing more of the impact while health care systems work to fill the gaps.

There are 243 active OB-GYNs in the state, according to state data, but 49% of those practices are in Christiana, Lewes, Dover, Greenville and near the ChristianaCare hospital. | PHOTO COURTESY OF ADITYA ROMANSA/UNSPLASH

With a nationwide exodus of obstetricians and gynecologists continuing at significant rates, women in Delaware’s rural communities are facing more of the impact while health care systems work to fill the gaps.

For years, studies have sounded the alarm about OB-GYN doctor shortage. A 2019 report by the American College of Obstetricians and Gynecologists projected a shortage of up to 8,800 obstetricians and gynecologists by 2020, and a shortfall of up to 22,000 by 2050. 

But in Delaware, that data has been the reality for years, exacerbated by Dedicated to Women closing five of its private practices by the end of the year. Maternity and Gynecology Associates, a practice with offices in both Middletown and Newark, will also be closing their doors. 

There are 243 active OB-GYNs in the state, according to a June 2022 report from the Delaware Academy of Medicine, although the report is due to be updated within months. But 49% of those physicians are in Christiana (19713), Lewes (19958) Dover and Cheswold (19904), Greenville, (19807) and Newark (19718).

Some pockets of the state, like in Laurel, Selbyville, Ocean View, Milton and Millville, among others, have one or two OB-GYNs listed per zip code, according to the data. However, physicians may have privileges at multiple locations throughout the state.

Dr. Garrett Colmorgen, the chairman of the Medical Society of Delaware’s Maternal and Child Health Committee and has practiced for nearly 40 years, said it’s been a trend he’s seen play out for a while, with similar circumstances in rural areas.

For patients, the cost sometimes may not justify the care – speciality or otherwise – particularly for the uninsured or those on Medicaid. Sussex County’s growing Hispanic and Creole population, some of them immigrants, complicates some matters in terms of getting access to care.

Colmorgen said one of his Haitian Creole patients is having some troubles in her pregnancy, and is going out of state to see a specialist since none in Delaware is willing to bear the cost.

“It can be 20 to 30 miles to get to care in some cases, and the earlier we see patients, the sooner we could mitigate complications in pregnancies as they happen,” Colmorgen said. “Some hospitals will support patients who truly can’t pay, but if they don’t it can be thousands of dollars.”

Looking at the financial picture, in Delaware the mean wage for OB-GYNs is $169,560, according to the 2021 Department of Labor wage report. Nearly 30% of medical liabilities insurances increased in 2021, with Delaware’s increasing year-over-year by 6%, according to the Medical Liability Monitor. With rising costs, obstetricians are ceasing services to avoid paying higher costs.

Medicaid reimburses a portion of these births, but at most times not enough to cover the complete costs, likewise for prenatal visits. At a point, some of the smaller firms may decide to transition to working with a larger health care system to trade off those costs. 

“You’re seeing individual practitioners is where the practice gets bigger, and at some point, those practices simply decide the [malpractice] risk is too high and withdraw OB services,” Colmorgen said. “Sussex County in particular faces a number of problems with the immigrant population that can be late to get into care.”

La Red Health Center helps fill that need, as do nurses at TidalHealth Nanticoke, which has also contracted with TeamHealth to offer round-the-clock services since July, after many of its OB-GYNs left the health care system earlier this year.

But when the immigrant patients do start care, there sometimes is a language and cultural barrier. Some of it can be bridged via translator and pictorial instructions, or even using iPads with video translations to help. 

“For the Hispantic, Haitian and French Creole population, transportation can also be a challenge to make the visits and even navigate the system,” TidalHealth Senior Director of Nursing Administration Diane Hitchens said. “It’s like we need someone in the community able to make those connections. How do we establish trust in that community?”

With OB-GYNs scarce, patients quickly spread the word of a good one, which can also make scheduling difficult and pushing appointments out months in advance. Recruitment and retaining nurses has always been a challenge in rural areas, but the COVID-19 pandemic is also causing some major shifts in how the medicine is practiced. Instead of a physician being available 24/7, they are now starting to keep on-call hours to maintain a work-life balance.

“It’s especially hard to attract graduating residents, because sometimes they come from training at big centers. It’s hard to attract physicians to a rural area they’re not from and where there’s a low volume of patients or not many [physicians] to take calls with,” said Dr. Katie Borders, an OB-GYN who works in Shelby, N.C., and advocates for rural maternal health with the American College of Obstetricians and Gynecologists.

“We need to just get people to give us a chance,” she added. “Medical school needs to be made more affordable, and the reimbursements need to change to help make that happen.”

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