Diversity of Physician Faculty in Obstetrics and Gynecology.

OBJECTIVE: To investigate physician faculty diversity in obstetrics and gynecology (ob-gyn) and how it compares with other clinical departments and medical student demographics. STUDY DESIGN: Data from the Association of American Medical College's Faculty Roster were extracted to differentiate full-time physician faculty by gender and by underrepresentation in medicine (Black, Hispanic, Native American/ Alaskans, and Pacific Islanders). Whole population data were updated on a rolling basis from the earliest year of reliable data (1973) to the most recent year (2012). RESULTS: The total number of full-time ob-gyn faculty increased from 922 in 1973 to 4,208 in 2012. The increase in proportion of faculty who were women (from 9.9% to 52.7%) contributed to the growth of underrepresented faculty (from 7.7% to 13.3%) during this period. Percentages of ob-gyn faculty who were women and underrepresented in 2012 were higher than in other core clinical departments and similar to those of current medical student matriculants. CONCLUSION: Expansion of physician faculty in ob-gyn over the past 40 years has led to greater diversity than exists in many other departments and is more reflective of medical student demographics.

Geographical information systems for mapping maternal ground transport to level III care neonatal centers.

OBJECTIVE: The objective of this investigation was to determine maternal ground transport times from community hospitals to the nearest hospital offering comprehensive (level III) neonatal care within the contiguous United States. STUDY DESIGN: This observational study combined data from the 2010 U.S. Census tract and 2010 American Hospital Association Annual Survey. Level III (full complement of care) neonatal centers were plotted using 2010 geographical information systems (GIS) mapping software (ESRI, Redland, California, United States). Locations of level I (uncomplicated care) and level II (limited complicated care) centers and residences of reproductive-aged women (18 to 39 years old) were mapped to identify maternal ground transport times to level III centers. RESULTS: Most of the 584 level III neonatal centers were located in metropolitan areas (83.5%). The proportions of level I and level II hospitals within a 30-minute drive of a level III neonatal center were 19.8 and 47.3%, and 52.2 and 69.8% were within a 60-minute drive time. Ground transport times were shortest in the Northeast and metropolitan areas, and longest in the rural Great Plains and noncoastal West. CONCLUSION: GIS mapping enables health providers and health policy makers to better understand maternal ground transport times to current and future regional hospitals offering level III neonatal services.

Estimated demand for women's health services by 2020.

OBJECTIVE: To estimate the demand for women's health care by 2020 using today's national utilization standards. METHODS: This descriptive study incorporated the most current national data resources to design a simulation model to create a health and economic profile for a representative sample of women from each state. Demand was determined utilizing equations about projected use of obstetrics-gynecology (ob-gyn) services. Applying patient profile and health care demand equations, we estimated the demand for providers in 2010 in each state for comparison with supply based on the 2010 American Medical Association Masterfile. U.S. Census Bureau population projections were used to project women's health care demands in 2020. RESULTS: The national demand for women's health care is forecast to grow by 6% by 2020. Most (81%) ob-gyn related services will be for women of reproductive age (18-44 years old). Growth in demand is forecast to be highest in states with the greatest population growth (Texas, Florida), where supply is currently less than adequate (western United States), and among Hispanic women. This increase in demand by 2020 will translate into a need for physicians or nonphysician clinicians, which is clinically equivalent to 2,090 full-time ob-gyns. CONCLUSION: Using today's national norms of ob-gyn related services, a modest growth in women's health care demands is estimated by 2020 that will require a larger provider workforce.

Pursuit of accredited subspecialties by graduating residents in obstetrics and gynecology, 2000-2012.

OBJECTIVES: To estimate whether there has been an increase in resident graduates pursuing fellowship training in the currently accredited subspecialties and to compare whether any trend toward subspecialization is similar to those seen in other specialties. METHODS: This descriptive study examined data from the National Residency Match Program for academic years 2000-2012. Annual comparisons were made between the numbers of residents who either pursued careers in their specialty or were accepted into fellowship training in an accredited subspecialty. We compared the numbers in each group who took the American Board of Obstetrics and Gynecology (ABOG) written board examination and who became board-certified. RESULTS: Although the annual number of residency graduates in obstetrics and gynecology remained essentially the same (1,185 ± 56), the proportion of graduates accepted into fellowships increased steadily in all subspecialties (from 7.0% in 2000 to 19.5% in 2012). All other core specialties saw higher proportions of their graduates pursuing subspecialties except for family medicine. Coincident with rises in fellowship programs and positions was eventual increase in trainees who took the ABOG written examination for the first time in the three established subspecialties (maternal-fetal medicine, gynecologic oncology, reproductive endocrinology and infertility) and who became board-certified. CONCLUSION: Like with residents in other specialties, more graduates in obstetrics and gynecology are pursuing accredited subspecialty fellowship training, adding to the complexities of workforce planning. The percent of obstetrics and gynecology residents who pursued accredited subspecialty fellowship training was lower than all but one other specialty.

Maternal-fetal medicine workforce in the United States.

OBJECTIVE: To identify the current supply and locations of maternal-fetal medicine (MFM) subspecialists in active practice in the United States. STUDY DESIGN: This observational study examined the membership roster of the American Congress of Obstetricians and Gynecologists in 2010 for those whose practice was in either general obstetrics and gynecology or maternal-fetal medicine. Reliable national databases were used to determine the numbers and locations of births annually, reproductive-aged (15 to 44 years old) women, and level III perinatal centers in each state. RESULTS: There were 1355 MFM subspecialists in the United States in 2010 with the highest number being in the most populous states. Nearly all (98.2%) resided in metropolitan counties with level III perinatal center(s). Nationwide, there was one MFM subspecialist for every 24 general obstetrician-gynecologists and for every 3150 births. States with the highest number of MFM subspecialists per 10,000 live births were Vermont (9.5), Connecticut (6.4), Maryland (5.8), New Jersey (5.7), Hawaii (5.7), and Massachusetts (5.6). The lowest densities were in Indiana (1.5), Mississippi (1.3), Idaho (1.2), and Arkansas (1.0), and North Dakota and Wyoming had none. CONCLUSION: Data from this population-level study will serve as a baseline to follow trends in the workforce of MFM practitioners.

Creation of an advisory group for physician workforce studies in obstetrics and gynecology.

OBJECTIVE: A projected shortage of obstetrician-gynecologists prompted us to query other major national medical and surgical organizations about internal efforts to examine their specialty's physician workforce needs. STUDY DESIGN: We sought the experience of the top 20 academies, societies or colleges of those medical or surgical specialties. Each organization had approximately 10,000 or more physician members. Those identified as being the most knowledgeable about physician workforce efforts in their specialty were asked to electronically complete a 14-question survey about the existence, structure and function of any workforce office or advisory group in their specialty. RESULTS: Each organization responded to the survey. A task force, permanent committee or office (in large organizations) was formed to ascertain their specialty's workforce needs and projections. The results prompted the Executive Board of the American Congress of Obstetricians-Gynecologists to approve in July of 2010 the creation of an advisory group to conduct research and inform members about trends that affect the obstetrician-gynecologist workforce nationally and in individual districts. CONCLUSION: In response to the potential shortage of obstetrician-gynecologists, an advisory group was approved by the American Congress of Obstetricians and Gynecologists to undertake workforce studies.

Drive times to hospitals with perinatal care in the United States.

OBJECTIVE: To evaluate access to inpatient obstetric care, we determined the proportions of women of reproductive age who resided within 30-minute and 60-minute driving times to the nearest hospital offering perinatal services. METHODS: Perinatal centers, identified from the 2007 American Hospital Association survey, were designated as being level I (uncomplicated obstetric and nursery care), level II (limited complicated care), or level III (full complement of care). The study population consisted of all reproductive-aged (18-39 years) women included in the 2010 U.S. Census Bureau estimates. We used geographic information system mapping software to map 30-minute and 60-minute drive times from the census block group centroid to the nearest perinatal center. RESULTS: A total of 2,606 hospitals in the United States offered some level of perinatal care for the 49.8 million reproductive-aged women. Access to perinatal centers within a 30-minute drive varied by the level of care: 87.5% of the population to any center; 78.6% to level II or level III centers; and 60.8% to level III facilities. Access to the centers within a 60-minute drive also varied: 97.3% of the population to any center; 93.1% to level II or level III centers; and 80.1% to level III facilities. The mostly rural western half of the United States (except for the Pacific Coast) and Alaska had the greatest geographic maldistribution of perinatal services. CONCLUSION: Driving times to hospitals offering perinatal care vary considerably. Using geographic information system software can be valuable for regional obstetric workforce planning and policy-making in relation to accessing care.