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.

Distribution of American Congress of Obstetricians and Gynecologists fellows and junior fellows in practice in the United States.

OBJECTIVE: To develop effective policies addressing access to health care for all women in the United States, we report the distribution of the American Congress of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in practice at county and state levels. METHODS: Data were gathered from the 2010 U.S. County Census File for adult women (aged 15 years or older) and reproductive-aged women (15-44 years old) and from the 2010 membership roster of ACOG. The number of postresidency, actively practicing physicians trained in general obstetrics and gynecology per targeted population were recorded at state and district levels and mapped at county levels using uDig GIS software and U.S. Census TIGER/Line Shapefiles. RESULTS: In 2010, the 33,624 general obstetrician-gynecologists (ob-gyns) in the United States, comprised 5.0% of the total 661,400 physicians. There were 2.65 ob-gyns per 10,000 women and 5.39 ob-gyns per 10,000 reproductive-aged women. The density of ob-gyns declined from metropolitan to micropolitan and to rural counties. Approximately half (1,550, 49%) of the 3,143 U.S. counties lacked a single ob-gyn, and 10.1 million women (8.2% of all women) lived in those predominantly rural counties. Such counties, located especially in the central and mountain west regions, were commonly in designated Health Professional Shortage Areas. CONCLUSION: An uneven distribution of ACOG Fellows and Junior Fellows in practice exists throughout the United States and may worsen if resident graduates continue to cluster in metropolitan areas. Meeting the needs of women in underserved areas requires creative innovations in enhancing a more uniform geographic distribution of providers. LEVEL OF EVIDENCE: III.