Will You be Able to Find an OB/GYN When You Need One?

By 2020, there will be a major US shortage of OB/GYNs.

Currently, women in Philadelphia wait up to an average of 51 days for a new patient appointment with an OB/GYN1. The Affordable Care Act has caused some additional increase in the wait times as more individuals are able to seek care; however, the shortage of primary care physicians has been evident for many years now. ACOG estimates that by 2020, there will be 8,000 less OB/GYNs than needed2. Having a shortage of OB/GYNs puts women, especially those in more rural areas, at a huge risk. This means less access to prenatal care and preventative health screenings, as well as, a larger dependence on nurse practitioners and midwives.

Two of the biggest causes of this problem are physician burn-out leading to early retirement and residency shortages3. So, what is burnout? Burnout is a combination of lack of enthusiasm for work, skepticism, distrust, and low sense of personal accomplishment. This can be due to long work hours, lower than desired pay, lack of control over work situations and lack of support within the work environment. OB/GYN is a field with long, unpredictable hours, many medical liability lawsuits, and high stakes decision making. This can quickly lead to burnout over a short period of time4.

There are 241 OB/GYN residency programs which translates into 1,288 resident spots5. There has been little change to the number of residency programs/spots since the 1997 Balanced Budgeting Act which capped federal funding of medical residency programs. The limited amount of residency spots for OB/GYN continues to worsen the shortage of OB/GYNs available to women, as well as, adds to the physician burnout by causing additional stress to the providers we do have. Approximately 47% of physicians remain in the area where they completed residency training6. The residency programs for OB/GYN are primarily in hospitals in more urban regions. The location of OB/GYN residency programs adds to the lack of OB/GYNs within rural areas, where half of the women must travel over 30 minutes to the nearest hospital with OB/GYN services in the region7.

As, a fourth-year medical student hoping to match into OB/GYN this Spring, I find this information disheartening. I hope we can find ways to rectify this problem soon to assure all women have access to female reproductive health care services.
Victoria Martino, MS4, Women’s Health Pathway

Resources

1https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Pdf/mha2017waittimesurveyPDF.pdf

2https://www.acog.org/Clinical-Guidance-and-Publications/The-Ob-Gyn-Workforce/The-Obstetrician-Gynecologist-

Workforce-in-the-United-States

3https://www.documentcloud.org/documents/3897592-Doximity-Report-OB-GYN-Workload-and-Potential.html

4http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/why-are-obgyns-burning-out?page=0,0

5http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf

6 https://members.aamc.org/eweb/upload/2015StateDataBook%20(revised).pdf

7 https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-

Underserved-Women/Health-Disparities-in-Rural-Women

https://medicalschoolhq.net/ss-27-a-deep-dive-into-obgyn-residency-match-data/

 

Caring for your heart on Valentine's Day!

Happy Valentine ’s Day to all you wonderful readers! And what better way to celebrate this Valentine ’s Day than to care for our hearts? This powerful,  pumping organ is vital for not only our wellness but survival. Therefore, it is important to understand all the factors that may impact your own heart. From diet to exercise, daily activities have a way of helping you feel better, inside and out. But as women, we may not necessarily have time for ourselves. This “always on the run” mentality stems from the double burden phenomenon—or the stress caused by the pressure to succeed in professional and household settings.  Stressors that women often face are both physical and emotional, often causing headaches, crying spells or irritability.

A recent study conducted by Dr. Nieca Goldberg evaluated 678 individuals and how their coronary artery disease is impacted by stress (in this case, public speaking). Coronary artery disease is essentially the narrowing of arteries caused by plaques along the walls. The study revealed that for 15% of the patients with stressed-induced ischemia (low blood flow), the cause differed between genders. For men, ischemia was caused by a rise in blood pressure and heart rate.  In contrast, for women, their small blood vessels impaired flow by constricting. Therefore, women suffer from microvascular dysfunction. Moreover, it appears as though stress-related ischemia is often asymptomatic until it isn’t anymore. This means that many patients who suffer from this condition are unaware of it until it’s too late.

However, it’s not all bad news. Stress is something that everyone deals with, but it’s how we manage it that affects our health. Physical activity and regular exercise can help keep blood vessels adequately dilated, combating the impact of stress.  Moreover, it is important to identify factors in our lives that cause us the most stress and find healthy outlets with meditation, spending time with family, or going on a walk.  A healthy and happy heart begins with little things that we can do daily. So despite your ever hectic schedules, find time for yourself!

Happy Valentine’s Day!

Meghana Pisupati

IHS 2018 

UPDATE: Perimenopausal/Menopausal symptom duration and changing treatments to meet needs of our transitioning female population

As women, we experience several stages of transition based on hormone fluctuations throughout our lifetimes. Though menarche and pregnancy get much of the attention in Obstetrics and Gynecology, the large and growing population of women living past middle age has been historically overlooked by medicine. This transition, known as perimenopause and menopause has only gained major recognition in medicine in the last 30 years. As one example, the National American Menopause Society, a non-profit organization with the agenda to “promote the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging” was formed in 1989. Today we know that women experiencing menopause and beyond require more dedicated research attention so physicians can better understand and manage the natural course of this major physiologic transition that affects all aspects of their health.

As an aspiring physician with special interests in women’s health, I am boggled by the idea that at baseline, physicians and researchers are just now investigating menopause in depth. One major study from 2015 published in JAMA Internal Medicine looked at the duration of vasomotor symptoms in women transitioning through menopause.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2110996

Many physicians currently espouse that women should expect symptoms to persist for 1-2 years and have been treating with hormone replacement therapy for a very limited period of time to alleviate discomfort.  Yet, based on the study in JAMA which followed 1,449 US women from several racial and ethnic backgrounds beginning at age 42 to 52 for up to 17 years, the transition appears to be more gradual, lasting up to 13 years based on epidemiological studies.

Emerging studies like this one provide hope for a future of equality of women’s healthcare and gender equality in research.

For menopause updates, follow the Normal American Menopause Society (NAMS) on twitter for some of the latest research and developments in post reproductive women’s health.

  https://twitter.com/MenopauseOrg or @MenopauseOrg

Lindsey Lee  DUCOM 2018