Fragile Rural Health Care System
Tue June 24, 2014
OB Care In Humboldt County Nears The Breaking Point
The United States is facing a shortage of obstetrician/gynecologists of nearly 25-percent over the next 15 years.
The strain is already being felt in rural areas such as Humboldt County, California, where the ratio of OB/GYNs to women is about one-third the national average.
Why that is, and what can be done about it, says as much about the plight of rural health care as it does about who will - or won’t - be there to deliver our babies.
According to a study in the New England Journal of Medicine, a county the size of Humboldt should have at least 13 OB/GYNs. But it has only five, and four of them are age 65 or older. Only two of them work full-time.
Deepak Stokes: “I’ll be 65 this year and I had a heart attack three years ago.”
Dr. Deepak Stokes is one of those full-time obstetricians. He does gynecologic surgery two days a week and, along with four midwives on his staff, delivers about 40 babies a month.
Deepak Stokes: “What would happen if I have a heart attack again tomorrow? Then all of a sudden is a major crisis and you just can’t fill it overnight”
Dr. Stokes and 69-year-old Dr. Jack Anderson have either delivered or been on-call back-up for well over half the recent deliveries in the county. Over the past decade the number of physicians delivering babies in Humboldt County has dropped by half.
Even though both doctors have 3 or 4 midwives working with them, state law still requires that they be close by and reachable for all these deliveries in case of complications. So, these two men have been on-call, 24-7, for most days of their 30-plus-year careers. What happens when they stop? And how did we get into this bind?
Chris Cody: “There is no slack in the system. Everybody is working as hard as they possibly can.”
Dr. Chris Cody is a pediatrician who’s been working with the local obstetricians on a daily basis for 33 years.
Chris Cody: We need a couple more bodies. Because if one of the large producers should go down, then you will be in a crisis. Then you may be having a problem with patients not being able to find care."
The answer seems straightforward: just recruit more OB/GYNs. But there are both national and local obstacles to consider. Nationally, the number of OB/GYN training programs - and the number of medical students entering them - has been dropping.
At the same time malpractice liability premiums paid by obstetricians have soared to levels about a third of their total income. OBs are one of the most-sued types of doctors. They have some of the longest and most unpredictable hours of any physicians. It’s no wonder there has been no net increase in obstetricians for over 30 years.
Then there’s Humboldt County.
Leslie Broomall:”Recruiting in Humboldt County is difficult”
Leslie Broomall is director of marketing and communications at Saint Joseph’s Hospital in Eureka.
Leslie Broomall: “Predominantly the difficulty lies in our payer mix. We have a lot of MediCare and Medi-CAL. Those reimbursement rates are going down and down."
With one out of four people in the county on Medi-Cal, and a very large uninsured population, it’s no wonder that area doctors and hospitals are struggling to get paid.
This may be a strong deterrent to young doctors who need to pay back an average of 150 to 200-thousand dollars in medical school loans. Many of them, understandably, are seeking a lifestyle in which they only have to be on-call a few times a month.
Finally, studies show that a patient mix like Humboldt County’s is more likely to be older, impoverished, chemically addicted, unemployed, and suffer from under-treated and severe chronic illness.
So, it’s easy to understand how even bucolic Humboldt could lose its luster.