Arizona is experiencing a shortage of maternity doctors while the state population continues to grow at a rapid rate.
“We face real challenges in recruiting and retaining physicians in Arizona,” said Jennifer Carusetta, executive director of the Health System Alliance of Arizona. “We are training more physicians in our medical schools than we are actually retaining in residency.”
More than 70 percent of physicians end up practicing in the same place they attend their residency, and Arizona does not have enough residency spots to meet demand and growth, Carusetta said.
According to Carusetta, Arizona is seeing a significant health care workforce shortage across the state, and rural communities lack physicians who can deliver babies, also known as obstetricians, or OBs.
“It’s an issue statewide,” she said. “We have a particularly hard time getting those types of physicians to practice in rural Arizona, and there are a couple different reasons behind that.”
For one, rural communities do not have the “economy of scale” that metropolitan areas have, Carusetta said. In other words, in heavily-populated areas there is higher patient volume, meaning more money for doctors.
As a result, many rural Arizonans must travel long distances to reach a doctor trained to not only deliver babies but to care for the mother and baby before and after the birth.
“There are two counties in the state that no longer have OB-GYN services, Greenlee and La Paz counties,” said Nick Goodman, CEO of MomDoc, the state’s largest women’s health care group, which was founded in 1976. “A total of over 31,000 people have no access to OB-GYN care within their own counties.”
There are 12 percent fewer OB doctors practicing in Arizona than 10 years ago, Goodman said. Meanwhile, Arizona’s population has grown by 584,000, or about 9 percent, in the same time period, according to Census data.
“We’re in a spot where individuals have considerable mobility, and physicians are leaving Arizona,” Goodman said.
Rural communities have trouble attracting physicians, and when it comes to OB-GYNs this becomes a cause for concern, Carusetta said. While a typical family doctor may have been trained to deliver a baby, they might not have the additional training necessary to identify complications during pregnancy or address postpartum challenges.
“It’s extra important that we get those types of specialists into our rural communities, because there’s really nobody else to do that job,” Carusetta said.
The problem, according to Goodman, is that health care providers — and especially OB-GYN doctors — are not reimbursed by insurance providers and Medicaid (known as AHCCCS in Arizona) at a competitive rate.
“Arizona’s issue… is that Arizona’s compensation is lower for the physicians, because reimbursements from health plans are lower to the physicians or physician groups than other neighboring states and other states in the nation,” Goodman said. “That’s making it so that these physicians are choosing not to practice in Arizona, which then leads to higher volumes for those that do practice here.”
Higher volumes plus lower pay does not attract new doctors to the state, he said. Arizona has an aging population of OB doctors, many of whom are close to retirement, and fewer young doctors are choosing Arizona.
Many times, physicians will finish medical school in Arizona and leave for an out-of-state residency, and then they do not return, Carusetta said.
“Let’s say, they go to Colorado or California — they’re more than likely going to establish their practice there and not come back,” she said. “And it’s very expensive for us to try to recruit physicians back to Arizona, because at that point we’re competing with other states in terms of pay, benefits, everything like that.”
OB-GYNs also have more career opportunities than in past decades, Goodman said.
“There was a time where it was: practice OB-GYN or be an educator — those were your two choices,” Goodman said.
Now, OB-GYN doctors still have those pathways, as well as several subspecialties: maternal-fetal medicine (MFM), which focuses on high-risk pregnancy; gynecological oncology, focusing on cancer in gynecology patients; urogynecology, which is related to pelvic dysfunction; pediatric gynecology, which focuses on young patients; and hospitalist positions where the doctor covers more general needs of the hospital.
None of these specialties involve general OB-GYN, so delivering babies is not typically part of the job.
Aside from rural areas like Greenlee and La Paz counties, health care providers on the border of metropolitan areas are seeing more demand from farther away.
“Five years ago, there were 12 OB-GYN physicians that called Banner Ironwood their home hospital,” Goodman said, referring to the medical center in Santan Valley, southeast of Phoenix.
As of August 2019, that number will be five, he said.
“As the maternity desert grows and other counties have less care, places that are on the periphery, like Banner Ironwood… are depended on more fully to care for people that have to drive long distances,” Goodman said. “But when you’re talking about only a third of the physicians in that area that were there five years ago, we’re talking a major problem.”
Another issue at play is called “physician burnout,” which happens when doctors are overworked and overstressed.
Before the recession, the state would match funding for residency positions, which would then be matched with federal Medicaid dollars, but that went away when the U.S. economy crashed, Carusetta said. The latest state budget might get those programs back on track.
“The budget this past year included dollars for graduate medical education residency programs in Arizona,” she said. “Arizona has been constrained in that their hospitals are really just limited. If your local county’s able to put up the dollars, great; if not, you can’t build a program.”
“This year, for the first time since the recession, the Legislature and the governor appropriated some dollars to start to build that program back up, and we’re very grateful for that. So now, in addition to those local matching dollars, we’ll have [the] state General Fund again.”