More S. Florida obstetricians stop delivering babies, cut services
By Patty Pensa
http://www.sun-sentinel.com/
Pregnant women in South Florida face fewer choices for medical care as more doctors stop delivering babies and avoid taking on high-risk patients.
The result: More patients flock to fewer doctors, who in turn send expectant mothers to even fewer specialists. It means more juggling of appointments, longer waits to see doctors and a break in doctor-patient relationships.
Projections show 30 percent fewer obstetrician-gynecologists in Palm Beach County, while the need will grow 7 percent in three years, according to the county’s medical society. Similar numbers are not available for Broward County, but doctors said they see the same trend.
Ob-Gyns are grappling with a crisis in medicine in South Florida and around the nation, compelling many to change how they practice. From neurosurgeons to family physicians, doctors say they are stung by the high cost of malpractice insurance and low reimbursement for care.
The reaction by Ob-Gyns in Florida is more pronounced than in the rest of the nation. Nearly twice as many in Florida said they were dropping high-risk patients, according to an industry survey.
Likewise, more physicians in Florida than in the rest of the nation are ending the long marriage between obstetrics and gynecology. Instead, they practice only gynecology, which looks broadly at the health of female reproductive organs. Obstetrics focuses on care leading up to childbirth. Many doctors traditionally have practiced both for most of their careers.
“Obstetrics is a very important part of medicine,” said Dr. Jay Trabin, chairman of the Florida chapter of the American College of Obstetrics and Gynecology. “But it’s not what it used to be. I love delivering babies but I can’t do it anymore.”
The Boynton Beach physician stopped delivering babies five years ago when his malpractice insurance costs outstripped his income from obstetrics. Trabin recently launched a survey of all obstetrician-gynecologists in the state to find out the severity of the shortage among counties.
In Palm Beach County, almost 20 percent have cut obstetrics out of their practices and another 15 percent plan to do the same in less than two years, according to preliminary survey results. The data do not include retirements but focus solely on those who stop practicing because of liability concerns.
To spread risk, more doctors who remain in dual practice will join groups of 10 to 25 doctors, much larger than the typical office of three or four physicians. Patients may not get to see their own doctors, especially in the delivery room, Trabin said.
Data for Broward County are not complete yet. But Dr. Aaron Elkin, a Hallandale Beach obstetrician-gynecologist, said he can tell the numbers Ob-Gyn doctors are dwindling — even if it’s only doctors quitting obstetrics. Insurance reimbursements for patients considered high risk, such as diabetics, are low despite the extra care required, he said.
“The actual number of all-service Ob-Gyns that will not cherry-pick patients — that number is down drastically,” Elkin said. “I think it will continue to go down.”
Elkin, a board member of the Broward County Medical Association, estimates a third of Ob-Gyns in the county have limited their practices or do only simple procedures. For instance, doctors are cutting out risky deliveries such as natural birth after a woman has had a Cesarean section. Some don’t even do standard gynecological surgeries such as hysterectomies.
Dr. Alan Patterson, who practices in Boca Raton and Coral Springs, sends patients who want to deliver naturally after C-sections to someone else. In these cases, physicians fear being sued even though the risk of uterine rupture is small. They also must cancel office appointments or weekend plans to attend the entire labor.
“You’re just waiting there and insurance doesn’t reimburse extra for doing that,” said Patterson, who plans to drop obstetrics in five to eight years. “If the uterus does rupture, it’s horrible because you may not get the baby out on time. It only takes one case to ruin everybody’s life.”
Patterson’s patients, though, say they’re lucky they don’t have to search for another doctor to deliver their babies. Stephanie Tomasini, 33, of Delray Beach, said such a switch would be devastating.
“To go to your gynecologist is one of the most personal things a person does,” she said. “It’s a shame if the doctors aren’t there. I don’t know how you would get the care you need.”
Obstetricians commonly send patients to a perinatologist, a specialist for problems during pregnancy. Obstetricians don’t want to be responsible for missing any abnormalities, so they have a perinatologist do ultrasounds and help care for women with problems such as high blood pressure, heart disease and cancer, doctors said.
Dr. Ruel Stoessel, a perinatologist in Lake Worth and Palm Beach Gardens, has seen his practice swell since he came to the area a decade ago. Part of it, he said, could be that more older women, who are typically high-risk patients, are having babies. But he also sees obstetricians sending him more patients than in the past.
More doctors are needed, he said, but recruiting is difficult because of the high cost of malpractice insurance — around $100,000 a year for coverage of $250,000 per incident for up to three claims. Fewer medical students nationwide are interested in obstetrics because of such issues, said Dr. Ann Honebrink, with the American College of Obstetricians and Gynecologists.
“Medical students see a bunch of unhappy people and say, ‘I don’t want to be in that situation,'” she said.
To fill the gap, the role of nurse-midwives has grown steadily. Nurse-midwives across the nation deliver about 11 percent of babies born naturally, according to most recent government statistics. Midwives, who are not doctors and cannot perform C-sections, perform about 17 percent of natural births in Florida, showing a greater presence in the state compared with the rest of the nation.
A demographic study by the Palm Beach County Medical Society last year showed about 140 Ob-Gyns in the county, though 150 were needed to match the population. In three years, retiring doctors will leave about 100 physicians, though 166 will be needed. The census did not include physicians who only practice gynecology. There is no similar study in Broward.
“Everyone is so busy right now,” Stoessel said of obstetricians, “that no one has time to spend any real time with patients who have underlying medical conditions. It’s not like [obstetricians] don’t know how to do it. But the system is set up to penalize you.”
Patty Pensa can be reached at ppensa@sun-sentinel.com or 561-243-6609.
