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Healthcare Policy/Economics

Poster Session 3

(693) OBGYN shortage by Hospital Referral Region: Opportunities to reduce reproductive disparities

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To examine pre-Dobbs decision hospital referral region (HRR) characteristics and their association with OBGYN physician density outliers.

Study Design: Data on active non-subspecialist OBGYNs and total Graduate Medical Education full-time equivalents were obtained from Centers for Medicare and Medicaid Services. Census and socioeconomic data for each zip code were abstracted from the US Census Bureau, including total female population, population by race, and percentage (%) of females by marital status, education, household income, insurance status/source, and public assistance factors. These data were then aggregated by HRR per the Dartmouth Atlas. Linear regression was performed comparing each HRR’s female population to number of active OBGYNs to identify regions with the highest and lowest deciles of variance in expected compared to actual number of OBGYNs. Logistic regression was used to determine variable significance of demographic factors in the highest and lowest physician density deciles.

Results: Of the 306 HRRs, the highest OBGYN density decile comprised 31,463,100 females and 11,914 OBGYNs for a density of 2,641 females per OBGYN. In the lowest decile, there were 41,549,887 females and 7,980 OBGYNs for a density of 5,207 females per OBGYN. In univariate analysis, the % of Hispanic females, ≥bachelor's degree, fulltime employment, private insurance, poverty, households receiving SNAP assistance, mean household income, and overall population density were significantly associated with OBGYN density outliers (Table). In multivariate analysis, HRRs with a higher percentage of Hispanic females (p=0.013) and those with less than a bachelor’s degree (p< 0.001) were associated with more pronounced physician shortfalls.

Conclusion: HRRs with a higher proportion of Hispanic patients and lower educational attainment were more likely to have an OBGYN shortage. Policy aimed at recruitment and retention of OBGYNs in HRRs with an OBGYN shortfall as well as innovative healthcare delivery solutions should be a public health priority to reduce disparities.