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At one of the largest groups in Las Vegas providing obstetrical and gynecological care, the job keeps getting busier.
This year, the 11 faculty obstetrician-gynecologists at the University of Nevada, Las Vegas School of Medicine have delivered an average of nearly 300 babies a month — 10 percent more than in 2018. It's the second straight year that monthly deliveries have risen 10 percent from the year before.
But as the practice's workload has spiked, their staff has stayed flat — something they are eager to address.
"We are in recruiting mode," said Dr. Michael Gardner, vice dean for clinical affairs at the University of Nevada, Las Vegas School of Medicine and an obstetrician-gynecologist who specializes in maternal-fetal medicine. "We've had some success, but there are a lot of people out there looking to hire OB-GYNs, so we're competing against a lot of places across the country."
Across the United States, a growing physician shortage has hit doctors in both primary and specialty health care. For years, obstetrics and gynecology have been among the worst affected, with the American College of Obstetricians and Gynecologists projecting in 2011 that the U.S. would have a shortage of 8,800 obstetrician-gynecologists by 2020 (the 2011 projection is the latest available from the college).
The problem is pronounced in Las Vegas, which on Wednesday was ranked the metropolitan area most likely to experience an obstetrician-gynecologist shortage in the coming years in a new study by Doximity, a professional medical network for physicians.
Doximity has tracked the number of obstetrician-gynecologists across the 50 largest U.S. metropolitan areas for the past three years and has consistently ranked Las Vegas in the top slot for being at risk of a shortage.
The probability is calculated based on a number of factors, including whether the number of obstetrician-gynecologists has kept up with the population growth of a metropolitan area, said lead study author Christopher Whaley, a health economist at the University of California, Berkeley.
In Las Vegas, which has seen a recent population boom, there has not been enough of an influx of obstetrician-gynecologists to compensate for those who are nearing retirement, Whaley said, citing data that found that the typical obstetrician-gynecologist retires around age 59, and in Las Vegas, more than 41 percent are 55 or older.
"That really suggests that in the next couple of years, there could potentially be a pretty big drop-off if they're not replaced by younger doctors," he said.
The Doximity study ranked Salt Lake City second and Miami third in its list of metropolitan areas with the highest risk of shortages. Portland, Oregon; San Jose, California; and San Francisco were ranked as having the lowest risk.
The data only focused on large cities but Whaley said he suspected that "in rural areas, the problem is much worse" — especially given that half of all U.S. counties lack a single obstetrician-gynecologist, according to the American College of Obstetricians and Gynecologists.
One factor contributing to the shortage is physician burnout, said Dr. Ted Anderson, president of the American College of Obstetricians and Gynecologists.
"OB-GYN is one of the most exciting, emotionally charged, wonderful professions to be in," he said. "But on the other hand, the work can be very demanding. The hours are very demanding. And when things go wrong, they go very wrong."
He said the high cost of liability insurance for medical malpractice and the risks associated with the job lead some obstetrician-gynecologists to leave the profession and said that the added hours of computer work — such as filling out electronic medical records to keep up with government regulations — after seeing patients has also contributed to burnout.
The trend could have worrisome repercussions for patient care, Anderson said. As the U.S. grapples with a maternal mortality crisis, all patients — particularly those who develop dangerous pregnancy conditions or have underlying medical conditions that require close monitoring — need to be able to access their providers.
"We always have to plan for the disaster and hope it never occurs, and fortunately, most of the time, it doesn't," Anderson said. "But not having access when there are very critical problems is going to increase maternal deaths."
Dr. Christine C. Greves, an obstetrician-gynecologist at Orlando Health Winnie Palmer Hospital for Women and Babies in Orlando, Florida, a city that did not rank among the likeliest to face a shortage, described her field as rewarding — and taxing at times.
"OBGYN is 95 percent pure joy, 5 percent sheer terror."
"OB-GYN is 95 percent pure joy, 5 percent sheer terror," Greves said. "We take this very personally. Patients are not a number to us. They're people, and we give our hearts and souls trying to help them. And we are perfectionists. So when we don't get the results that we or our patients want, that is hard."
In Las Vegas, administrators at the University of Nevada, Las Vegas School of Medicine have been actively looking at ways to combat the burnout factor, Gardner said.
In the past few years, the school has doubled the size of its residency program in the hopes of recruiting more new obstetrician-gynecologists. And practitioners now have a 12-hour cap on the length of their shifts, as opposed to 24 hours, so they are not as grueling as they used to be, he said.
But Gardner said there is still work to be done to guarantee Las Vegas has the number of obstetrical providers necessary.
"Most of us pick the specialty because we love the specialty. Nobody goes into OB-GYN thinking it's a particularly easy lifestyle," Gardner said. "That said, people feel it, and we're doing the best we can to make sure people don't burn out."