And why we need the Clinic more than ever!
The shortage of ob/gyns in California, as elsewhere, is real, says Dr. David Ahdoot of Burbank. Except for the northeast, this problem is nationwide. According to a 2021 update from the U.S. Department of Health and Human Services (HHS), the number of ob/gyns nationwide is expected to decrease seven percent between 2018 and 2030, while the demand is headed in the other direction—projected to rise four percent. The need for nurse-midwives, nurse-practitioners and physicians assistants who provide women’s healthcare is also expected to exceed the supply in coming years. California will likely need an additional 4,700 primary care clinicians by 2025, according to the HealthForce Center at the University of California, San Francisco.
California has not sat idle in the face of dire predictions says Janet Coffman, PhD, Associate Professor at UCSF. Over the past decade the legislature has “substantially” boosted funding for grants to support ob/gyn residency programs through CalMedForce and the Song-Brown Healthcare Workforce Training Program. The result is an 18 percent increase in the number of residents entering the field over the past decade. Funding for midwifery, nurse midwifery and nurse practitioner education has been more modest, says Coffman, “which I find disappointing because they are qualified to provide many reproductive health services and are more likely to care for underserved populations.”
Each year an estimated 800 to 16,100 more people are expected to travel to California for abortions, according to projections made in 2022 by the UCLA Center on Reproductive Health, Law, and Policy. As of January 2023, Gov. Newsom signed into law the California Reproductive Health Service Corps. “The Corps will be responsible for recruiting, training, and retaining a diverse workforce of healthcare professionals who will be part of reproductive healthcare teams assigned to work in underserved areas.” The teams will include MDs, licensed midwives, nurses, physician’s assistants, doulas and medical assistants. They will provide abortion care, contraception, perinatal care, gynecology services and gender-affirming care, among other needs.
Efforts are also underway to expand the scope of practice for nurse practitioners, certified nurse-midwives and physicians assistants. Effective January 2023, trained and qualified nurse practitioners and certified nurse-midwives in California can perform first-trimester abortions without a doctor’s supervision. On February 13, Toni Atkins (D-San Diego), now president pro tempore of the State Senate authored SB385 which gives physicians assistants the same ability to become qualified in abortion care.
Working relationships between MDs and RNS are, generally, extremely collaborative. Many doctors welcome the expansion of scope of practice for non-MD healthcare providers. “The consensus is, you can’t practice without nurse practitioners anymore,” Expanding the scope of practice helps everyone, including the patients, says Ahdoot. He is right. We often hear women complaining because they cannot schedule a Pap smear for months, they don’t get a return call from their doctor, or they simply cannot find a doctor at all.
Thank you and credit to Kathleen Doheny, freelance health journalist for her work on this subject in Healthday. Ed.