What is driving the shortage and what can be done about it?
In mid-February, Dakota Richardson went to the emergency room at Stafford Hospital for abdominal pain.
Ultrasound imaging revealed a large cyst on one of her ovaries. “They told me they were not going to remove it right away because it wasn’t an emergency yet,” Richardson told the Advance. “But they said, we want you to go to your gynecologist.”
She did, and a follow-up ultrasound showed that the cyst was still there. She and her doctor decided to move forward with surgery at Mary Washington Hospital to remove it.
But after two months, Richardson was still waiting for a surgery appointment.
“[My doctor] told me he’s been reaching out to the scheduling department, and he can’t even hear back from them,” Richardson said. “Me as a patient, I can’t get ahold of them. Apparently, some of their own doctors can’t get ahold of anyone to schedule a surgery.”
By mid-April, the pain from the cyst had become disruptive to her life and she’d taken unpaid leave from her job as a delivery driver at Domino’s. She wasn’t sure if the store would have a job for her when she was ready to go back.
On April 18, Richardson turned to the Facebook group Fredericksburg Talk for advice.
“Any recommendations on a [gynecologist] who doesn’t go through Mary Washington who can get me into surgery asap? Must take Medicaid,” she wrote.
In the 75 responses, women urged Richardson either to go to the emergency room or seek care in the Richmond area.
“You have Medicaid. Please go to the ER. The gynecology system here is frankly broken, and it could take you forever to get in—especially with Medicaid,” one woman wrote. “I’d much rather go to the ER to take care of it than be admitted with a burst ovarian cyst. Please take care of yourself.”
“There’s a shortage of [gynecologists] in Fredericksburg,” another person wrote. “No one is getting in quickly. Maybe call VCU [Medical Center].”
“Go to Richmond. Please,” another woman wrote.
“We do not have enough doctors to do all the doctoring”
In Planning District 16—which is comprised of Fredericksburg City and the counties of Stafford, Spotsylvania, Caroline, and King George, and has a population of 320,000—there are seven obstetrics and gynecology practices.
Together, according to their websites, these practices employ a total of 22 doctors—physicians with either an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) degree.
In order to practice obstetrics or gynecology, physicians must have gone through a residency in the specialty and taken a specialty exam within five years of receiving training, said Ami Keatts, a practicing OB-GYN in the Shenandoah Valley and chair of the Virginia chapter of the American College of Obstetricians and Gynecologists (ACOG).
OB-GYN physicians are the only providers who can perform surgical management of gynecological conditions and obstetrics, Keatts said.
“Midwives and nurse practitioners can do a ton of stuff, but if let’s say someone has a pregnancy failure and needs a D&E [surgical management of a miscarriage]—that would require a surgeon,” Keatts said. “Only OB-GYN doctors do that procedure. No other specialty can do that.”
Other surgical procedures that only OB-GYN physicians can provide are endometrial ablations for treatment of unusually heavy menstrual bleeding, and laparoscopy, which is used either to diagnose potentially debilitating conditions such as endometriosis or fibroids or to perform treatments such as cyst removal or hysterectomy.
Across Virginia and the country, Keatts said, “We do not have enough [OB-GYN] doctors to do all the doctoring.”
In her practice area, which covers Augusta, Allegheny, Highland, and Bath counties, “Patients really want to see a physician and it often takes a month or so to get in,” she said.
The Advance called all the Fredericksburg-area practices earlier this spring to ask how long it would take to be seen as a new patient. Most practices said it would be about two months and at Pratt Medical Group, it would take five months, unless the patient was currently pregnant.
Of the eight physicians at Mary Washington Obstetrics and Gynecology, five are currently taking new patients, according to information on the healthcare system’s website.
New Beginnings OB-GYN in Fredericksburg City is no longer taking any obstetric patients.
Elite Women’s Health, which has offices in Fredericksburg, Spotsylvania, and south Stafford, is no longer accepting patients who have Medicare as their primary insurance, and About Women, which has an office in north Stafford, is no longer accepting gynecology patients who have Medicaid.
Another practice, Women’s Health and Surgery Center, closed both its area locations permanently this spring.
What’s causing the shortage?
The Fredericksburg area is not alone in experiencing a shortage of OB-GYNS.
There were about 50,800 OB-GYNs practicing in the United States in 2018, according to a 2021 report from the U.S. Department of Health and Human Services’ Health Resources and Services Administration. This number is expected to decrease by 3,300 providers by 2030, while demand is expected to increase by 7%.
Physicians are retiring or cutting back their hours, Keatts said, and while the number of medical students going into the specialty hasn’t changed, there are not enough facilities offering residencies in OB-GYN for those students.
“The potential deficit is 5,000 OB-GYN physicians by 2030 all over the country,” Keatts said. “Now those numbers come from 2018, so personally, I would expect it to be even worse, because with the pandemic, we saw people retiring a little bit earlier than expected.”
The cost of malpractice insurance is also driving the shortage. OB-GYN physicians pay higher rates than physicians in any other specialty—$50,000 to $130,000 annually, Keatts said, as compared to about $22,000 for an internal medicine, family medicine, or pediatric practitioner.
OB-GYNs in Virginia cannot practice without malpractice insurance, Keatts said. The cost of malpractice insurance is “the biggest reason most [OB-GYN] physicians are working for hospitals and large healthcare systems,” she says.
In the Fredericksburg area currently, three of the seven OB-GYN practices are owned by Mary Washington Healthcare or Spotsylvania Regional Medical Center.
Virginia places a cap on the amount of compensation a patient can receive in a medical malpractice case. The cap is set to increase each year through 2031, when it will reach $3 million.
“That will be a huge problem, because it will increase the cost [of malpractice insurance] for OB-GYN physicians in Virginia and will lead to more doctors leaving the workforce,” Keatts said.
The U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health, which returned to the states the power to regulate and restrict abortion, has also exacerbated the national OB-GYN shortage.
“We see this in other states [where there are strict abortion restrictions] and it will happen in Virginia if we lose access to that service,” Keatts said. “Physicians do not want to practice in a state where abortion is illegal. Even if they don’t perform the procedure, it’s a very unpleasant climate to be in.”
What can be done?
The General Assembly this legislative session took steps towards increasing the supply of OB-GYN physicians by funding five new residency programs in fiscal year 2025.
“We hope that this will help lead to more providers in maternity care shortage areas,” said Nicole Lawter, a lobbyist for ACOG.
This, along with not removing the cap on medical malpractice compensation and not restricting access to abortion can help alleviate—or at least not worsen—the OB-GYN shortage in Virginia, Keatts said.
“Restricting access to abortion and criminalizing the providing of birth control will drive OB-GYN providers out of the state,” she said.
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