Kitsap County faces a dire OB-GYN shortage

Bringing babies into the world is hard work. And if you're a doctor working in obstetrics and gynecology on the Kitsap Peninsula, it's recently gotten a lot harder.

Health care providers say the county is facing an acute shortage of OB-GYNs.

Dr. Katherine Hebard is a doctor at Kitsap OBGYN. She said you can measure the local crisis by looking at the number of specialists in prenatal and perinatal care per 100,000 residents.

As a state, Washington averages 15 OB-GYN physicians per 100,000 people.

Hebard said that in Kitsap County there were previously 8 OB-GYNs per 100,000 people. Now that number is 3 per 100,000.

Hebard added that the number of providers includes a certified nurse midwife at her private practice. And there's not one cause to point to here — there's a nationwide shortage of reproductive health care providers looming. But some things have changed in Kitsap County recently.

Last spring, Naval Hospital Bremerton stopped delivering babies amid staff reductions and a rollback of services. Another Kitsap County clinic closed its OB-GYN practice this year when all of its four providers quit or went on leave.

The situation is sending many patients all the way to Tacoma for care. It's also sent more patients to Hebard's clinic.

"We of course try to absorb as many of those patients as we possibly can, because we feel strongly in our group that all women deserve to have adequate prenatal care," Hebard said. "If you look at the average range, for us, we're estimating somewhere between 15 and 20 women who are due and delivered each month. So that puts us at about 80 deliveries a month, which is about 200 deliveries per provider, per year."

That's double the national average.

On top of the OB-GYN shortage, Hebard said that the rising demand in care has also had financial impacts on her clinic.

"I don't know of very many industries where people continue to try to provide the same quality product for the same or less pay as time goes on."

Hebard noted that, as independent providers, OB-GYNs negotiate separate contracts with each insurance carrier. Those companies determine if they'll pay for each point of service the OB-GYN provides — from annual exams to post-partum care.

"We don't really have much negotiating power to be able to increase those rates as the costs of doing business increase," Hebard said. "So we operate on a fairly tight margin. And it's very difficult to continue to provide excellent care when you have limited resources, and it's tiring."

A Naval Hospital Bremerton spokesperson told the Kitsap Sun earlier this year that the decision to stop delivering babies was based on declining births in the area, coupled with recent staffing losses. Fewer than 200 babies were born at the hospital in 2021, according to the spokesperson.

The OB-GYN shortage in Washington extends beyond Kitsap County. If you live on the coast or in the central part of the state, there may not be any reproductive health care doctors in your county.

On the national level, the Department of Health and Human Services predicts there will be a shortage of OB-GYNs and other women's health providers in many regions of the country by 2030.

Meanwhile, the national rate of maternal mortality is climbing. American women die preventable deaths from pregnancy complications at a rate far higher than other wealthy nations.

One person who watches this closely is Paula Sullivan, a managing director at the health insurance brokerage company Marsh. She broke down some of the reasons there aren't enough doctors to deliver babies across the U.S.

"Like all higher education, medical school [tuition] continues to increase," Sullivan said. "There is a huge need for additional federal funding, but if you look at the years of training — everybody knows it takes a long time to become a physician — but obstetricians specifically go through 13 to 16 years, depending on their subspecialty and fellowship."

Moreover, when those doctors finish school, they're the lowest paid providers of all surgical specialties. That reality is contributing to a rapidly dwindling pool, along with the fact that retirement is around the corner for many practicing obstetricians.

Sullivan said there's also a major problem with OB-GYN burnout, even compared to other health care workers.

"Provider burnout is at an all-time high globally, but arguably, OB-GYNs have the most erratic schedule. So they're always going to be 24/7 on call. There's always a strong desire to have your OB there at delivery."

Additionally, the Supreme Court's rollback of abortion rights earlier this year has also had a negative impact on the field, Sullivan added.

"It's brought a lot of negative attention to obstetrics and gynecological surgeons," Sullivan said. "It has also put added pressure on them, so you're going to see a large influx of required gynecological services in states where abortion and other procedures are still legal — Washington being one of them."

With some states adding the possibility of criminally prosecuting OB-GYN providers for performing abortions, additional pressure is mounting on an already strained workforce.

Sullivan said there are efforts afoot to provide more dedicated hospitalists who can support clinicians, so they don't have to be on call 24/7. But more comprehensive solutions seem to be lacking.

As a result, one of life's most important decisions — where to have your baby — could become even harder to make.