Relocation Patterns of Ob/Gyns May Limit Patient Access

Jennifer Garcia

February 09, 2017

Approximately one third of obstetrician-gynecologists (ob/gyns) in the United States have moved in the last 10 years to areas that are more urban and have less poverty, a trend that may affect access to care and implementation of healthcare policy.

"The greatest migration involved urban counties, which is where most ob-gyns already practiced," write William F. Rayburn, MD, MBA, from the University of New Mexico, Albuquerque, and colleagues. "At a time of shrinking scopes of practice among other adult care physicians (family medicine, general internal medicine, general surgery), rural counties may suffer more from this observed ob-gyns relocation pattern," the study authors note in an article published in the March issue of Obstetrics & Gynecology.

The researchers evaluated data on ob/gyn relocation from 2005 through 2015, which included physician background and county characteristics. They excluded data on physicians who were not engaged in direct patient care. Factors associated with relocation over this entire period were modeled using a multilevel regression model.

In a given year, approximately 2446 (6.5%) of the 37,385 ob/gyns in practice in the United States relocated. During the 10-year period, 32.1% relocated at least once.

In the multivariable analysis, the authors found that compared with non-Hispanic white ob/gyns, ob/gyns who were young (aged 27-39 years), black, or male or who were graduates of an international medical school were more likely to relocate, and the move was often to either urban counties or those with lower levels of poverty (poverty levels below 21.2%).

The researchers used information gathered from three data resources: ob/gyn practice location data came from the American Medical Association Physician Masterfile, physician race and ethnicity data came from the Association of American Medical Colleges data sources, and county information on poverty and racial and ethnic diversity measures came from the 2013 American Community Survey 5-year estimates. Rural-urban designation was determined using the US Department of Agriculture's 2013 Rural Urban Continuum Codes.

The authors note that 58.2% of ob/gyns moved within the same state; however, Florida, Washington, and California experienced a net increase in ob/gyns, whereas Michigan, Pennsylvania, Ohio, Illinois, and New York experienced a net loss. An overall increase in the population:ob/gyn ratio was also noted during the observed period.

The authors hypothesize that factors such as physician density in certain geographic areas and the desire for greater opportunity may play a role in relocation patterns. They acknowledge, however, that the influence of other factors such as practice type, sex, race, or healthcare policy was unclear.

The researchers underscore the importance of understanding physician relocation patterns and conclude that "[o]bserving this trend might contribute to a better understanding about the uneven national distribution of ob-gyns."

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2017;129:543-550.

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