A shortage of OB-GYNs is looming. Why are they fleeing NJ?

The young doctor wanted to pursue a career in New Jersey.

Dr. Matilde Hoffman completed her residency at Cooperman Barnabas Medical Center in Livingston in June, and the OB-GYN GP sought employment in the Garden State. She wanted to stay close to her family in Summit.

But Hoffman did not stay. She couldn’t stay, she decided. She accepted a job 300 miles away at Boston Medical Center.

“One of the main [reasons] is definitely the paycheck,” the obstetrician-gynecologist said. “I’ve definitely noticed that salaries are lower in New Jersey.”

But it wasn’t just the salary.

“It’s also how the state does OB-GYN,” Hoffman, 32, said.

She’s not alone among New Jersey-born or trained OB-GYNs, many of whom have chosen to flee the Garden State and practice elsewhere, doctors and experts say. Relatively low salaries, exorbitant malpractice insurance premiums, lower insurance and Medicaid reimbursement rates, exorbitant cost of living, and the state’s litigious climate keep specialists away.

The result is a looming shortage of OB-GYNs in New Jersey.

This is already the case in Cape May County, where hospital obstetric care is no longer available. In September, Cape Regional Medical Center in Middle Township — the county’s only hospital — ceased obstetrics services after struggling to hire OB-GYNs. Women will have to walk 20 or 30 miles to the nearest hospital.

“A lot of medical students and residents are leaving the state, and it’s a combined reason,” said Dr. Lisa Pompeo, residency program director at Rutgers New Jersey Medical School. “One is the malpractice climate. Two is the cost of living.

“And three, you’ll be paid the same amount – and in fact, you’ll probably be paid more in Arkansas or Louisiana than in New Jersey. And your dollar will go further in Arkansas [and] Louisiana it’s going to go to New Jersey.

The exodus of local OB-GYNs comes as experts on the ground have greater concerns. Studies predict a nationwide shortage in the near future.

A 2019 report from the American College of Obstetricians and Gynecologists predicted “a shortage of up to 8,800 obstetricians and gynecologists.” [OB-GYNs] by 2020, and a deficit of up to 22,000 by 2050.” In fact, half of the counties in the United States lacked “a single OB-GYN” in 2017, ACOG estimated.

“There is going to be a huge shortage of obstetricians over the next 10 years,” said Dr. Donald Chervenak, president of the New Jersey Obstetrical and Gynecological Society, an advocacy group of about 400 specialists.

The field also includes an aging physician population.

“In OB-GYN, a lot of doctors are retiring,” Chervenak said.

Although New Jersey is full of doctors and hospitals, it fears the specialty of obstetricians is dwindling – with increasing numbers of people leaving the state for higher salaries and malpractice insurance premiums. lower.

“There are more doctors, per se, around, but a lot of them are dropping out of midwifery, and a lot of younger doctors are leaving the state because salaries are lower in Jersey,” said Chervenak, who believes to 2,000 certified OB-GYNs. work in the state.

The average salary for OB-GYNs in the New York-Newark-Jersey City area was $274,740 in 2021, according to the US Bureau of Labor Statistics. It tracks metro areas such as Los Angeles-Anaheim ($277,960), Minneapolis-St. Paul ($294,600), Boston-Cambridge ($303,870), Dallas-Fort Worth ($328,570), and Philadelphia-Wilmington ($357,820).

Equally urgent, New Jersey OB-GYNs paid an average annual premium of $90,749 in 2021 for medical malpractice liability insurance with coverage limits of $1 million per occurrence and a total of $3 million. dollars, according to a 2022 analysis by the American Medical Association.

Even though the state is losing OB-GYNs, the demand for specialists is only increasing.

The field is vast and growing. It’s not just about giving birth. Improvements in reproductive medicine have redefined the field. And the specialty has grown as advanced technology now allows for more complex procedures.

This means more training and career paths.

“Residency programs need to educate each individual,” said Dr. Gloria Bachmann, professor of obstetrics and gynecology and associate dean for women’s health at Rutgers Robert Wood Johnson Medical School. “And that involves a lot of supervision, and you can only have so many people that can be properly trained each year.”

Dr. Eric Elias is originally from Louisiana, but was considering a career in New Jersey.

The thought did not last long.

He decided to return to his home country after completing his residency in 2010 at Cooperman Barnabas Medical Center. The 45-year-old OB-GYN – who lives in Lafayette, Louisiana – said the cost of living and rampant litigation in the Garden State left him with no choice but to leave.

“The cost of living in New Jersey is much higher than in Louisiana, and more importantly, the litigious company you have – my malpractice insurance in Louisiana this year is $48,000 a year,” Elias said in his thick Louisiana accent. “And from what I understand, in New Jersey people are currently paying upwards of $150,000, $160,000 a year in malpractice insurance.

“Man, this is crazy,” he added. “I’m telling you, this is the biggest threat to medicine in my opinion.”

For doctors fresh out of school, saddled with debt and looking to jump-start their careers, New Jersey is a daunting place to work.

Even doctors can struggle to make ends meet between student loan repayments and six-figure insurance premiums.

“If you’re a fresh graduate of medical school with $250,000 in debt, then you lived four years as a resident, earning $60,000, $70,000 a year, and now your student loans are going up… “, Pompeo said.

“And now you’re going to start your first job and earn $250,000, more or less, if you’re lucky – maybe even less than that?” It becomes very difficult for you to have a more pleasant standard of living.

And then come the expenses.

New Jersey ranks fifth in the nation in medical malpractice lawsuits, behind Indiana, New York, Pennsylvania and Illinois, according to the 2021 Medscape Malpractice Report. OB-GYNs ranked fifth among the 29 most commonly sued specialty groups, just behind plastic surgeons, general surgeons, orthopedists and urologists.

Nearly 80% of OB-GYNs have been named in at least one malpractice claim, according to Medscape.

While the average Garden State insurance premium is much lower than that of Miami-Dade County, Florida ($215,649) or Long Island, New York ($165,824), it is nearly double that of that of California’s Los Angeles and Orange counties ($49,804), according to the report.

Malpractice lawyers will capitalize on a market, Elias said. But he noted there was a big difference between Louisiana and the Garden State.

“In Louisiana, we also have lawyers…but they’re suing the oil companies here,” he said. “In New Jersey, they don’t have an oil industry, so they’re suing doctors.”

In Bayou State, doctors have more protection, Elias said. They have tort reform, which sets limits on litigation.

But in New Jersey, “from what I understand they can go after anything — they can go after your home, your personal property,” he said. “And so that’s something that was on my mind at the time.”

After completing his residency, Elias was also offered higher paying jobs compared to his colleagues in New Jersey.

“From the start, I was offered almost double that,” he said.

There are other issues. Many doctors don’t accept all patient insurance companies, and “nearly 50% of deliveries in New Jersey are Medicaid,” which typically pays less, Chervenak said.

That number could only rise, according to a report from Kaiser Health News.

The Garden State has one of the lowest Medicaid reimbursement rates in the nation, according to ACOG. Its Medicaid payment rate for the Global Obstetrical Code — the code doctors are required to bill when performing services under the federal state program — is just 41.7% of the fee schedule. Medicare doctors. Only Rhode Island’s rate (32.4%) is lower.

All of this comes against the backdrop of Cape May County’s loss of its only hospital obstetrics service. Cape Town Regional Medical Center has struggled to recruit OB-GYNs, the facility’s spokesperson Susan Staeger said in July when the news broke.

She cited three reasons: few babies were born at the facility (only 259 in 2021), there was no work schedule, and doctors had to be on call all the time. The decision was “very disappointing for everyone at Cape Town Regional Health System,” Staeger said.

Although the OB-GYN shortage is a national problem — and shortages are especially difficult in rural areas — Chervenak said New Jersey’s problems cannot be ignored.

“What makes New Jersey a little different from Texas or Florida or North or South Carolina? Cost of living, salary, taxes [and] med-mal,” Chervenak said, referring to medical malpractice insurance.

Not to mention that obstetricians began to feel undervalued, he said.

“As an obstetrician, I can tell you that I feel like most people think it’s undervalued,” Chervenak said. “In other words, in other subspecialties, a lot of things can be billed that you can’t be billed in obstetrics. But you see, the public doesn’t want to hear that.

“They just want to make sure they’re taken care of. And the problem is, if you can’t get doctors to pay back their training loans, then they have to leave the state in order to survive.

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Spencer Kent can be reached at skent@njadvancemedia.com.