Looking for answers to rural Wisconsin OB-GYN shortage

November 2, 2019 GMT

EAU CLAIRE, Wis. (AP) — Dr. Alexa Lowry, an obstetrician-gynecologist who grew up in Barron County, returned to her native western Wisconsin for three weeks this fall.

The move isn’t permanent — although Lowry would like to practice medicine in a smaller community one day.

The rural Cumberland native spent three weeks in October at a St. Croix County hospital as a resident. She’s part of the nation’s only rural OB-GYN residency, a UW Health program that recently added Western Wisconsin Health in Baldwin to its roster of rural hospital training sites.

The program brings young OB-GYNs — doctors who provide women’s reproductive health and care for pregnant women before and after birth — to rural Wisconsin communities for short-term rotations.

The long-term goal? Getting young OB-GYNs to come back permanently, the Leader-Telegram reported.

“Since 1996, there were about 20% of Wisconsin counties without obstetric care units in their hospitals,” said Dr. Ryan Spencer, director of the UW Health OB-GYN residency programs. “That’s increased to 40% of counties without an OB care unit, most recently in 2016.”

One of the biggest issues rural women face during pregnancy is “just sheer distance,” said Dr. David Hirsch, OB-GYN and chief of staff at Marshfield Medical Center-Eau Claire.

“Even in a relatively large rural community like Ladysmith (in Rusk County), people might live an hour from there,” Hirsch said.

Another problem for mothers: Getting to a hospital that regularly delivers babies.

Just over half of rural Wisconsin hospitals — 56% — provide obstetric delivery, but a few hospitals have been discontinuing those services over the last decade, according to a July report from the Wisconsin Office of Rural Health.

Eleven rural Wisconsin hospitals closed their OB units in the last 10 years, according to the report.

In larger cities, mothers have several options for obstetric delivery. Mayo Clinic Health System, Marshfield Clinic Health System and HSHS Sacred Heart Hospital deliver babies in Eau Claire; obstetric delivery is also available in Chippewa Falls, Menomonie, Barron and Rice Lake.

Mayo Clinic Health System-Northland in Barron is expanding its birth center, a nearly $1 million project adding four new rooms for labor, delivery and postpartum and building upgrades that are expected to be complete in early 2020.

But for women who live far from those cities, delivery is a tricky service, because babies come on their own time, Lowry said.

“In some cases . you may still only need to drive 15 to 30 minutes down the road to get to a place,” Lowry said. ”(That’s) not nearly as concerning as people who potentially are driving more than an hour to get to an OB-GYN . I think that’s one of the biggest things that’s a problem at this point.”

The good news? Ninety-nine percent of Wisconsin women of childbearing age live within 30 minutes of a hospital with obstetric delivery, according to the report.

In smaller communities, hospitals train emergency departments to deliver babies in a pinch.

″(Emergency room delivery) is not optimal, but faced with the resource challenge we’re talking about, it helps provide a safety net,” Hirsch said.

Looking ahead

Of Wisconsin’s 72 counties, 27 have no OB-GYN, according to UW Health.

But some health officials say a lack of OB-GYNs is only part of a larger problem — that running obstetric units in small communities simply isn’t feasible.

Spencer began seeing the problem in the early 2000s. But rather than simply cutting services, some rural hospitals are closing altogether.

“We started seeing an increase in rural hospital closures across the country,” Spencer said. “We do see a significant worsening of the problem over time, especially related to women’s health and obstetric care.”

Some hospitals can’t afford to keep an obstetrics unit, Hirsch said.

Delivery is safest at a facility with an intensive care unit, operating room, anesthesiologist, emergency department and experienced nurses, he said.

“It’s difficult, the resources you need to have available to run labor and delivery,” Hirsch said.

Keeping multiple OB-GYNs on hand is an expensive business. To support a whole community around the clock with an on-call schedule, at least three providers are needed, said Alison Page, CEO of Western Wisconsin Health in Baldwin.

For a small hospital an hour away from a large city, three OB-GYNs means “well over $1 million in expenses,” Page said. “It’s not going to support that.”

Western Wisconsin Health has two OB-GYNs. The hospital delivers about 250 babies each year, up from about 40 babies per year four years ago, Page said.

Midwives and family practice doctors help fill in the gaps. But even in a fully-staffed obstetrics unit, providers can’t keep their competency if there aren’t many babies born in a rural community.

“Providers have to have a certain number of births, cesarean sections, things like that so they can demonstrate they’re competent,” Page said.

And fewer young women are moving to smaller communities, said Jeff Euclide, chief administrative officer of Marshfield Medical Center-Ladysmith.

“I don’t think it’s a secret that rural areas aren’t as attractive to the childbearing population as the city,” Euclid said.

Finding a fix

Lowry grew up in a “tight-knit community where everybody knows everybody” in rural Cumberland, where doctors knew and cared for their neighbors.

“That was the experience I had growing up, and (was what) I pictured I’d do with my future career in medicine,” Lowry said.

Plenty of medical students are interested in the OB-GYN field, Spencer said — but new OB-GYNs aren’t getting experience working in rural communities.

That’s where Wisconsin’s rural residency program comes in.

In the program, newly-graduated OB-GYNs practice at rural sites throughout Wisconsin in rotations.

Health organizations in Portage, Waupun, Monroe and most recently Baldwin, about 20 miles (32 kilometers) from the Minnesota border, are the training sites.

“We’re beyond pleased, thrilled to be selected as a partner,” Page said. “They had heard we have two OB-GYNs here.”

The program started in 2016, and will yield its first graduate in 2021. Lowry plans to graduate in 2022.

One of Western Wisconsin Health’s OB-GYNs will likely retire in five years, Page said. For more rural hospitals, she said, this is an obvious answer.

“How do I attract an OB-GYN who could be working at United Hospital or in Eau Claire? You start with people that came from rural places, love rural places, and they want to practice here,” Page said.


Information from: Leader-Telegram, http://www.leadertelegram.com/