Many clinics can't afford obstetricians

April 29, 1993|By Robin Myers | Robin Myers,Capital News Service

Michele Middleton, 9 months pregnant, has been waiting more than an hour with 20 other expectant mothers to see the doctor at People's Community Health Center, near Memorial Stadium in Baltimore.

The 18-year-old is unmarried and unemployed, and is about to have her first baby. Her due date is just four days away.

The Baltimore resident said she doesn't mind waiting: "The doctors spend time with you, ask you if you have any problems."

Ms. Middleton's recent wait was caused by a problem not unique to People's Community: The nonprofit clinic has no permanent obstetrician. Two residents from nearby Union Memorial Hospital come to run the baby clinic, but only on Friday mornings. The center has unsuccessfully searched for five years for a full-time obstetrician to care for pregnant women and deliver babies, said Pat Cassatt, executive director of the center. But it cannot afford to hire an obstetrician at the salaries candidates are demanding, she said.

An American Medical Association survey of 1991 found obstetricians were among the highest paid specialists, earning an average of $221,000 a year. Radiologists and anesthesiologists, the only specialties making more money, brought in about $229,000 a year, the survey showed.

Other clinics around the state -- particularly in rural areas -- are having similar problems recruiting obstetricians to serve poor women.

"To get an obstetrician to come to a rural area takes $250,000 a year," which clinics just don't have, said Lewis Jones, executive director of the Somerset County Organization for Progressive Enterprises, a clinic.

And because of the high cost of liability insurance, some rural counties are having trouble recruiting and keeping their obstetricians -- at a cost to the health of pregnant women and their unborn babies.

In a 1992 survey, 12 percent of the members of The American College of Obstetricians and Gynecologists said they stopped practicing obstetrics during the last decade due to the increase in liability insurance, said spokeswoman Kate Ruddon.

In 1983, obstetricians and gynecologists paid an average of $14,100 for malpractice insurance, Ms. Ruddon said. By 1991, that figure more than doubled to $36,946, she said.

Five Maryland counties do not have any obstetricians; four are on the Eastern Shore: Caroline, Queen Anne's, Worcester and Somerset counties, said Jonathan Foley, administrator for primary care at the state health department. The nearest obstetricians are in Easton and Salisbury, he said. The fifth county, Garrett, is in Western Maryland.

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