Rural areas in the US and around the world have historically had a difficult time attracting doctors at all, much less specialists. As reported recently on Think Progress, a new study from Doximity (a social networking site for doctors) has found that several major metropolitan areas in the US are at risk for severe Ob/Gyn shortages. The top 10 cities at risk are: Las Vegas, Orlando, Los Angeles, Miami, Riverside CA, Detroit, Memphis, Salt Lake City, St. Louis MO and Buffalo NY.
I know first hand about the Ob/Gyn shortage in Riverside. I personally travel about 200 miles roundtrip to provide care to women there and know several other Ob/Gyns who travel to Riverside from LA. However, based on this analysis, it appears that LA is at even greater risk for an Ob/Gyn shortage!
The reasons for such shortages are complex and include fewer young doctors going into Ob/Gyn (working in women's health is not that attractive of a proposition in many parts of the country) leading to an aging Ob/Gyn workforce that is nearing retirement and increased interest in part-time or hospitalist/shift work in newly graduating physicians.
Short of improving conditions for new doctors to encourage Ob/Gyn as a career choice (and keep current Ob/Gyns practicing full-time) there are other options to ensure continued access to healthcare for women.
1) Task-sharing: A task-sharing model of including non-physician clinicians, such as physician assistants, certified nurse midwives and nurse practitioners to serve as front-line providers while referring more complicated cases to MDs is one such option. This model is widely used at Planned Parenthood and other community clinics around the country as a way to provide cost-efficient care to women, including those who may be uninsured. These providers can provide a wide range of services depending on their individual training and local regulations including routine exams and evaluations, diagnosis and treatment of infections, minor procedures such as IUD insertions (and in some states, medical or aspiration abortion) and initial assessments and treatments for more complicated conditions such as menstrual problems or pelvic pain. (Yet another reason why "defunding" Planned Parenthood is a bad idea.)
2) Think "outside of the office": Newer options include bypassing the "brick and mortar" office settings altogether in favor of telemedicine and online prescriptions for birth control and STI testing. A recent report highlighted how birth control apps can help meet demand in "contraception deserts" in the US.