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Obstetric Anesthesiology in the United States: Current and Future Demand for Fellowship-Trained Subspecialists
Abstract Number: SAT-11
Abstract Type: Original Research
The US has one of the highest maternal mortality rates (MMR) in the developed world; even more alarming, MMR has been increasing 1. Preexisting medical conditions in parturients have been increasing 2, along with maternal obesity 3, and maternal age 4. The US cesarean delivery rate is 32%, and high risk cesarean deliveries have increased 4. A physician anesthesiologist specializing in obstetric (OB) anesthesiology is uniquely qualified to assist in the reduction of OB-related morbidity and mortality 5, but their workforce need has never been estimated.
After IRB exemption, we queried the 2015 American Hospital Association (AHA) Annual Survey Database for hospitals doing deliveries, # of deliveries annually, and OB Level of Care (Level 3 = “all serious illnesses and abnormalities”). The national need for Fellowship trained OB anesthesiologists was estimated. Low estimate assumptions were: 1) hospitals with >4000 deliveries need at least one OB anesthesiologist on staff (additional staffing for high volume services), and 2) hospitals with 2000-3999 deliveries that are OB Level 3 also need an OB anesthesiologist on staff. The high estimate assumptions were: 1) hospitals doing > 1500 deliveries per year need an OB anesthesiologist on staff (additional staffing for high volume services) and 2) hospitals with <1500 deliveries that are OB Level 3 also need an OB anesthesiologist on staff.
In 2015, ACOG/SMFM established maternal levels of care, I-IV; levels III & IV require an OB anesthesiologist to provide expertise and improve outcomes. The AHA Level 3 also reflects such regionalization of maternal care. The goal and trend of regionalized maternal care is to provide medical expertise, reducing maternal morbidity and mortality. The estimated demand for OB anesthesiologists to lead and staff these centers exceeds the current training/supply of 53 graduates per year from ACGME-accredited OB anesthesia fellowship programs for several years.
1. MacDorman MF. Recent increases in the US MMR. Obstetrics & Gynecology 2016; 128: 447-55.
2. Berg CJ. Overview of Maternal Morbidity During Hospitalization for L&D in the US. Obstetrics & Gynecology 2009; 113: 1075-81.
3. Kim et al. Trends in Pre-pregnancy Obesity in Nine States. Obesity 2007; 15: 986-93.
4. Martin et al. Births in the US, 2015. CDC NCHS Data Brief 2016.
5. Bateman BT. Anesthesiologist as Epidemiologist. Anesthesiology 2014; 1311-12.