A growing shortage of obstetrical and maternal fetal medicine specialists is putting pregnant patients at higher risk, particularly those with complex conditions such as fetal and neonatal alloimmune thrombocytopenia (FNAIT), according to a special statement from The Society for Maternal-Fetal Medicine.
The Society for Maternal-Fetal Medicine warns that limited access to subspecialty care is closely tied to worse pregnancy and newborn outcomes, especially in rural and underserved communities.
In 2021, nearly 48% of US counties did not have a single obstetrician gynecologist (OBGYN). Older data show there is only one maternal fetal medicine clinician for every 24 general OBGYNs and for every 3,150 births. In 2021 and 2022, about one in 25 obstetrical units closed nationwide. More than 150,000 babies were born to people living in maternity care deserts and another 200,000 were born in counties with limited access to maternity services.
For families facing high risk pregnancies, including those complicated by FNAIT, access to a maternal fetal medicine specialist can be critical. Yet in 2010, about 1,355 maternal fetal medicine subspecialists practiced in the United States and 98% worked in urban centers, even though more than one in six births occurred in rural facilities. Some patients must travel 3 to 6 hours for subspecialty care. In certain regions, the closest specialist is in another state, creating insurance and financial barriers.
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Recent policy changes have added strain. After the 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, some OBGYN and maternal fetal medicine physicians relocated from states with abortion restrictions to states with more permissive laws. States with restrictions already had worse maternal and fetal outcomes, and training programs in those states may face added challenges meeting accreditation requirements.
“Perinatal regionalization promises to appropriately distribute finite maternity care providers and resources across a region or state, ensuring high-risk pregnant patients living in rural areas receive the higher level of care needed to protect their health and the health of their infants,” explained the authors of this special statement.
Federal programs invest about $16 billion annually in graduate medical education. However, although OBGYN residency positions grew by 22% over the past decade, new training slots have not focused on rural areas. Programs such as the Health Resources and Services Administration’s Teaching Health Center initiative and loan repayment efforts offer incentives, but most loan forgiveness programs exclude maternal fetal medicine subspecialists.
For patients with FNAIT and other high risk conditions, these workforce gaps can mean delayed diagnosis, fewer monitoring visits and limited access to coordinated care teams. Experts recommend expanding rural training tracks, including maternal fetal medicine physicians in loan forgiveness programs, strengthening perinatal regionalization systems and building out telehealth. While virtual visits can help with counseling and follow up, specialists stress that telehealth cannot replace in person evaluations when managing complex pregnancies.
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