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183: Maternal-fetal medicine specialist workforce density and distribution in the United States 1998-08

      Objective

      To determine the trends in Maternal-Fetal Medicine (MFM) specialist density and distribution between 1998-2008 in the United States.

      Study Design

      This was a cross-sectional, observational study of MFM specialist density in the United States from 1998-2008. Individual state provider density data were obtained directly from the membership department of the Society for Maternal-Fetal Medicine. Fellows in training and honorary/affiliate members were not considered for this analysis. State demographic data including population density and birthrates was obtained from the US Census Bureau. Provider densities were calculated for each region and individual state by MFM per 10,000 live births to control for differences in population. Gini coefficients and Lorentz curves for MFM providers were calculated as measures of equality of distribution and compared to average US physician values previously published.

      Results

      Absolute numbers of MFM specialists in the United States have increased by 28% from 1998-2008. The national provider MFM density has increased in the same time frame from 3.4 to 4.1 providers per 10,000 live-births. The Northeast region has the highest MFM median provider density and the Midwest region the lowest (6.6 [IQR 2.1] vs. 3.1 [IQR 1.3]). There was a significant difference seen in the median change of MFM density among regions (p<.03) with the Midwest region having the lowest overall median change and the South the highest. (-1.0 [IQR 0.87] vs. 0.13 [IQR 0.65]). The Gini coefficient for MFM providers increased from 0.213 to 0.243, indicating increased mal-distribution. Lorentz curves for distribution were calculated, which indicate MFM providers are less equitably distributed than the average physician population in the United States (0.243 vs. 0.215).

      Conclusion

      The density of practicing MFM specialists has increased slightly relative to birthrate from 1998-2008. However, these MFM specialists have become more mal-distributed and are less equally distributed than the average physician population in the United States.