Costs, quality of life drive doctors from the baby business

By Beth Cooney
http://www.greenwichtime.com

When they tell their pregnant patients someone else will have to deliver their babies, it is not unusual for the doctors of Brookside Obstetrics and Gynecology Associates in Greenwich to get a special request.

“They’ll say, ‘How about just one more?’ ” said Dr. Gaetane Francis.

“Or ‘Can you make an exception for my baby?’ ” said Dr. Michele Rohr.

The answer, the doctors said, is a regrettable no. Not after Sept. 1. On that day, the three Brookside doctors who still deliver babies will stop. Francis, Rohr and Dr. Caroline Filor will still see patients, but only for gynecological care, related surgeries and first-trimester pregnancies.

It is a decision the doctors – who as a group deliver about 400 of the approximately 2,000 babies born at Greenwich Hospital annually – said they arrived at with a mix of grief and relief.

The Brookside doctors’ decision makes them part of a growing trend as doctors in Fairfield County and beyond consider leaving the baby business behind.

Many of the doctors cite skyrocketing malpractice premiums, reduced compensation from third-party insurers as well as the taxing demands on the personal lives of doctors who preside at labor and deliveries as reasons for the exodus.

“This news at Brookside, unfortunately, is a microcosm of what we’ve seen happening in obstetrics for several years,” said Dr. Lawrence Bruck, chairman of obstetrics and gynecology at Stamford Hospital. “It is a crisis for the profession and ultimately, it will impact the patients, if not in this generation of mothers, the next.”

A 2006 liability survey by the American College of Obstetrics and Gynecology found that 8 percent of its members stopped practicing obstetrics. In Connecticut, one of 20 states the AMA has labeled a malpractice “crisis” state, the trend appears worse.

From 2002 to 2004, the last year figures are available from the Connecticut Medical Society, the number of doctors who have stopped deliveries and prenatal care in the state rose by 16 percent. That includes doctors who have dropped obstetrics, retired or left the state, according to a spokesman for the society.

It has sent child-bearing women of the lower Fairfield County looking for new doctors.

“I am bummed because I really love these doctors. And since I started having kids, this is the third time this has happened to me,” said Catherine Castelli, a Greenwich mother of three, whose son was delivered by Rohr a year ago. Twice before transferring to Brookside, New York City doctors who treated Castelli dropped obstetrics.

“Now I’m not sure what I’m going to do because I’m not sure we’re done with our family,” she said.

Bruck of Stamford Hospital and spokespeople for Greenwich and Norwalk hospitals say there is no shortage of qualified obstetricians in Fairfield County. They report no other recent departures from their obstetrics staffs. And at Stamford Hospital, applications for obstetrics residency positions were up and “we had some of the best, most qualified and talented applicants we’ve seen in years,” Bruck said.

In other parts of the country – especially in rural and impoverished areas – there are reports of shortages of obstetricians.

“This is a loss because the Brookside doctors are wonderful, caring physicians,” said Susan Brown, vice president of patient care services at Greenwich Hospital. “But what we’ve seen since this has been announced is that most of the Brookside patients expecting babies have decided to deliver in Greenwich. They’ve transferred to other practices. And some of those practices are in the process of adding doctors to their staff to accommodate those new patients.”

Francis and Rohr said it would be unfair to exclusively blame malpractice premiums for their decision.

“It was only one part of the problem,” Rohr said.

Several months ago, the practice endured several personnel changes when a doctor with 22 years experience took a medical leave. Two younger doctors also left.

“Greenwich was just too expensive for them,” said Francis, adding the debts from medical school, coupled with housing costs and malpractice premiums can make Fairfield County a prohibitive place to practice.

The personnel changes put new pressure on the remaining doctors, who are also mothers of young children.

Dr. Patrick Cahill, who practices obstetrics as part of a group of three doctors in Stamford, said though he has no plans to abandon obstetrics, he can empathize.

In eight years of private practice, he has seen his malpractice premiums triple “and I have not been sued, so imagine what they would be like if I had been.”

Adding to that burden are decreasing rates of reimbursement from insurance companies for services such as office visits and deliveries. Taking staffing and Fairfield County rents into account, “It can cost $200,000 a year just to open your doors,” Cahill said. “I love delivering babies. I love my job and my patients, but this is a reality of what we’re facing.”

The other negative, Cahill added, is quality of life.

“Babies come on their own schedule,” he said. “Obstetrics is tough on your family as well. There is a reason why so many new doctors are going into fields such as dermatology or emergency medicine. They are looking for more stability.”

These issues were all factors at Brookside.

“The way we were going to practice medicine was going to change so much we had to sit down and ask ourselves, how can we continue to do this,” Rohr said. “And more important, the question became, how do we do it well? We didn’t want to be doctors who were just running in and out the door.”

Francis said she always took pride in approaching each patient without considering the threat of malpractice claims.

“It was a conscious decision never to let that factor into the care I gave. É My goal was to give them the best. But the emotional trauma, the fear of being sued, is there. For many of us the question is not have you been sued, but when?”

Dr. Julia Gray of Stamford faced a similar dilemma a decade ago when she phased out of obstetrics after delivering babies for 15 years. “Many people assume it was the malpractice insurance issue, but I was one of that slim 7 or 8 percent of obstetricians who had never been sued,” she said.

For Gray, the decision to leave obstetrics grew in part out of a sense that other women in her practice were not getting her full attention. “I was too busy and distracted by the women who were in labor. With obstetrics you are always waiting for a bomb to drop. Who is having contractions? Who is cramping? I felt my patients who were not pregnant or in labor were getting gypped.”

Gray now focuses exclusively on gynecology in a practice that caters to teens, women in their 40s and beyond. Her practice also includes women of child-bearing age, “who for a variety of reasons don’t want to go to a practice where the waiting room is full of expectant mothers.”

She said the transition has been satisfying.

“I feel I can focus on the other kinds of needs women have beyond babies. I can spend a half-hour talking to a menopausal woman about complicated things and get a teenager who doesn’t want to discuss what’s really going on in her life to open up.”

The Brookside doctors envision building a practice similar to the one Gray describes. “We are already booking more time for our patients come fall. We expect to be able to offer really comprehensive women’s health care,” Francis said.

Francis teared up when considering if she would miss delivering babies and treating expectant mothers. “We would be lying if we said we won’t miss it, or that we won’t be relieved when we stop.”

– Staff Writer Beth Cooney can be reached at beth.cooney@scni.com or at (203) 964-2260.

see original

About