Surgical Science, 2011, 2, 95-101
doi:10.4236/ss.2011.22020 Published Online April 2011 (http://www.SciRP.org/journal/ss)
A Critical Deficit of OBGYN Surgeons in the U.S by 2030
Bhagwan Satiani, Thomas E Williams, Mark B Landon,
E. Christopher Ellison, Steven G Gabbe
From the Departments of Surgery & Obstetrics and Gynecology
The Ohio State University College of Medicine
Received April 9, 2010; revised Febr uary 20, 2011; accepted Marc h 28, 2011
Abstract
Objective: To estimate the OB/GYN Surgical workforce needed in the U.S by 2030 to meet the needs of our
population. Methods: Using a population based analysis, the net supply of OB/GYNs was calculated. Our
assumptions included: a ratio of OB/GYN’s to population of 27.10/100,000 women, practicing 25 years from
Board Certification to retirement, 1200 graduates finishing from residency programs per year. Results: To
maintain our current ratio per 100,000 population, we should have 50,135 OBGYN’s practicing for a popula-
tion of 364 million in 2030. We estimate the supply to be only 30,000 and hence a shortage of 20,135. To
rectify the deficit 44,135 residents will require training in OBGYN with the cumulative cost exceeding $14
billion. Conclusions: 1) We estimate a 40% shortage of OB/GYN’s as the best case scenario to meet the
needs of the U.S population by 2030 if the current training paradigm stays constant. 2) The cumulative cost
of training adequate numbers of OB/GYN’s is estimated at $14 billion and 3) In addition to revising the
BBA of 1997 to permit more residents to be trained in the United States, additional strategies must be con-
sidered to provide an adequate workforce and ensure patient access to OBGYN’s.
Keywords: OBGYN, Surgeons, Shortage
1. Introduction
With healthcare reform legislation having passed and
coverage for millions of under-insured or uninsured be-
ing ensured, policy makers have not considered the ade-
quacy of the physician workforce in the U.S as a critical
factor in access to healthcare. Some stakeholders, how-
ever, are beginning to understand that the shortage of
physicians is bona fide and already here. In a 2009 sur-
vey by a large clinical staffing company 91% of Hospital
Chief Executive Officers (CEO’s) believe there is a
shortage of physicians. [1] Residents are now inundated
by employment offers early in their training. Residents
receiving between 51-100 job offers during their resi-
dency jumped from 16% in 1999 to 52% in 2006. [2]
The demand for selected specialties has raised starting
salaries well above the inflation rate with a cumulative
annual growth rate between 6.6% and 10.3% between
2001 and 2006 compared to 2.8% for other professional
occupations. [2] Merritt Hawkins reports that searches
offering signing bonuses soared from 50% in 2003/2004
to 85% in 2008-2009. [3] Finally, as a sign for politician s,
60% of voters believe there are too few physicians in
practice and over two-thirds believe th ere will be too few
physicians in the next ten years. [4]
There are multiple reasons for the shortage of physi-
cians in the U.S including the specialty of Obstetrics and
Gynecologists (OBGYNs). The chief cause is continued
growth in the U.S population and a static supply of phy-
sicians necessitated by a freeze in the funding of the
number of training residency positions at 1996 levels
through the Balanced Budget Act of 1997. In order to
pre-empt critical problems in access to OBGYN care,
there is a need to estimate the degree of shortages ahead
of us and discuss possible solutions. The objectives of
this study therefore were to estimate the OBGYN work-
force needed by 2030 to meet population needs, to quan-
tify the costs if Congress decides to revise the Balanced
Budget Act and to propose possible solutions.
2. Material and Methods.
To estimate the number of OBGYN specialists trained
each year, we used the number of certificates granted by
the American Board of Obstetrics and Gynecology as
published by the American Board of Medical Specialties.

96 B. SATIANI ET AL.
[5] Population estimates and the proportion of women in
the future was derived from the U.S Census Bureau fig-
ures. [6]
Assumptions
1) The ratio of 27.1 OBGYNs per 100,000 women will
remain the same as it was in 2005. [7]
2) There were 39,024 obstetricians and gynecologists
practicing in the United States as in 2005.
3) OBGYNs will practice 25 years from Board Certi-
fication to retirement, death or disability with 1,561 re-
tiring each year.
4) There will continue to be 1,200 OBGYNs certified
each year.
5) The Balanced Budget Act of 1997 will not be re-
vised and the number of first year trainees in OBGYN
will remain constant.
6) We used Richard Cooper’s figure of $80,000 for
direct medical education expenses per resident per year.
[8] The total cost consists of a salary of $50,000, benefits
of 30% or $15,000, and other direct medical education
funds of $15,000 for a total of $80,000. We have elected
to use nominal dollars unadjusted for inflation to sim-
plify our estimates.
3. Results/Calculations
25 year to retirement
1) To calculate the OBGYNs in practice for the base-
line year 2006, we started with 39,024 in practice in the
year 2005, subtracted the number of retired OBGYNs
(1,561) and added the newly Board Certified practitio-
ners (1200). This process was repeated to generate the
supply of OBGYNs until 2030. The calculations are il-
lustrated in Table 1, and also in Table 2 (fourth col-
umn).
2) The OBGYNs needed are calculated by multiplying
the population of women projected by the Census Bureau
in that year in that year by 27.1 (OBGYNs per 100,000
women) an d di vi ded by 100, 0 00. (Table 2, column 3)
3) The shortage (361 OBGYNs leaving the workforce
each year) is calculated by subtracting the OBGYNs
needed from those in practice (column 5 in Table II); the
shortage percentage is calculated by dividing the short-
age by the OBGYNs needed and multiplying by 100.
30 Years to Retirement
We use the same assumptions, method and calcula-
tions to project the OB/GYN workforce in Table III and
column 3 of Table IV.
This work is exempt from IRB permission since no
patient records or information was used.
Cost of Training
The cost of direct medical education for OBGYN
trainees is shown in Columns 2 and 3 of Table 3. The
Table 1. Supply of obgyn’s w i th 25 year s practice span.
YEAR PRACTICING NEW TOTAL
OBGYN’S OBGYN’S OBGYN’S
2005 39,024 39,024
2006 37,463 1,200 38,663
2007 35,902 2,400 38,302
2008 34,341 3,600 37,941
2009 32,780 4,800 37,580
2010 31,219 6,000 37,219
2011 29,658 7,200 36,858
2028 3,121 27,600 30,721
2029 1,560 28,800 30,360
2030 0 30,000 30,000
2031 0 30,000 30,000
Table 2. Shortage of obgyn’s: 25 years practice span.
Projected OBGYN’sOBGYN’s Per Cent
YearPopulationNeededin Practice ShortageShortage
2005144,000,00039,024 39,024
2010157,000,00042,547 37,219 5,328 13%
2020171,000,00046,341 33,609 12,732 27%
2030185,000,00050,135 30,000 20,135 40%
Table 3. Shortage of obgyn’s: 30 years practice span.
Projected OBGYN’sOBGYN’s Per Cent
YearPopulationNee dedin Practice ShortageShortage
2005144,000,00039,024 39,024
2010157,000,00042,547 38,519 4,028 9%
2020171,000,00046,341 37,509 8,832 19%
2030185,000,00050,135 36,499 13,636 27%
surgeons needed, surgeons in practice, and the shortage
as indicated in Column 2 of Table 4 are from the year
2030 in Table 2. The total ESTIMATED TO BE CER-
TIFIED-2011 TO 2030 in the 4 th row of Table 4 (24,000
OBGYNs) is obtained by multiplying 1200 (board certi-
fied OBGYNs) by twenty years. The shortage was esti-
mated at 20,135 and 13,636 OBGYNs for a career span
of 25 and 30 years, respectively.
We then added the shortage and the estimated to be
certified to obtain the TOTAL TO BE TRAINED-2011
TO 2030 (44,135 OBGYNs) in Table 4, Column 2 for 25
years and 37,636 in Column 3 for 30 years. This number

B. SATIANI ET AL.
97
Table 4. Costs for direct medical education.
YEARS TO RETIREMENT 25 YEARS 30 YEARS
OBGYN’s NEEDED 50,135 50,135
OBGYN’s IN PRACTICE 30,000 36,499
SHORTAGE 20,135 13,636
ESTIMATED TO BE CERTIFIED-2011 TO 2030 24,000 24,000
TOTAL NEEDED TO BE TRAINED-2011 TO 2030 44,135 37,636
NUMBER PER CLASS 2,207 1,882
TRAINEE YEARS PE R CLASS 8,827 7,527
PER CLASS COST AT $80,000 $706,160,000 $602,176,000
TOTAL COST-2011 TO 2030 $14,123,200,000 $12,043,520,000
Figure 1. The supply of OBGYNs from 2006 (assuming a 25 year career span) as the baseline to 2050 is illustrated by adding
new practicing OBGYNs (light grey), attrition of practici ng OBGYNs (blac k) and total supply (medium grey).
4. Discussion was divided by 20 to obtain the class size, NUMBER
PER CLASS, for 20 years, more than 2,200 for 25 years
and almost 1,900 for 30 years. There have been several workforce studies in the OB-
GYN specialty starting with a 1998 actuarial supply
model analysis by Jacoby and colleagues. [9] A number
of different algorithms or models have been used for
estimating physician supply including the Work Per
Capita Analysis model [10], the Cooper model [11] and
the Physicians Supply Model & Physicians Requirement
Model. [12] Our algorithm is a simplified population
analysis model because it uses gross numbers by spe-
cialty, adds the number of physicians entering the work-
force, subtracts those leaving medical practice, and esti-
mates the future supply. Yet, our population analysis
estimate for the total medical workforce in 2020 of
We multiplied these figures by 4 to determine the
TRAINEE YEARS PER CLASS–8828 in column 2 and
7,528 in column 3 of Table 4.
To calculate per class cost we multiplied the TRAINEE
YEARS PER CLASS by $80,000 for the PER CLASS
COST AT $80,000. This results in a $706,000,000 cost
for 25 years and about $600,000,000 for 30 years.
We subsequently multiplied the PER CLASS COST
AT $80,000 by 20 to arrive at more than $14 billion and
$12 billion for cost estimates of 25 years to retirement
and 30 years, respectively (TOTAL COST-2011 TO
2030).

98 B. SATIANI ET AL.
960,960 is consistent with the Health Resources and Ser-
vices Administration model of 951,800 and with the
Council of Graduate Medical Education (COGME)
model, which arrives at physician supply of 971,817.
[13,14] In addition, our estimate of a shortage of about
200,000 physicians in 2020 is akin to Cooper’s shortage
estimate of about 200,000 physicians. [15]
The U.S Census Bureau projects the female population
to be 157 million in 2010, 170 million in 2020, and 213
million in 2050. [16] The ratio of OBGYNs per 100,000
women has gradually increased from 23.0 in 1978 to
27.1 in 1997. [7] Our assumption of 27.1 OBGYNs per
100,000, which approximates 39,000 OBGYNs practic-
ing in 2000, is consistent with the American Board of
Obstetrics and Gynecology’s actual number of 40,240
OB/GYNs in practice in the year 2000. [17] Assumed
board certification of 1,200 residents each year and
using 27.1 OBGYN specialists per 100,000 women in
2010 as a baseline, 42,547 OB/GYN specialists will be
needed to take care of our women’s’ needs. [17] In 2030,
that number will increase to almost 50,135 specialists.
Using a 25-year practice horizon, the shortage in the year
2030 is estimated to be 20,135 (40%) OBGYNs. (Table
2) The Balan ced Budget Act (BBA) of 1997 attempted to
slow the growth of the physician workforce by freezing
the full time equivalent (FTE) resident cap at 1996 levels
and created incentives to reduce resident positions in
response to a chorus of concerns about physician over
supply. Medicare has been the main source of graduate
medical education (GME) since its inception in1965. In
2007, the Congressional Budget Office estimated that
indirect medical education expenses incurred by Medi-
care alone were $5.7 billion and direct medical education
costs were $2.8 billion. [18] With large budget deficits
and a stratospheric national debt, rather than increasing
funding for trainee positions, existin g subsidies are lik ely
to face increased scrutiny.
Confounding variables
Some of the variables influencing the accuracy of this
workforce model include: the per-unit work by the phy-
sician, the duration of practice and retirement patterns,
lifestyle considerations and the increasing sub-speciali-
zation of OBGYNs. Although the number of Board Cer-
tified OBGYNs pe r 100,000 women h as increased, ab out
20 percent of OBGYNs do not practice obstetrics and
stopped doing so at an average age of 48. [19] A signifi-
cant error in estimation of workload may also occur if
these specialists provide more or less primary or gener-
alist care than is generally estimated in most workforce
studies. Jacoby and associates observed that of the
women Medicare patients seen by an OBGYN, 13% re-
ceived more than half of their medical work (as meas-
ured by relative value units billed) from their OBGYN.
[9] Any change in th is pattern could alter the de mand for
OBGYNs.
Discussion of per-unit work by sex as a variable is an
important consideration. In 2006, women represented 27
percent of active physicians, but 42 percent of all resi-
dents/fellows in ACGME accredited programs in the
United States. [20] For the years 1997–2004, 73.3 per-
cent of residents who chose OBGYN were female in
contrast to 21.6 percent and 47 percent who selected sur-
gery and primary care, respectively. [19]
Pearse et al. used the American Medical Association
socio-economic survey to review gender differences in
work reported by OBGYNs. More female OBGYNs un-
der age 40 reported reducing their hours or stopped their
practice completely for extended periods of time for
family reasons than men (23% versus 5%). [7] In the
survey of 230 ACOG members, female OBGYNs under
age 40 reported working 24.7 hours per week in the of-
fice compared to 27.5 hours for men. Significant differ-
ences in in-patient visits per week (females 10.1 versus
males 12.8 per week, p < 0.01) and working > 60 hours
per week (females 22.1% versus males 31.5%, p < 0.05)
were reported by Benedetti and co-authors. [21]
Much has been made about women choosing ‘control-
lable’ specialties. In a survey of medical students from
1996–2003, the percentage of women who chose special-
ties with controllable lifestyles increased from 18 percent
in 1996 to 36 percent in 2003. [2] But, importantly the
percentage of men who chose controllable lifestyles grew
from 28 percent in 1996 to 45 percent in 2003. [22]
There are varying opinions about whether reduced work
hours lead to greater career satisfaction in women. [23,
24] Based on the evidence cited generational preferences
for a controllable lifestyle may be more of a factor than
gender differences today.
Early retirements sooner than the 25 or 30-year career
span we have used in our estimates will also change the
OBGYN future workforce estimates. Early retirements
among physicians over the age of 55 are 35.7% in 2007
compared to 27.5% in 1985. [25] The average age of
retirement of female physicians is four years sooner than
male physicians. [26] Eighty percent of female physi-
cians are retired by age 65 compared to only 60% of
male physicians. [27] In addition, female OBGYNs also
have a higher percentage of physician spouses (46%)
compared to male OBGYNs (7%) further explaining
their choice of fewer work hours and possibly retiring
earlier. [28]
If surveys of physician practice plans are an indicator,
the shortages may be more severe than our estimates.
[29]
Another variable is the increasing number of OBGYN

B. SATIANI ET AL.
99
trainees who choose one of the sub-specialties within
OBGYN. Pearse and co-authors in a workforce analysis
in 2000 projected that by 2020 Gynecologic Oncology
and Maternal Fetal Medicine sub-specialists would dou-
ble (460 to 955 and 648 to 1317, respectively) and REI
specialists would increase from 605 to 760. [30] In-
creasing sub-specialization will have a negative effect on
OBGYNs available for delivering babies.
Jacoby et al estimated that in 1994 82% of deliveries
were performed by OBGYNs and 22% by family and
general practitioners. [9] According to a 2008 survey of
FP’s by the American College of Family Physicians,
about 23% of members reported performing an average
of 40 deliveries annually (2003 data). [31] Failing a
long-term solution for high professional liability, it is
possible that family practitioner’s may abandon deliver-
ies further increasing the workload for OBGYNs.
5. Some Solutions
Our estimates indicate that additional funding for 1000
additional physicians per year from 2011 to 2020 unad-
justed for inflation would amount to about $1.6 billion
over a 20-year period or $80 million per year starting in
2011. (Tab le 4) Despite massive budget deficits and un-
funded liabilities, we believe this relatively modest in-
vestment would partially address the OBGYN shortage.
We have previously discussed some solutions for the
coming shortage of surgical specialties. [32, 33] How-
ever, OBGYN has unique specialty needs in that it has a
large and important primary care component.
Work hour restrictions also effect care of the OB GYN
patient. Fewer work hours translate to about a 20 percent
reduction in work effort of the n ation’s medical residents
and fellows, which is equivalent to losing the workload
of about 15,000 to 22,000 full-time residency positions.
[34] In order to compensate for fewer work units per
OBGYN physician, part-time employment must be of-
fered. The percentage of part-time physicians increased
from 13 percent in 2005 to 20 percent in 2007 and more
than 80 percent of physicians who practice part time are
at least 0.5 FTE. [35] Expectedly, the work force in this
category consists mostly of pre-retirement males and
early career females. [35] Eighty- four percent of all
academic OBGYN departments report part-time faculty,
who constitute 21.2% of all OBGYN physicians. [36] A
higher percentage of women had part-time jobs com-
pared to men (23% versus 16.2%, p = 0.23) Because
part-timers wish to avoid the long hours and night call,
yet cannot afford to reduce their practices, many are
forced to retire prematurely or choose alternative careers.
Sixty-nine percent of female physicians and 11% of male
physicians who practiced part-time indicate family re-
sponsibilities as the reason for cutting back. Until com-
prehensive tort reform is enacted, one way for hospitals
to take advantage of the older doctors’ experience is to
employ them under a hospital liability umbrella program.
The advent of the hospitalists as promoted by the In-
stitute of Medicine may allow for a controlled lifestyle,
less burnout and prolongation of a physician’s career
span. It may also lead to more efficient and standardized
obstetric practice. The ‘laborist’ model may allow future
obstetricians to work part-time, limit their work hours
and escape the malpractice premium burden. [37]
The average age at retirement of physicians is 63 years.
[38] In the 55–65 age group, the percentage of physi-
cians planning to retire in the next three years has more
than doubled from 9 percent in 2004 to 20 percent in
2007. [2] The brunt of the work will be assumed by
OBGYNs in this age group but with the lifestyle choices
of this generation, mentoring programs to assist younger
physicians, periodic sabbaticals and hospital employment
to reduce the added stress of practice management may
all be necessary to keep them from dropping out.
In business terms, the return on investment for sig-
nificant taxpayer and private resources expended into
physicians is poor when they either take substantial time
off or retire early due to family obligations, illness or
burnout. One way to recoup the outlay and add them
back into the pool is through so-called ‘re-entry’ pro-
grams. The American College of Obstetricians and Gy-
necologists Task Force on Reentry is one such initiative
that could be expanded. The task force estimates there
are several hundred, if not more, OBGYNs who co uld be
re-trained through establishment of short refresher pro-
grams. [39]
A whole host of other actions such as function shifting
by training more Physician Assistants and Nurse Practi-
tioners, reducing non-clinical duties of OBGYNs, im-
proving productivity by electronic medical records, de-
creasing regulatory coding and documentation require-
ments and possibly shortening training programs are
steps that could be taken in conjunction with other ac-
tions. Simply cycling more med ical students through our
schools and trying to convince Congress to fund addi-
tional GME positions with billions in a time of financial
crisis without other fundamental changes in our system
will likely fail and result in a crisis of access for OBGYN
patients used to extraordinary care.
Conflict of interest. None of the autho rs have any co n-
flicts to disclose.
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