The government's financial support for labor and delivery centers in vulnerable areas is not enough to increase the number of obstetricians and gynecologists, according to a new study.

The researchers noted that the increase in medical fees for labor and delivery is insufficient to convert non-regular obstetricians and gynecologists into regular employees, emphasizing the need for a multidimensional approach to secure manpower.

Professor Ko Han-soo of the Department of Health Administration and Policy at George Mason University in the United States and Professor Ok Min-soo of the School of Preventive Medicine at University of Ulsan College of Medicine published a study in the Journal of Korean Medical Science (JKMS), which analyzed the changes in the number of obstetricians and gynecologists concerning the government’s support policies.

The researchers analyzed changes in the number of obstetricians and gynecologists in vulnerable areas from 2011 to 2020 using data from the Health Insurance Review and Assessment Service's medical personnel statistics. During this period, the government implemented financial support policies, including providing facilities and equipment for vulnerable delivery areas and increasing the number of deliveries.

The government has designated and supported vulnerable delivery areas since 2011. In 2016, it increased the delivery fee for areas deemed vulnerable by 200 percent. The fee for high-risk deliveries was increased by 30 percent, and for late-night deliveries by 100 percent.

The study found that as of 2011, the vulnerable delivery centers were run by non-regular obstetricians. For every 1,000 women of childbearing age, there were 0.295 full-time obstetricians, compared to 5.764 part-time obstetricians. Additionally, the designated labor and delivery centers were considered “environmentally more vulnerable” due to their limited financial independence.

When the government provided facilities and equipment through the Labor Vulnerable Areas Support Project, the number of obstetricians and gynecologists in these areas increased. On average, there were 1.4 more obstetricians per 1,000 women of childbearing age in the designated areas than in the non-designated areas. However, most of them were non-regular employees.

The combination of fee hikes has changed the employment mix of obstetricians in underserved areas. Since 2016, the last year for which labor fees were recognized, the number of full-time obstetricians per 1,000 women of childbearing age in labor-risk areas has increased by 0.08, a 20 percent increase from the overall average. In contrast, the number of part-time obstetricians has decreased by 3.5. Since 2016, the overall number of obstetricians and gynecologists has decreased by an average of 0.56.

The increase in delivery fees may have influenced the conversion of part-time ob/gyns to full-time positions in underserved areas, the study analyzed.

“The number of full-time obstetricians in underserved areas was significantly associated with the increase in delivery rates,” the researchers found. “However, the increase was limited because it was not an influx of new specialists, but a change in the working patterns of existing specialists.”

Simply raising fees is not enough to ensure that delivery centers are adequately staffed, the researchers concluded. Given the declining number of obstetricians and gynecologists, it is expected that retention of specialists in delivery centers will become more difficult in the future, they predicted.

“While market-driven strategies, including fee increases and subsidies, are not without merit, relying solely on these measures will have limited success in ensuring a stable workforce in underserved areas,” the researchers said. “Multidimensional and comprehensive measures that include both financial and non-financial support are crucial.”