OBGYNs and the Provision of Sexual and Reproductive Health Care: Key Findings from a National Survey
The 2020 KFF National Physician Survey on Reproductive Health obtained responses from a nationally representative sample of OBGYNs practicing in the United States who provide SRH care to patients in office-based settings. The survey was designed and analyzed by researchers at KFF, and an independent research company, SSRS, carried out the fieldwork and collaborated on questionnaire design, pretesting, sample design, and weighting. Survey responses were collected via paper and online questionnaires from March 18 to September 1, 2020 from 1,210 OBGYNs.
The initial sample release in March 2020 corresponded with the emergence of the COVID-19 pandemic. As such, after the initial sample release, a supplement of questions were added regarding the impact of the COVID-19 pandemic on providers and their practices. Among the 1,210 OBGYNs who completed the main survey, 855 OBGYNs completed the supplemental questions related to COVID-19. The full results from the COVID-19 supplemental questionnaire can be found on the KFF website here.
In this report, we present findings on issues within SRH care provision by OBGYNs, including the range of services provided (contraception, abortion, STI care), as well as the impact of payors, particularly Medicaid, on the services they offer, and how changes in reproductive health policy have impacted their practices.
The samples were weighted to match known demographics. Taking into account the design effect, the margin of sampling error for the total sample is +/- 4 percentage points at the 95% confidence level. All comparisons noted in this brief are statistically significant (p <0.05). Please see the attached topline for the full methodology report.
We surveyed a nationally representative sample of 1,210 U.S. OBGYNs currently in clinical practice. Eligible physicians were board-certified OBGYNs, spent at least 60% of their time providing direct patient care, and provided sexual and reproductive health care to at least 10% of their patients in an office-based setting. We compared survey responses by key physician and practice characteristics. Gender, age and race were determined by physician self-report. For practice type, those who indicated they work in a private practice or a health maintenance organization (HMO) were classified as “private office-based,” while those who indicated they work in a community health center (e.g., FQHC, rural health center), a reproductive health care or family planning clinic (e.g., Planned Parenthood) or a government operated clinic (e.g., VA, state/county health department) were classified as “health center/clinic.” Practice size was determined by the number of full-time equivalent (FTE) physicians or advance practice clinicians (small ≤ 3, medium 4-10, large >10). Urbanicity and region were determined by the ZIP code of the practice, using U.S. Census definitions. Practicing in a Medicaid Expansion state was determined by zip code and the KFF list of states that had implemented Medicaid expansion by March 2020. OBGYNs were asked to estimate the share of patients with different insurance coverage types, including Medicaid, Medicare, private insurance, and uninsured patients.
Characteristics of Survey Respondents
Table 1 shows the demographics of the survey respondents. The majority of OBGYNs surveyed worked in private office-based practices (77% in solo, group or hospital owned private practice, 6% in HMOs and 3% in other private practices). A minority practiced in what was defined as a health center/clinic (7% in a community clinic or health center, 1% in a reproductive health care clinic, 1% in a government operated clinic, and 3% in another type of publicly-funded clinic). Half of OBGYNs worked in medium size practices with 4-10 clinicians, and the majority practiced in urban locations. OBGYNs were split fairly evenly by region, and the majority practiced in a state with Medicaid Expansion.
|Table 1: Demographics of Survey Respondents|
|Overall OBGYNs||N= 1,210|
|Characteristic||Unweighted Distribution (%)||Weighted Distribution (%)|
|Race and Ethnicity||White||71%||70%|
|Practice type||Health Center/Clinic||14%||12%|
|Practice size||Large (>10 FTE)||19%||20%|
|Medium (4-10 FTE)||46%||50%|
|Small (≤ 3 FTE)||33%||28%|
|Medicaid Expansion State||Yes||66%||68%|
|Share of Medicaid Patients||≥ 25%||47%||45%|
|A small percentage of respondents left demographic questions blank or their responses were unspecified, including unweighted n= 3 (0.2%) for gender, 18 (1%) for age, 14 (1%) for practice type, 26 (2%) for practice size, 35 (3%) for urbanicity, and 16 (1%) for share of Medicaid patients.
NOTES: Gender, age, race and share of Medicaid patients defined by self-report. Practice type was also based on self-report: private office-based = private practice/HMO, health center/clinic = community health center/reproductive health care clinic/government operated clinic. Practice size defined by number of full-time equivalent physicians and advance practice clinicians that physicians reported in their practice (small ≤3 FTE, medium 4-10, large >10). Urbanicity, region and Medicaid Expansion state derived from zip-code.
SOURCE: KFF 2020 Physician Survey on Reproductive Health. Fielding from March 18 to September 1, 2020. N = 1210