OBGYNs and the Provision of Sexual and Reproductive Health Care: Key Findings from a National Survey
Cost of Care
OBGYNs reported that affordability comes up commonly when talking to patients. Nine in ten OBGYNs said the issue of affordability always (11%), often (42%) or sometimes (38%) comes up when they recommend tests or treatment to their patients. Few said affordability came up rarely (7%) or never (1%).
Despite the topic of affordability arising frequently in patient-provider interactions, OBGYNs were not always aware of the out-of-pocket (OOP) costs patients were facing. When making diagnostic and treatment recommendations for patients, 14% said they were always aware of the magnitude of patients’ out of pocket costs. The rest said they were often (39%), sometimes (31%), rarely (13%) or never (2%) aware of these costs (Figure 25).
The issue of affordability and awareness of OOP costs varied by certain practice characteristics. OBGYNs in small practices compared to medium or large were more commonly found to report the issue of affordability always arising when recommending care to patients (small 18%, medium 9%, large 7%), and to report always be aware of the magnitude of OOP costs (small 23%, medium 11%, large 10%). There was no difference in how often the issue of affordability arises or awareness of OOP costs by practice type or share of Medicaid patients (25%+ vs. <25%).
Nearly all OBGYNs acknowledged the cost burden that can be associated with seeking reproductive health care. Almost all OBGYNs said the cost of reproductive health services poses a major (55%) or minor (37%) financial burden for low-income patients in their practices, while only 7% believed it poses no financial burden (Figure 26). A higher share of OBGYNs in states without Medicaid expansion reported these services pose a major financial burden for low-income patients compared to OBGYNs in states with Medicaid expansion (63% vs. 52%).
Impact of the ACA on Contraceptive Use
The passage of the Affordable Care Act (ACA) had several implications for women’s health care, and SRH care more broadly. Beginning in 2012, the law required nearly all private insurance plans to cover prescription contraceptive services and supplies without cost sharing to women. Since this regulation was implemented, over six in ten OBGYNs (63%) reported a significantly or somewhat increased share of their patients using any contraceptive method, while fewer reported no impact (34%) or a decreased share of patients using contraception (2%). In a similar vein, nearly seven in ten (69%) OBGYNs said the share of their patients who are able to select their desired contraceptive has increased significantly or somewhat since 2012 (Figure 27). Overall, these findings are consistent with other research documenting increases in contraceptive use, like IUD and implant use, since the contraceptive coverage requirement was implemented.
A higher share of OBGYNS in private office-based practices reported increased contraceptive use as compared to those working in health centers/clinics (any contraceptive use 66% vs. 47%, desired contraceptive 72% vs. 51% respectively). This could reflect the fact that those in private practice saw on average more patients with private insurance than those in health centers/clinics (60% vs. 28%); those in health centers/clinic on average saw a higher share of Medicaid patients who are already covered for contraceptive services, but many of their formerly uninsured patients could now be covered as result of the ACA’s Medicaid expansion and have better access to contraceptive services and supplies.
Impact of Reproductive Health Policy Debates on Practice
Over the last year, several reproductive health policy debates have made their way into the news and judicial system. This includes changes to the Title X Family Planning program, debates over federal- and state-level abortion regulations and rulings on contraceptive coverage for religious employers. [For context, 27% of OBGYNs surveyed identified as Republicans, 40% as Democrats, 25% as Independents, and 6% as something else.]
Two thirds OBGYNs reported following developments or news regarding federal and state policy debates on reproductive health very closely (22%) or fairly closely (46%). The other third of OBGYNs reported they have followed these debates not too closely (27%) or not at all (4%) (Figure 28). It was more common for OBGYNs who provide abortions compared to non-abortion providers to report following reproductive health policy news very closely (36% vs. 18%), as it was for providers at practices that offer gender affirming services compared to those who do not (29% vs. 19%). This is perhaps not surprising given that access to abortion and care for transgender individuals have been the targets of a number of policy changes over the past year.
Several states across the country have passed an increasing number of laws regulating abortion in recent years, including gestational age limits and regulations on abortion providers and facilities. Most OBGYNs (68%) reported these new regulations did not impact their ability to provide quality reproductive health care to their patients, although about a quarter reported a negative impact (28%). Very few (3%) believed these regulations had a positive impact on their ability to provide quality reproductive health care (Figure 28). A higher share of the youngest group of OBGYNs perceived a negative impact of these regulations on provision of care compared to all other age groups (age <45: 40%, age 45-54: 23%, age 55-64: 19%, age 65+: 21%), as did OBGYNs in the Midwest (35%) and South (35%) compared to the Northeast (17%) and West (21%). Of note, abortion providers were just as likely to report a negative impact of these regulations as non-abortion providers (32% vs. 27%).
It is well documented that many physicians suffer from burnout and career dissatisfaction. When asked if they could do things again based on their experience as a physician, 70% of OBGYNs reported they would choose the same specialty. A minority said they would choose a different specialty (19%), and few said they would not be a physician at all (10%) (Figure 29). There were no differences seen by physician age, race, practice type, urbanicity or practice size, however a higher share of men said they would choose a different specialty if they could do things again compared to women (24% vs. 16%). A higher share of abortion providers said they would choose the same specialty again compared to non-abortion providers (79% vs. 68%). A larger share of OBGYNs in the West said they would choose the same specialty compared to OBGYNs in the Northeast (76% vs. 63%) (Table 11).
|Table 11: Career Satisfaction of OBGYNs|
|Characteristics||Based on your experience as a physician, if you had the chance to do things again would you:|
|Choose the same specialty||Choose a different specialty||Not be a physician at all|
|Race and ethnicity||Asian||68||20||11|
|Practice type||Health Center/Clinic||66||24||9|
|Practice size||Large (>10 FTE)||73||17||10|
|Medium (4-10 FTE)||72||19||8|
|Small (≤3 FTE)||64||22||13|
|Practice provides abortions||Yes||79*||16||5*|
|*Indicates statistically significant difference from reference group in bold (p<0.05)
NOTES: Region derived from zip code, using U.S. census breaks
SOURCE: KFF 2020 Physician Survey on Reproductive Health. Fielding from March 18 to September 1, 2020. N = 1210