The maternity care crisis in rural America: How locum tenens can help fill the gaps in maternity care in rural hospitals

A new report from the Center for Healthcare Quality & Payment Reform reveals a shocking reality for families in rural America: More than half of rural hospitals in this country (55%) do not offer obstetric services.

This alarming figure is indicative of a worsening trend in the face of rising costs and labor shortages that are impacting medical facilities across the country and require immediate attention.

Between 2011 and 2021, 267 rural hospitals – a quarter of all rural obstetric departments – stopped offering maternity care, leaving pregnant women in rural areas with few options at a critical time for their mental and physical health.

Some institutions have alleviated their short-term acute staffing needs by deploying locum tenens, i.e., traveling medical professionals who can temporarily ensure continuity of care.

But systemic problems remain. Despite spending a higher percentage of our GDP on health care than any other wealthy country, the United States has the highest maternal mortality rate in the developed world, and the growing lack of maternity care in rural areas will only add to the crisis.

Pregnant women in rural communities were vulnerable even before the surge in obstetrics closures. A 2021 report from the U.S. Government Accountability Office found that the maternal mortality rate in the most rural counties was 23.8 deaths per 100,000 live births — more than 60% higher than the 14.6 deaths per 100,000 live births in large metropolitan counties.

There are several factors coming together to create this crisis

Rural hospitals often struggle to retain adequate staff, which can lead to closures of maternity units. In 12 states, the majority of hospitals that provide maternity care are operating at a loss. The problem is even worse for smaller rural hospitals, two-thirds of which are in the red on patient care.

Combined with rising costs, these shortages make it harder to recruit and retain staff, despite the need for maternity care. It’s not the hospitals’ fault; the cost to deliver a baby now tops $20,000, but Medicaid reimbursements haven’t kept up.

Understaffed facilities can turn to temporary providers for essential short-term care. A birthing center in Michigan’s rural Upper Peninsula recently faced closure after the departure of two OB/GYNs, but was able to use temporary providers to keep the center open. This model is replicable everywhere, but it requires health systems to continue investing in serving locations that may not be profitable for them.

Part of the financial burden on rural health care systems stems from the fact that rural women are less likely to be insured than urban women. A Michigan Medicine study published in the journal Obstetrics & Gynecology found that 15.4 percent of women in rural areas were uninsured before pregnancy, 27 percent higher than the 12.1 percent uninsurance rate of women in urban areas.

The federal government has recently taken some encouraging steps in that direction. In 2019, the U.S. Health Resources & Services Administration created the Rural Maternity and Obstetrics Management Strategies (RMOMS) Program to increase access to maternal and obstetric care in rural communities. It now funds programs run by 14 awardees in 11 states to test innovative programs aimed at addressing the maternal health needs of their residents.

In addition to providing grants, RMOMS says it also collects data on maternity care in rural hospitals, establishes networks to coordinate continuity of care, leverages telehealth and specialist care, and improves financial sustainability with its partners.

In private life, education and payments are the most important issues

When rural residents are trained in midwifery, there is no guarantee that they will stay in rural communities to provide care. Hospitals and medical schools in rural areas should recruit and train doctors, nurses, and midwives who work specifically in those areas, but there should be a reason for these health care providers to stay, such as through incentive programs.

These efforts may require government funding, which would be a worthy investment. New York State recently provided a $5 million emergency grant to help keep an otherwise closed birthing center open, a move that cheered the surrounding community.

Until more grants are approved, private philanthropy can help pick up some of the burden. Ruth Gottesman’s $1 billion donation to Albert Einstein College of Medicine in the Bronx made tuition free for all students; I’d encourage philanthropists to take a closer look at more rural medical schools where their money could have an even greater impact.

Addressing America’s maternal health crisis will be complex and nuanced; we’re starting in negative territory. The solutions above are just a few that have been proposed, and innovation will certainly play a role in the future, but one thing is clear: we must start now. In the meantime, rural hospitals can leverage locum tenens agencies to provide continuity of care to patients in their communities.

Photo: asiseeit, Getty Images

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