January 17, 2024
Losing a Legacy
By Judy Kimelman, MD
After 73 years, Seattle Obstetrics and Gynecology Group, the physician-owned practice where I have practiced for the last 25 years, is permanently closing its doors. While tragic for our patients and heart-wrenching for the doctors who care for them, our closure is a symptom of a much larger problem in health care today.
The loss of our clinic will affect over 16,000 patients, which includes over 300 pregnant patients who now must scramble to find a new doctor to deliver their babies. The closure of our practice resulted from the same issues impacting practices across our state that are making it increasingly hard to find timely and necessary medical care.
Physician shortages have been predicted for years. A study published in 2021 by the federal Health Resources and Services Administration predicted that by 2030 there will be a shortage of OB-GYNs across the country, with the West being hit the hardest. The supply of OB-GYNs will decrease by 7% while the need for their services will increase by 4%. The COVID-19 pandemic has accelerated this trend. Post-pandemic, many physicians have decided to retire early due to burnout coupled with poor reimbursement, stressful work environments, and long hours.
Reimbursement for primary care and especially women’s health care has long been undervalued. It is difficult for our patients on Medicaid or Medicare to find a clinic that will take them because of inadequate reimbursement rates. Medicaid reimbursement rates in Washington are some of the lowest across the country. This especially impacts independent medical clinics that treat pregnant people, as half of all the deliveries in Washington are covered by Medicaid. A normal vaginal delivery and the care afterward currently nets around $360 for the physician after covering all the overhead expenses. Reimbursement can be even lower for patients on Medicaid.
The closure of our exceptional OB-GYN group should serve as a warning that our medical system is ailing.
Our practice also treats patients on Medicare. Over the last 20 years, Medicare reimbursement rates (adjusted for inflation) have fallen by 26% while overhead costs have increased by almost 50%. This issue would be worsened if the looming Medicare physician payment cuts expected in January go into effect.
Along with low reimbursement rates, additional expenses make it difficult (and in our case impossible) to keep our doors open. OB-GYNs have some of the highest malpractice rates. Malpractice premiums are driven up by large jury awards since Washington has no cap on noneconomic damages. Additionally, our staff salaries have been driven up by inflation and the high cost of living in the Seattle area. As a private practice, we can’t compete against the salaries offered by the large health care systems in our area.
The closure of our exceptional OB-GYN group should serve as a warning that our medical system is ailing. We need to let our members of Congress and state legislators know that medicine is in trouble. Let’s urge Congress to stop cutting Medicare and instead plan for yearly inflationary increases. Locally we need to urge our legislators to increase Medicaid rates for those treating patients, not just hospitals, so that more medical groups can afford to see these patients.
My group is heartbroken to see an end to our legacy. We can only hope this serves as a sign that we need to make significant changes to our broken system. We all deserve top-quality health care with doctors we trust.
Judy Kimelman, MD, is a physician with Seattle Obstetrics and Gynecology Group and the District VIII chair of the American College of Obstetricians and Gynecologists.
Note: A version of this article ran in The Seattle Times on Nov. 17, 2023.
This article was featured in the January/February 2024 issue of WSMA Reports, WSMA's print magazine.