Teens, suburbanites getting prenatal care from non-ob/gyns

A first-of-its-kind report from the National Center for Health Statistics (NCHS) suggests that many teens and women in small towns or suburbs or who lack health insurance are receiving routine prenatal care from providers who are not ob/gyns.  

The findings are based on estimates from the 2009 and 2010 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (MHAMCS), conducted by the NCHS. More than 60% of office-based physicians listed in the master files of the American Medical Association and the American Osteopathic Association responded to the NAMCS survey. The NHAMCS survey looked at visits to nonfederal, general, and short-stay hospital emergency departments and hospital outpatient departments (OPD).

During 2009-2010, overall, 14% of routine prenatal visits in the United States were to providers who did not specialize in ob/gyn. Health care professionals other than ob/gyns handled nearly 25% of such visits for women on Medicaid and 23% of such visits for those who had no insurance.

Women in small towns or suburbs were most likely to have been seen for prenatal care by a non-ob/gyn (22.4%), whereas 14.4% of such visits occurred in urban areas and 5.1% of such visits in large suburban areas.  The older a woman, the more likely she was to have a prenatal visit with an ob/gyn, with 20.5% of visits to non-ob/gyns among women aged 15 to 19, versus 8.9% for those aged 30 to 34 and 10.3% for women aged 35 to 54. Race and ethnicity did not appear to impact the results.

Visits for routine prenatal care were limited to those with ICD-9-CM diagnoses of V22 (supervision of normal pregnancy) or V23 (supervision of high-risk pregnancy) or a reason for visit code of 3205.0 (prenatal examination, routine). The NAMCS definition of an ob/gyn was a physician with a specialty included in the obstetrics and gynecology specialty category;  the OPD component of NHAMCS was obstetrics and gynecology clinics. 

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