The Obstetrician–Gynecologist Distribution Atlas The Obstetrician–Gynecologist Distribution Atlas was developed by the Workforce Studies and Planning Group of the American Congress of Obstetricians and Gynecologists. The information, references, and Internet links contained in this publication were current as of August 2, 2012, and may be subject to change without notice. Reference to Internet sites and other sources of information other than ACOG does not indicate endorsement by ACOG. Readers are responsible for confirming the status of information contained in this publication before making decisions based on that information. Copies of The Obstetrician–Gynecologist Distribution Atlas can be purchased through the American College of Obstetricians and Gynecologists’ Distribution Center by calling 800-762-2264. Orders also can be made from the College web site at sales.acog.org. Copyright 2013 by the American Congress of Obstetricians and Gynecologists. All rights reserved. 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The American Congress of Obstetricians and Gynecologists 409 12th Street, SW PO Box 70620 Washington, DC 20024-9998 www.acog.org ISBN: 978-1-935718-07-9 12345/76543 Contents Contributors v PrefaCe vii interPreting the MaPs viii National and District Maps ..................................................1 United States .................................................................................... 2 District I ............................................................................................. 4 District II ............................................................................................ 6 District III ........................................................................................... 8 District IV......................................................................................... 10 District V.......................................................................................... 12 District VI......................................................................................... 14 District VII........................................................................................ 16 District VIII....................................................................................... 18 District IX ......................................................................................... 20 District XI ......................................................................................... 22 District XII ........................................................................................ 24 State Maps............................................................................ 27 Alabama......................................................................................... 28 Alaska ............................................................................................. 30 Arizona ........................................................................................... 32 Arkansas ......................................................................................... 34 California........................................................................................ 36 Colorado ........................................................................................ 38 Connecticut..................................................................................... 40 Delaware ........................................................................................ 42 Florida.............................................................................................44 Georgia .......................................................................................... 46 Hawaii ............................................................................................ 48 Idaho............................................................................................... 50 Illinois .............................................................................................. 52 Indiana............................................................................................ 54 Iowa ................................................................................................ 56 Kansas............................................................................................. 58 Kentucky ......................................................................................... 60 Louisiana......................................................................................... 62 Maine ............................................................................................. 64 Maryland and Washington, DC .................................................. 66 Massachusetts ................................................................................ 68 Michigan ........................................................................................ 70 Minnesota....................................................................................... 72 Mississippi ...................................................................................... 74 Missouri .......................................................................................... 76 Montana ......................................................................................... 78 Nebraska........................................................................................ 80 Nevada........................................................................................... 82 New Hampshire............................................................................. 84 New Jersey..................................................................................... 86 New Mexico .................................................................................. 88 New York........................................................................................ 90 North Carolina............................................................................... 92 North Dakota ................................................................................. 94 Ohio ................................................................................................ 96 Oklahoma ...................................................................................... 98 Oregon .........................................................................................100 Pennsylvania.................................................................................102 Rhode Island ................................................................................104 South Carolina .............................................................................106 South Dakota................................................................................108 Tennessee ..................................................................................... 110 Texas ............................................................................................. 112 Utah............................................................................................... 114 Vermont......................................................................................... 116 Virginia.......................................................................................... 118 Washington ..................................................................................120 West Virginia ................................................................................122 Wisconsin .....................................................................................124 Wyoming ..................................................................................... 126 aPPendix a. definitions 129 aPPendix b. obstetriCian–gyneCologists Per 10,000 WoMen by state, 2010 130 bibliograPhy 132 Contributors Workforce Studies and Planning Group of the American Congress of Obstetricians and Gynecologists Jeffrey C. Klagholz, BS William F. Rayburn, MD, MBA, FACOG Albert L. Strunk, JD, MD, FACOG James J. Lumalcuri, MSW The Workforce Studies and Planning Group of the American Congress of Obstetricians and Gynecologists gratefully acknowledges the contributions of the following individuals: Michael E. Richards, MD, MPA University of New Mexico Susannah J. Frazier, JD American Congress of Obstetricians and Gynecologists Legal Affairs Department Preface The American Congress of Obstetricians and Gynecologists (ACOG) is committed to providing reliable and useful data to support policy making for women’s health care services in the United States. Effective decision making regarding access to health care services requires accurate information at regional, state, and local levels. As the population grows and the demand for women’s health care services expands, the supply of obstetrician–gynecologists is predicted to be insufficient in many locations. In 2010, 33,316 ACOG Fellows and ACOG Junior Fellows in Practice were documented to practice in the United States, which represented 5% of the total of 661,400 physicians in active practice and yielded a national ratio of 2.62 obstetrician–gynecologists per 10,000 women. The mean number of obstetrician– gynecologists per 10,000 women (or “density” of obstetrician–gynecologists) decreased significantly in metropolitan, micropolitan, and rural counties. A total of 49% (1,550 of 3,143) of the U.S. counties lacked a single obstetrician–gynecologist, and nearly 10 million Americans lived in those predominately rural counties. These counties were present in most states but especially in the Midwest, South, and Mountain West. In 2011, 2,639 hospitals reported having a maternity center. These centers were categorized into three levels based on provision of different levels of maternity care: 1) level I (uncomplicated obstetric and neonatal care), 2) level II (limited complicated obstetric and neonatal care), or 3) level III (full complicated obstetric and neonatal care). Drive times to the closest maternity centers varied considerably across the United States, with the longest drive times experienced in the Midwest. The Obstetrician–Gynecologist Distribution Atlas is intended to provide ACOG Fellows, medical schools and residency training programs, health services researchers, health care policy makers, and the public with the most current data available to better understand the national distribution of the obstetrician–gynecologist workforce. The goal is to show the geographic distribution of active obstetrician–gynecologists relative to the population to help practitioners, policy makers, and patients identify places with sufficient or inadequate geographic access to obstetrician–gynecologists. Please refer to Appendix A for a listing of definitions of terms used in this book. See Appendix B for a table of obstetrician–gynecologists per 10,000 women by state in 2010. Interpreting the Maps This collection of maps on national, district, and state scales provides a snapshot of two key areas in access to care: 1) where obstetrician–gynecologists are practicing relative to the population and 2) how long patients need to drive to a hospital with a maternity center. The five categories of shading in the obstetrician– gynecologist distribution maps reflect certain threshold levels of numbers of obstetrician–gynecologists in each geographic area: 1) none, 2) minimal, 3) acceptable, 4) desirable, and 5) maximal. These threshold levels were determined from previous studies, and definitions were approved by ACOG’s Workforce Studies and Planning Group. The driving-distance maps reflect what areas of the country are within 15-minute, 30-minute, and 60-minute drive times to a hospital with a level I, level II, or level III maternity center (see the Preface for the definition of the levels of maternity centers). The distribution of maternity care centers and obstetrician–gynecologists described and illustrated in this document will likely change because of provider migration and shifts or growth in area populations. Places with greater resources and better living conditions attract health care practitioners with greater ease, whereas areas with fewer amenities and weaker economies may struggle to attract and retain obstetrician–gynecologists. Data for this publication came from the ACOG membership database, which is continually updated. Only those obstetrician–gynecologists who are ACOG Fellows and ACOG Junior Fellows in Practice, which represent approximately 93–95% of all obstetrician–gynecologists in the United States, were included. Membership information was not intended for research purposes; therefore, data presented here cannot be guaranteed as being absolutely accurate. Data regarding the location of maternity centers were obtained from the American Hospital Association’s annual survey database. For each state and district, two maps are provided: 1) illustration of the number of general obstetrician– gynecologists per 10,000 women and 2) representation of the drive time required to reach the closest maternity center. The number of women was gathered from the U.S. Census Bureau’s data for 2010 using the American FactFinder database. Maps in this collection were generated by ACOG’s Workforce Studies and Planning Group. Maps were created using ArcGIS software, Version 10, and map colors were derived through ArcGIS color palettes. United States Obstetrician–gynecologists per 10,000 women in the United States, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Sources: American Congress of Obstetricians and Gynecologists. Membership information. Washington, DC: American Congress Driving times to hospitals with maternity centers in the United States, 2010. United States Less than 15 minutes Less than 30 minutes Less than 60 minutes Sources: American Congress of Obstetricians and Gynecologists. Membership information. Washington, DC: American Congress District I Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District I, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in the American Congress of Obstetricians and Gynecologists’ District I, 2010. District I Less than 15 minutes Less than 30 minutes Less than 60 minutes Sources: American Congress of Obstetricians and Gynecologists. Membership information. Washington, DC: American Congress District II Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District II, 2010. None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in the District II American Congress of Obstetricians and Gynecologists’ District II, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes District III Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District III, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more District III Driving times to hospitals with maternity centers in the American Congress of Obstetricians and Gynecologists’ District III, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes District IV Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District IV, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in the District IV American Congress of Obstetricians and Gynecologists’ District IV, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes District V Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District V, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in the District V American Congress of Obstetricians and Gynecologists’ District V, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes District VI Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District VI, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in the District VI American Congress of Obstetricians and Gynecologists’ District VI, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes District VII Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District VII, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in the District VII American Congress of Obstetricians and Gynecologists’ District VII, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes District VIII Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District VIII, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in the District VIII American Congress of Obstetricians and Gynecologists’ District VIII, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes District IX Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District IX, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in the District IX American Congress of Obstetricians and Gynecologists’ District IX, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes District XI Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District XI, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in the District XI American Congress of Obstetricians and Gynecologists’ District XI, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Sources: American Congress of Obstetricians and Gynecologists. Membership information. Washington, DC: American Congress of Obstetricians and Gynecologists; 2010 and U.S. hospitals reporting an obstetrics unit or obstetrics level, FY2010. FY2010 AHA District XII Obstetrician–gynecologists per 10,000 women in the American Congress of Obstetricians and Gynecologists’ District XII, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in the District XII American Congress of Obstetricians and Gynecologists’ District XII, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Alabama Obstetrician–gynecologists per 10,000 women in Alabama, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Alabama, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Alabama Alaska Obstetrician–gynecologists per 10,000 women in Alaska, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Alaska, 2010 Alaska Less than 15 minutes Less than 30 minutes Less than 60 minutes Arizona Obstetrician–gynecologists per 10,000 women in Arizona, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Arizona, 2010 Arizona Less than 15 minutes Less than 30 minutes Less than 60 minutes Arkansas Obstetrician–gynecologists per 10,000 women in Arkansas, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Arkansas, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Arkansas California Obstetrician–gynecologists per 10,000 women in California, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in California, 2010 California Less than 15 minutes Less than 30 minutes Less than 60 minutes Colorado Obstetrician–gynecologists per 10,000 women in Colorado, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Colorado, 2010 Colorado Less than 15 minutes Less than 30 minutes Connecticut Obstetrician–gynecologists per 10,000 women in Connecticut, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Connecticut Driving times to hospitals with maternity centers in Connecticut, 2010 Less than 15 minutes Less than 30 minutes Delaware Obstetrician–gynecologists per 10,000 women in Delaware, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Delaware, 2010 Delaware Less than 15 minutes Less than 30 minutes Less than 60 minutes Florida Obstetrician–gynecologists per 10,000 women in Florida, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Florida, 2010 Florida Less than 15 minutes Less than 30 minutes Less than 60 minutes Georgia Obstetrician–gynecologists per 10,000 women in Georgia, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Georgia, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Georgia Hawaii Obstetrician–gynecologists per 10,000 women in Hawaii, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Hawaii, 2010 Hawaii Less than 15 minutes Less than 30 minutes Less than 60 minutes Idaho Obstetrician–gynecologists per 10,000 women in Idaho, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Idaho, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Idaho Illinois Obstetrician–gynecologists per 10,000 women in Illinois, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Illinois, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Illinois Indiana Obstetrician–gynecologists per 10,000 women in Indiana, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Indiana, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Indiana Iowa Obstetrician–gynecologists per 10,000 women in Iowa, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Iowa, 2010 Iowa Less than 15 minutes Less than 30 minutes Less than 60 minutes Kansas Obstetrician–gynecologists per 10,000 women in Kansas, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Kansas, 2010 Kansas Kentucky Obstetrician–gynecologists per 10,000 women in Kentucky, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Kentucky, 2010 Kentucky Louisiana Obstetrician–gynecologists per 10,000 women in Louisiana, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Louisiana, 2010 Louisiana Less than 15 minutes Less than 30 minutes Less than 60 minutes Maine Obstetrician–gynecologists per 10,000 women in Maine, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Maine, 2010 Maine Maryland and Washington, DC Obstetrician–gynecologists per 10,000 women in Maryland and Washington, DC, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Maryland and Washington, DC Driving times to hospitals with maternity centers in Maryland and Washington, DC, 2010 Massachusetts Obstetrician–gynecologists per 10,000 women in Massachusetts, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Massachusetts Driving times to hospitals with maternity centers in Massachusetts, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Michigan Obstetrician–gynecologists per 10,000 women in Michigan, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Michigan, 2010 Michigan Less than 15 minutes Less than 30 minutes Less than 60 minutes Minnesota Obstetrician–gynecologists per 10,000 women in Minnesota, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Minnesota, 2010 Minnesota Less than 15 minutes Less than 30 minutes Less than 60 minutes Mississippi Obstetrician–gynecologists per 10,000 women in Mississippi, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Mississippi, 2010 Mississippi Less than 15 minutes Less than 30 minutes Less than 60 minutes Missouri Obstetrician–gynecologists per 10,000 women in Missouri, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Missouri, 2010 Missouri Less than 15 minutes Less than 30 minutes Less than 60 minutes Montana Obstetrician–gynecologists per 10,000 women in Montana, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Montana, 2010 Montana Less than 15 minutes Less than 30 minutes Less than 60 minutes Nebraska Obstetrician–gynecologists per 10,000 women in Nebraska, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Nebraska, 2010 Nebraska Less than 15 minutes Less than 30 minutes Less than 60 minutes Nevada Obstetrician–gynecologists per 10,000 women in Nevada, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Nevada, 2010 Nevada Less than 15 minutes Less than 30 minutes Less than 60 minutes New Hampshire Obstetrician–gynecologists per 10,000 women in New Hampshire, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more New Hampshire Driving times to hospitals with maternity centers in New Hampshire, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes New Jersey Obstetrician–gynecologists per 10,000 women in New Jersey, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more New Jersey Driving times to hospitals with maternity centers in New Jersey, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes New Mexico Obstetrician–gynecologists per 10,000 women in New Mexico, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more New Mexico Driving times to hospitals with maternity centers in New Mexico, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes New York Obstetrician–gynecologists per 10,000 women in New York, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in New York, 2010 New York North Carolina Obstetrician–gynecologists per 10,000 women in North Carolina, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more North Carolina Driving times to hospitals with maternity centers in North Carolina, 2010 North Dakota Obstetrician–gynecologists per 10,000 women in North Dakota, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more North Dakota Driving times to hospitals with maternity centers in North Dakota, 2010 Ohio Obstetrician–gynecologists per 10,000 women in Ohio, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Ohio, 2010 Ohio Less than 15 minutes Less than 30 minutes Less than 60 minutes Oklahoma Obstetrician–gynecologists per 10,000 women in Oklahoma, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Oklahoma, 2010 Oklahoma Less than 15 minutes Less than 30 minutes Less than 60 minutes Oregon Obstetrician–gynecologists per 10,000 women in Oregon, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Oregon, 2010 Oregon Pennsylvania Obstetrician–gynecologists per 10,000 women in Pennsylvania, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Pennsylvania Driving times to hospitals with maternity centers in Pennsylvania, 2010 Rhode Island Obstetrician–gynecologists per 10,000 women in Rhode Island, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Rhode Island Driving times to hospitals with maternity centers in Rhode Island, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes South Carolina Obstetrician–gynecologists per 10,000 women in South Carolina, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more South Carolina Driving times to hospitals with maternity centers in South Carolina, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes South Dakota Obstetrician–gynecologists per 10,000 women in South Dakota, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more South Dakota Driving times to hospitals with maternity centers in South Dakota, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Tennessee Obstetrician–gynecologists per 10,000 women in Tennessee, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Tennessee, 2010 Tennessee Less than 15 minutes Less than 30 minutes Less than 60 minutes Texas Obstetrician–gynecologists per 10,000 women in Texas, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Texas, 2010 Texas Less than 15 minutes Less than 30 minutes Less than 60 minutes Utah Obstetrician–gynecologists per 10,000 women in Utah, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Utah, 2010 Utah Less than 15 minutes Less than 30 minutes Less than 60 minutes Vermont Obstetrician–gynecologists per 10,000 women in Vermont, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Vermont, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Vermont Virginia Obstetrician–gynecologists per 10,000 women in Virginia, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Virginia, 2010 Virginia Less than 15 minutes Less than 30 minutes Less than 60 minutes Washington Obstetrician–gynecologists per 10,000 women in Washington, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Washington Driving times to hospitals with maternity centers in Washington, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes West Virginia Obstetrician–gynecologists per 10,000 women in West Virginia, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more West Virginia Driving times to hospitals with maternity centers in West Virginia, 2010 Less than 15 minutes Less than 30 minutes Less than 60 minutes Wisconsin Obstetrician–Gynecologists per 10,000 women in Wisconsin, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Wisconsin, 2010 Wisconsin Less than 15 minutes Less than 30 minutes Less than 60 minutes Wyoming Obstetrician–gynecologists per 10,000 women in Wyoming, 2010 None 0.1–1.9 2–2.4 2.5–2.9 3 or more Driving times to hospitals with maternity centers in Wyoming, 2010 Wyoming Less than 15 minutes Less than 30 minutes Less than 60 minutes Appendix A Definitions* Active physicians: Physicians who report working in administration, direct patient health care, medical research, or other nonpatient health care activities. Physicians whose major professional activity is unclassified also are considered active. Excluded are physicians in training (residents and fellows) and those who are retired, semi-retired, temporarily not in practice, or not active for other reasons. Active patient care physicians: This group is a subset of active physicians. It comprises only those physicians whose self-reported type of practice is direct patient health care. Fellows†: Physicians whose professional activities are devoted to the practice of obstetrics, gynecology, or both. Practicing board-certified obstetrician–gynecologists in the geographic confines of the American Congress of Obstetricians and Gynecologists may apply for membership under this category. Junior Fellows†: Residents in obstetrics and gynecology in an approved program (by the American Council of Graduate Medical Education) in the United States or Canada, recent graduates of an approved program who are not yet board certified (board candidates), or residents in obstetrics and gynecology in Mexico, Central America, Argentina, Dominican Republic, Chile, or the West Indies. Metropolitan‡: A statistical area containing at least one urban area of 50,000 or more inhabitants. Micropolitan‡: A statistical area with at least one urban area with a population between 10,000 inhabitants and 50,000 inhabitants. Reproductive age§: Age of a woman between 16 years and 44 years based on fertility rates. Rural¶: A statistical area with a population less than 10,000 inhabitants. Woman§: A female person aged 15 years and older. *Source: Association of American Medical Colleges. 2011 state physician workforce data book. Center for Workforce Studies. Washington, DC: AAMC; 2011. Available at: https://www.aamc.org/download/263512/data/statedata2011.pdf. Retrieved August 22, 2012. † Modified from American Congress of Obstetricians and Gynecologists. Membership services. Washington, DC: American College of Ob- stetricians and Gynecologists; 2012. Available at http://www.acog.org/About_ACOG/ACOG_Departments/Membership_Services/ Fellow. Retrieved September 27, 2012. ‡Metropolitan and micropolitan: about metropolitan and micropolitan statistical areas. Washington, DC: U.S. Census Bureau; 2012. Avail- able at: http://www.census.gov/population/metro/about. Retrieved September 27, 2012. §An arbitrarily chosen age range that corresponds with ages reported by the U.S Census Bureau. ¶ An arbitrary definition derived from the definitions of “metropolitan” and “micropolitan” and designed to account for the remaining statisti- cal areas (ie, areas with less than 10,000 inhabitants). Appendix B Obstetrician–Gynecologists per 10,000 Women by State, 2010 Total ACOG Fellows and ACOG Junior Number of Fellows per State Fellows in Practice* Total Women† 10,000 Women Alabama 460 2,002,729 2.30 Alaska 82 264,985 3.09 Arizona 553 2,550,938 2.17 Arkansas 216 1,195,873 1.81 California 3,622 15,007,558 2.41 Colorado 608 2,007,652 3.03 Connecticut 618 1,509,703 4.09 Delaware 98 379,920 2.58 District of Columbia 143 276,072 5.18 Florida 1,765 8,005,074 2.20 Georgia 1,124 3,944,011 2.85 Hawaii 209 556,316 3.76 Idaho 125 606,795 2.06 Illinois 1,446 5,277,535 2.74 Indiana 580 2,643,513 2.19 Iowa 239 1,243,760 1.92 Kansas 276 1,141,352 2.42 Kentucky 411 1,789,857 2.30 Louisiana 501 ,860,016 2.69 Maine 141 569,999 2.47 Maryland 861 2,437,254 3.53 Massachusetts 937 2,814,185 3.33 Michigan 990 4,102,530 2.41 Minnesota 548 2,151,723 2.55 Mississippi 265 1,220,294 2.17 Missouri 596 2,480,157 2.40 Montana 99 403,117 2.46 Nebraska 187 732,707 2.55 Nevada 219 1,066,424 2.05 (continued) Obstetrician–Gynecologists per 10,000 Women by State, 2010 (continued) State Total ACOG Fellows and ACOG Junior Fellows in Practice* Total Women† Number of Fellows per 10,000 Women New Hampshire 176 553,618 3.18 New Jersey 1,202 3,684,395 3.26 New Mexico 191 830,613 2.30 New York 2,600 8,274,206 3.14 North Carolina 1,109 3,961,468 2.80 North Dakota 51 271,968 1.88 Ohio 1,161 4,807,176 2.42 Oklahoma 280 1,515,126 1.85 Oregon 461 1,584,854 2.91 Pennsylvania 1,359 5,400,494 2.52 Rhode Island 71 455,575 3.75 South Carolina 505 1,935,726 2.61 South Dakota 79 324,444 2.43 Tennessee 727 2,646,914 2.75 Texas 2,530 9,865,520 2.56 Utah 269 1,014,493 2.65 Vermont 93 266,836 3.49 Virginia 979 3,324,601 2.94 Washington 688 2,736,573 2.51 West Virginia 163 783,560 2.08 Wisconsin 548 2,325,508 2.36 Wyoming 55 221,209 2.49 *American Congress of Obstetricians and Gynecologists. Membership information. Washington, DC: American Congress of Obstetricians and Gynecologists; 2010. † American Fact Finder. American FactFinder. Washington, DC: US Census Bureau; 2010. Available at: http://factfinder2.census.gov/ faces/nav/jsf/pages/index.xhtml. Retrieved August 2, 2012. Bibliography American Fact Finder. American FactFinder. Washington, DC: US Census Bureau; 2012. Available at: http://factfinder2. census.gov/faces/nav/jsf/pages/index.xhtml. Retrieved August 2, 2012. Association of American Medical Colleges. 2011 state physician workforce data book. Center for Workforce Studies. Washington, DC: AAMC; 2011. Available at: https://www.aamc.org/download/263512/data/statedata2011.pdf. Retrieved August 2, 2012. Graduate Medical Education National Advisory Committee. Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services. Volume VII: GMENAC members’ commentaries and appendix. DHHS publication; no. (HRA) 81-657. Washington, D.C.: U.S. DHHS Health Resources Administration; 1980. Available at: http://www.eric.ed.gov/PDFS/ED203771.pdf. Retrieved August 3, 2012. Rayburn WF. The obstetrician–gynecologist workforce in the United States: facts, figures, and implications 2011. Washington, DC: American Congress of Obstetricians and Gynecologists; 2011. Solucient LLC. Physician community requirements in the 21st century: the 2003 physicians to population ratios. New York (NY): Solucient; 2004. Statistical and Science Policy Branch, Office of Information and Regulatory Affairs, Office of Management and Budget. Metropolitan statitical areas, micropolitan statistical areas, combined statistical areas, New England city and town areas, and combined New England city and town areas - 2003. OMB Bulletin No. 03-04. Washington, DC: OMB; 2003. p. 1–141. Available at: http://www.whitehouse.gov/sites/default/files/omb/bulletins/b03-04_attach. pdf. Retrieved August 2, 2012. U.S. hospitals reporting an obstetrics unit or obstetrics level, FY2010. FY2010 AHA annual survey database. Chicago (IL): American Hospital Association; 2011.

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