Editor's note: In this article, we are pleased to unpack the key elements of our latest Acute Care Concerns issue, Obstetrics and Gynecology released in January 2025.
Fewer resources, systemic issues
Obstetricians and gynecologists (OBGYNs) are grappling with systemic issues that hinder women’s access to fundamental, timely care in Alberta.
As skilled specialists at the forefront of maternal and reproductive health, OBGYNs serve in hospitals, community clinics, private offices and academic health centres. Obstetricians need to be on call 24/7 in hospitals to care for mothers and welcome newborn babies, who typically don’t tell us when they plan to arrive.
But despite the discipline’s critical role in health care, the spectrum of women’s health typically garners fewer resources and less attention in our health system than care for men – whether through available programs, research, resources or physician compensation. And while other medical specialties face these inequities to some degree, the OBGYN speciality is disproportionally impacted by this systemic issue due to its predominantly female physicians and patients.
Obstetrics and gynecology today
It is becoming increasingly difficult for Alberta’s OBGYNs to deliver the expert services women need, resulting in care gaps across the province. The situation is especially dire in rural Alberta, where many women are forced to travel for obstetrical and gynecological care that should be available closer to home. For obstetrics specifically, locum physicians have been the only ones to deliver babies in some communities, with no one available to provide prenatal or gynecological care.
Reduced access to primary care leaves more women without the preventative screening, chronic disease management and critically important prenatal care they need. Consequently, gynecologists report patients arriving to clinics and hospitals with more serious and advanced conditions at an alarming frequency.
Shrinking operating room access
Access to operating rooms is dwindling. Gynecological surgery is underprioritized and often excluded from the surgical supports available to other surgical specialties, despite hysterectomies being among the most common surgical procedures.
Exacerbated by the shortage of anesthesiologists in Alberta, limited operating room resources burden women with unacceptably long wait times for surgical relief from debilitating pain, bleeding, incontinence or pelvic organ prolapse.
Care team constraints
Skilled care teams play a vital role in supporting OBGYNs to deliver the care women need and deserve.
OBGYNS report that nursing teams can be reduced by as much as half, leaving those who are on shift to be run ragged. The results are burnout, illness and even nurses who choose to leave obstetrics entirely.
There is also a province-wide shortage of available obstetrical resident physicians, making the 24/7 coverage required impossible at many sites. Compounded with the short supply of nurses specially trained in obstetrical and gynecological care, care in labour and delivery units is impeded and puts women and their unborn babies at risk.
Non-competitive compensation
Fewer physicians are willing to do general obstetric work due to poor remuneration, extensive after-hours work and the speciality’s litigious nature.
OBGYNs are among lowest paid of the surgical specialties, including those who provide similarly complex care to male patients. They are also impacted more than most specialties by after-hours care on nights and weekends. Most operate under a fee-for-service model, with some fees remaining unchanged for almost 20 years and falling far behind inflation.
Recent hiring efforts at some Alberta hospitals have failed, and Alberta is not a competitive environment for OBGYNs compared to other provinces and territories.
Burnout
Along with recruitment challenges, a growing number of OBGYNs are considering leaving the specialty due to unprecedented levels of burnout caused by myriad factors.
Alberta’s population boom means more women are delivering babies in Alberta hospitals, yet our province has fewer OBGYNs per patient that neighbouring provinces. These specialists are squeezed by the rising demand for obstetrical and gynecological care while contending with inadequate resources, long hours and physically demanding work that leaves many practitioners with musculoskeletal injuries.
Solutions
The challenges encroaching on obstetrics and gynecology in Alberta are becoming more perilous each day, and the ramifications for women who fall through the cracks can be life-altering.
Alberta’s OBGYNs need action from government to ensure they can provide the safe, timely care women need throughout their lives. They are calling on the province to increase funding for these imperative services, provide more training and clinical support for specialists and expand operating room time to ensure women can access timely care. The compensation disparities that leave the discipline struggling to attract and retain OBGYNs must also be addressed to reflect the complexity and importance of the care these specialists are uniquely qualified to provide.
Banner image: Dr. Cameron Sklar, President of the Section of Obstetrics and Gynecology for the Alberta Medical Association (photo credit: Marvin Polis)