The Crisis Hiding in Plain Sight
Why Women's Healthcare Doesn't Make the Agenda
Last Thursday, thanks to my incredible patent lawyer, I found myself in a room full of Georgia's healthcare elite at a major healthcare leadership breakfast. The invitation promised insights into how Georgia's unique assets—world-class hospitals, top universities, the CDC—could help us lead nationally in healthcare innovation.
What I witnessed was fascinating and frustrating in equal measure.
A Room Full of Solutions (But Not for Everyone)
The panel featured impressive healthcare leaders discussing challenges we're facing—including policy changes—opportunities in Georgia's growing innovation landscape, and creative solutions for staffing shortages through new medical schools and training programs.
The conversation centered on providing high-quality care in communities where people live, rather than forcing them to travel to major cities for access. It was inspiring to hear about strategic budget management, even with challenging payer mixes like one children's hospital's 55% Medicaid population.
But as I sat there, I couldn't shake one glaring question: Where were the voices speaking for women's healthcare?
The Reality Check: What Eight Years Taught Me
My experience tells a different story than the optimistic innovation narrative I heard that morning.
I spent eight years at a major academic medical center's safety net hospital. We were all mission-driven—certainly not motivated by money, since we could have earned much more elsewhere. But eight straight years of scraping by without enough resources, working exponentially harder due to chronic underfunding and constant turnover, takes an irreversible toll. It's simply not sustainable.
And I'm someone who thrives on challenges, an extremely stubborn people-pleaser motivated by solving impossible problems. Even I couldn't last.
The System's Failures, Patient by Patient
For the past two years at another major hospital system, I've witnessed the system's failures firsthand. Not a single private practice OB/GYN group takes Medicaid patients. Not one. The few who come through our emergency room see me, and I struggle to find them outpatient follow-up due to insurance limitations.
The pregnant patients I see fall into revealing categories:
Category 1: Privately insured patients who don't understand that doctors only have privileges at certain hospitals—they come to us for convenience.
Category 2: Medicaid or uninsured patients who haven't established prenatal care because it's too difficult to get into an OB office. They only come when something is really wrong.
Category 3: The most interesting and growing subgroup—mothers who understand exactly how their Medicaid insurance works. They see one doctor for prenatal visits but fully intend to show up at their preferred hospital for delivery, even though their doctor doesn't have privileges there. Why? Because they don't feel safe.
As a mother myself, I don't blame them one bit. I actually think it's a total boss move to advocate for yourself like that, despite a system designed to force you into care that doesn't feel right.
The Privilege of Choice
There's inherent privilege in having private insurance access. You need full-time employment with benefits, or enough disposable income for self-pay insurance. This inequality infuriates me. The people most vulnerable to pregnancy complications are most likely to have Medicaid and be most limited in where they're "allowed" to deliver.
Systemic Failures Hit Hardest for Black Mothers
The data makes this even more stark. Research consistently shows that Black mothers face maternal mortality rates three to four times higher than white women, and these disparities persist even within the same hospitals. What's particularly troubling is that hospitals that primarily serve Black patients show higher morbidity and mortality rates for all patients, including white mothers who deliver there. This isn't about individual providers—it's about systematically under-resourced institutions serving our most vulnerable populations.
When Hospitals Feel Dangerous
In my role as Medical Director of a local birth center, I witness something that should alarm us all. Birth centers like ours can only serve very healthy, low-risk populations—and we love providing that safe alternative for out-of-hospital birth. But here's what's deeply troubling: women who risk out of our birth center due to medical complications often choose community providers who may be less prepared to manage their conditions rather than seek traditional OB care with hospital delivery.
Think about that for a moment. Why would someone risk their baby's life rather than deliver at a hospital? This appears to be a growing trend, and we're not asking the right questions about it.
How do we bridge this gap so that high-risk pregnancies can access the kind of supportive, personalized care they might receive at a birth center while also getting the medical expertise that improves their outcomes? Shouldn't we be talking directly to these mothers to understand what might restore their trust in physicians and hospital systems?
The fact that women are choosing potentially dangerous alternatives over hospital care isn't a problem with the women—it's a massive red flag about our system.
The Perfect Storm: Rural Closures and Defensive Medicine
Add another layer: growing maternity deserts as rural OB units close. Access worsens while Georgia maintains some of the worst maternal and fetal outcomes nationally. We can't recruit qualified providers to rural communities, leaving us dangerously under-resourced.
There's no system facilitating transfer of care from community birth workers to hospitals. I witness tremendous animosity from my peers who refuse to care for patients who "chose" care outside traditional hospital/clinic settings.
But I understand their defensiveness too. OB/GYNs face a nearly 90% lifetime risk of being sued—significantly higher than the one-third rate for physicians overall. We must be ready for disasters at any moment—it's incredibly stressful. People deteriorate rapidly in maternity care with two lives at stake. We work grueling shifts without adequate sleep, face decreasing reimbursements, and live in constant fear of litigation.
This stress compounds when critically ill patients arrive from outside our system—patients we know nothing about who waited too long to seek hospital care, now with maternal and/or fetal lives hanging by threads. We're expected to fix everything.
Someone recently asked if I'd ever been diagnosed with PTSD. I laughed and said, "I'm an OB/GYN. Don't we all have PTSD?"
The Economics of Caring
Perhaps what breaks my heart most is the hospital argument that OB units are always financial losses. Because we don't generate revenue like neurosurgery, we're not prioritized in capital budgets. It's harder to recruit good people when there's no marketing money for the service line that "loses money."
Yet we're often the entry point for patients—both maternal and infant—into these larger hospital systems.
The Questions That Kept Me Quiet
Sitting in that breakfast room full of investors, C-suite executives, and bankers, I wanted to stand up and ask the obvious questions that seemed completely off everyone's radar:
What about the mothers?
What about doctors quitting in droves?
What about provider burnout?
What about the lawsuits?
What about laws restricting OB/GYNs from doing our jobs—caring for women and keeping them safe the best way we know how?
Why is no one talking about this?
The Work Ahead
I left that breakfast both energized and frustrated. It was probably good that I didn't get a chance to comment—I had way too much to say.
But that's exactly the problem. In rooms where healthcare's future is being planned, where innovation is celebrated and solutions are crafted, the voices of women's healthcare providers—and the women we serve—are notably absent.
There is so much work to do. And it starts with making sure we're part of these conversations.
Because until the people making decisions about healthcare's future understand the crisis in women's healthcare, the mothers showing up at the wrong hospitals because they don't feel safe, and the providers burning out from an unsustainable system, we'll continue planning a future that leaves half the population behind.
What questions do you think should be asked in these healthcare leadership discussions? What voices are missing from your local healthcare conversations?
