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medpundit |
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Saturday, January 25, 2003There's a very simple reason why there are fewer abortion providers, and why you won't find them in the rural areas of our country. It's the same reason why you generally won't find cardiothoracic surgeons in the rural areas, and why we are seeing a gradual decline in the number of surgeons. The overall need for service is down, and the resulting catchment area required is larger. ...One could estimate how many abortions an abortion provider has to do in order to have a "successful" practice. As you know very well, for the typical physician in solo or small group private practice, office overhead, malpractice insurance, staff salaries, etc., constitutes about 40 to 50% of collected fees. Add to this the considerable cost of security for an abortion practice. In an abortion practice, as I understand it, it's a cash or almost cash business. For a doc to make $200,000 a year in take-home income, he/she has to collect about $320,000 to $400,000. If the fee per abortion is $400 (about the average, I'm informed), that's 800 to 1,000 abortions per year, per physician. The Chicago Tribune recently ran an article about an abortion clinic in Granite City, Illinois, that did about 7,000 abortions a year. ...The abortion rate for 1996 was 22.9 per 1,000 nationally for women aged 15 to 44 (National Center for Health Statistics (Ventura et al., Nat. Vital Stat Rep., 47:29, 1999). That makes the catchment area about 40,000 women age 15 to 44, give or take. And that means the total catchment area about four times that (men, and women under 15 and older than 44, don't count). That's a rough estimate, and some digging in the Census Bureau tables would refine these numbers considerably. So realistically, for a county to have a single abortion provider, its total population needs to be about 160,000 or higher. In my home state of Illinois, population about 12.4 million as of 2000, only 12 of 101 counties had a population greater than 160,000. Six more had a population between 100,000 and 160,000, and one might argue that higher payments,higher numbers, etc., might make an "abortion practice" sustainable in these counties. If we grant that, then 18 of 101, or 18%, of Illinois counties would be expected to have at least one abortion provider, and 82% would not. The Maryland NARAL recently said that 84% of U.S. counties didn't have an abortion provider. From my off-the-cuff analysis above, that sounds about right. If abortion rates continue to move downward, the catchment area grows. We could run the numbers but the point is clear, and simple economics would suggest that more abortion providers would leave that area of medicine to do something else. This presumes that the providers couldn't raise fees, and I rather suspect that an elective abortion is some price sensitive -- make the fee too high and one could drive poorer women to other providers, including non-MDs. While some might question an annual income of $200,000 for a doc, most abortion providers are OBGYN physicians, and their average income is higher than that of family physicians or internists. While I'm sure that some abortion providers are dedicated to the principle, I'm also sure that if didn't pay beans, many of them would find something else to do. My analysis also assumes that an abortion provider devotes almost all of her/his time to such a practice; if one devoted 25% effort to providing abortions and 75% effort to general OBGYN practice these numbers change some, and one might incorporate such a combined practice into a smaller town (as the need for general OBGYN is greater). Practically, this could be difficult given security concerns and, I suspect, some fair general approbation in smaller, more conservative communities. Hmmm. Could be, but if most OB/GYNS had no moral qualms about abortion, they would be incorporating it into their practices just as they incorporate other procedures. They all have the skills to perform them. They use the same sort of procedure to take samplings of the uterine lining in women with abnormal vaginal bleeding and to clean out the uterus after incomplete miscarriages and spontaneous abortions. I suspect that this is why abortions came to be the province of special clinics rather than part of routine office practice. It’s asking a lot for an obstetrician to his switch his mindset from one that considers the fetus as much his patient as its mother, to one in which it’s nothing but a bunch of cells or some primitive, unimportant organism. That part about the approbation of the community is probably true, though. One would have to feel very strongly and passionately about the rightness of abortion to be able to face other parents at PTA meetings and soccer games if it was common knowledge that you provide abortions. Not to mention facing pregnant patients who expect their obstetrician to have the best interests of both themselves and their babies at heart. How many expectant mothers could trust their obstetrician if they also knew that he dispensed with other pregnancies so easily? For when it comes right down to it, most people don't think abortion is necessarily the right thing to do, but they wouldn’t want to tell anyone else they can’t do it. A lot of doctors feel that way to. If asked whether or not they support the right “to choose”, they would probably say “yes.” But if asked if they would actually choose to perform an abortion, most would say “no.” posted by Sydney on 1/25/2003 01:01:00 PM 0 comments 0 Comments: |
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