In the past 30 years, the number of neonatologists has increased while total births have remained nearly constant. It is not known how equitably this workforce is distributed. The Dartmouth Medical School researchers -- David C. Goodman, MD, MS; Elliot S. Fisher, MD, MPH; George A. Little, MD; Therese A. Stukel, PhD; and Chaing-Hua Chang, MS -- set out to determine the geographic distribution of neonatalogists in the United States.
"Despite rapid growth in neonatal intensive care, there is little information about whether services tend to be located where newborn needs are greatest, and whether more resources always lead to better outcomes," said Goodman. "This study finds a very high degree of regional variation for neonatal intensive care; studies are underway to understand how well this distribution serves newborns."
Neonatal intensive care, considered one of the most important recent advances in pediatrics, has been shown to be highly effective in reducing mortality and improving long-term outcomes for premature and ill newborns. The Dartmouth team found that the regional supply of neonatologists varies dramatically and cannot be explained by the substitution of neonatal mid-level providers or by the proximity of academic medical centers.
The team measured the number of neonatologists and neonatal mid-level providers per live birth within 246 market-based regions. They found that the neonatology workforce varied substantially across neonatal intensive care regions. The number of neonatologists per 10,000 live births ranged from 1.2 to 25.6 with a median of 5.8. Cities such as Washington, DC and Newark, NJ had high numbers, while Lebanon, NH and Omaha, NE were low.
Likewise, the volume of low birthweight deliveries per physician varied, with the "very high"supply regions having fewer low birthweight infants per neonatologist than the "very low" supply regions. The weakly positive correlation between neonatologists and neonatal mid-level providers per live birth is not consistent with substitution of neonatal mid-level providers for neonatologists. There was no difference in the percentage of neonatal fellows in the lowest and highest workforce quintile (14% vs. 16%) or in the percentage of neonatologists engaged predominantly in research, teaching or administration (14% in lowest and highest quintiles), two indicators of academic medical centers.
Further research is warranted to understand whether more resources improve newborn outcomes, say the Dartmouth researchers. They gathered their data from 1996 American Medical Association physician masterfiles; a 1999 survey of all US neonatal intensive care units; a 1995 American Hospital Association hospital survey; and 1995 US vital records.
For more information, contact David Goodman: David.C.Goodman@Dartmouth.edu. For a copy of the ECP article contact: Lynda Teer, American College of Physicians-American Society of Internal Medicine Communications Department at 800-523-1546 x2655, email: lteer@mail.acponline.org.