Scott Webb (Host): Those of us who live in more populated areas may take it for granted that our local hospital is ready, willing, and able to provide maternal and women's services, but things are turning the other way at many rural hospitals and clinics. And my guest today is here to tell us more and tell us how the OB Hospitalist Group is stepping up to help rural medical facilities solve for staffing and funding shortages and more. I'm joined today by Jami Walker. She's the VP of Maternal Health Access at the OB Hospitalist Group.

 This is the Obstetrics Podcast from OB Hospitalist Group. I'm Scott Webb. Jami, it's really nice to have you here today. We're going to talk about maternal and women's health in rural communities. And I know you're someone who frequently engages with hospital leaders, CEOs, chief medical officers, directors of women's services, and others. So, what do you believe is the primary concern for leaders of small to mid-sized hospitals when it comes to OB-GYN services?

Jami Walker: So, I do believe that there are things that keep hospital leaders up across the country, and I think that the access to care for women is of great concern in all places in the world, but specifically in rural communities in America.

Host: Yeah, I think you're right. I did my due diligence, if you will, some research here, and I was reading about maternity care deserts, right? And I was like, "I think I know what that means," but good to have an expert here. And it seems like that's been the news a lot. I was reading a lot about that. So first of all, how would you define a maternity care desert? And why is that such a significant issue?

Jami Walker: A maternity care desert is defined as a county that doesn't have enough care for women, essentially. But it is greater than that because there are places in the US that have multiple counties that don't have the issue. So instead of a woman who doesn't have it in her own county, that woman could be driving 90 to 350 miles to be able to receive maternal care. So, that's care for pregnant women, both all while they're pregnant and in addition to all the way up to six weeks postpartum. There is such a need everywhere in the country, but in the rural spaces where there is none, is a crisis at this point in time.

Host: Yeah. Thanks for sort of defining that for us. And I'm also hearing, I was reading about that a lot of hospitals are closing Labor and Delivery units, which is kind of shocking. So, with that in mind, what kind of impact is that having on respective communities?

Jami Walker: You know, it adds stress to not only to patients, but the staff at a hospital and not just the nursing staff or the front desk staff, but the physicians who work in that hospital who aren't able to provide care. So, imagine being an ER physician and a woman walks in ready to deliver, and you don't necessarily have the skill set to be able to perform this. And now, you're at the mercy of waiting for transport to get to the nearest delivering hospital. And all while that woman and her care is in your hands. So, the stress of that on the providers, on the people that support the providers is so great. And then, also from a patient standpoint, peace of mind of always worrying about where they have to go and . Are they arriving at the right places? Because a lot of women do not call an ambulance whenever they're ready to deliver. They go to the hospital. So if you show up at a place where last month they were open and had all the access and you didn't get information that is now closed, now you have to have a whole change of plan and maybe you don't have the resources to be able to go to the next hospital down the road. And maybe that next hospital down the road is 90 miles or 300 miles away, god forbid. It all depends on, you know, the ability to acknowledge there's power in that. But also, a lot of people aren't thinking very clearly about the possibility that they may not be able to get care at the nearest hospital. As a patient myself in earlier life, never once in my mind did I think that you couldn't get certain care at certain hospitals. So, it's a real issue and the impacts are greatly felt throughout the entire community.

Host: Yeah, they are for sure. And another word that came up that I was reading about was this concept of diversion, and I've heard about that and read about that related to like EDs having to turn folks away because they just simply don't have the capacity, the staff. So, some hospitals may not completely close their Labor and Delivery units, but they are being forced to go on diversion, which means they're passing them off to another facility, right? Another women's health facility. So, how does that impact the public perception of a hospital when they're having to turn folks away?

Jami Walker: Sure. So, diversion is a temporary closure of a certain service line, not necessarily the whole hospital. So again, as I talked about, a woman shows up for care at a hospital and she may or may not know that they can't serve her. They cannot take care of her there because they don't have the capabilities, whether it's for nursing or for lack of physician. Whatever the case may be, they had to make the decision to divert maternal care somewhere else. And the perception of that, once it's happened once, even if it was for a few hours or just a day, the perception now is you shouldn't go there because you may or may not receive care. And it's just detrimental on the perception side. It's damaging to a reputation of you put yourself out there to be a hospital to provide care 365 days a year. And as an ER, it's all-comers and then you decide from there where to go. But at the end of the day, if you aren't able to provide maternal care to a mother who has an emergency or is just showing up to truly deliver a baby, it was damaging because the world is small and the communication is vast. Especially in the day and age of social media and Google reviews and all the things, one bad experience can ruin a hospital's reputation.

Host: Yeah, it can. And as you say, a word can spread fast. And even if it's just a temporary closure, an interim closure, if that gets out into the community and beyond, as you say, when you're thinking about perception and public perception, perception becomes reality and so forth. So, in your opinion then, how can we prevent closures or interim closures of Labor and Delivery units?

Jami Walker: Hospitals have to be thinking forward and physicians have to be thinking forward too. There are many communities in the United States that have had one physician who's been practicing for years and years and years and they have done a fabulous job. But at the end of the day, they don't build OB-GYNs like they used to. They don't build doctors like they used to. The world is changing. The ask of the way that they, you know, have to provide health care and being able to really strategize and think and plan for the safety of those clinicians and the safety of those patients to ensure that they can think forward about how they're going to cover their unit and cover and provide access to care is really important in that prevention.

Host: Yeah, it is for sure. And sort of taking all this in here today and kind of preparing for this, I'm wondering, are Labor and Delivery units the only women's services at risk in hospitals today? I assume probably not, but what about other hospital clinics?

Jami Walker: So, you know, what's funny is that obviously we need to have care in hospitals because that's where women do deliver, but delivery is not the first point of care that women receive. Women need access to care through clinics. Not everything that happens to you in a healthcare setting has to be inside a hospital. And if we don't have clinics where patients can receive that low risk care or the prenatal care, then they certainly are not typical to show up at the hospital to deliver as well. And they go hand in hand. You need to be able to have a service line that is comprehensive to be able to handle the patients where they're appropriately suited and having the gateway to be able to see those patients in that clinic is just vital to be able to maintain the hospital setting just as well.

Host: Yeah, because I'm thinking like I don't live in a rural area, but I've spoken to a lot of other professionals and kind of about these topics about the trend seems to be bringing more of the medicine, more of the facilities to people to these rural areas so they don't have to travel as far perhaps out of state. So, it's sort of alarming now, right, Jami, hearing that some of these more rural facilities that people have really come to count on are closing or either interim closures, which we're calling diversion, things like that. I'm sort of thinking about this like, all right, well then what are the solutions? And maybe you can help us, like, what solutions have you encountered that really effectively address the challenges of these smaller or rural hospitals, you know, as they're trying to provide this comprehensive maternity care?

Jami Walker: You know, it's funny that you mentioned that the ability to travel and those things and, you know, we live in a world where not everyone has the same level of resources, and it is very challenging to think that you would have to drive so far to receive care or there's just no possible way that a woman could get to an appointment that's an hour and a half away. And being able to think through and think forward about how we bring care to those rural areas is really important to OB Hospitalist Group.

And when you hear our name, you think OB Hospitalist Group, that means that you place a physician in a hospital. That is not only what we do. But as an organization who has partnered with 270 hospitals to bring care for women to those hospitals and communities, being able to take the lessons that we've learned over the last 17 years and really think through of what hospitals are trying to solve for and utilize best practices that align with those smaller hospitals capabilities are what drives our maternal health access solutions program. There are no two hospitals the same and you'll never convince me that that's the case, but there are similarities in the capabilities and the functionalities of some of the hospitals and being able to not only bring clinical best practices, but operational efficiencies and really think through what how we combat the reduction of OB-GYNs and also still provide care to hospitals is really where OBHG has found themselves in the last two years. Just diving into, you know, what they're trying to solve for and thinking about it differently than we ever had.

Host: Really thinking outside the box, right?

Jami Walker: Yes, sir.

Host: Yeah. I'm glad you touched on there about sort of the shortage of all medical professionals in general, but that might be a different podcast related to COVID or whatever, but a shortage really, or some difficulty anyway, in recruiting OB-GYNs. And I know that staffing is just such an issue for many hospitals. So, wondering what your thoughts are on the difficulties of recruiting OB-GYNs or effectively utilizing other care providers, maybe like certified nurse midwives at some of these rural or smaller hospitals.

Jami Walker: You know, that goes into thinking through what they're trying to solve for, what their capabilities are within the hospital. And then also, what the state guidelines mandate is and the regulatory places mandate is what they need to be able to provide as a levels of care. But really, that's taking the expertise that OBHG has and understanding, you know, those things to be able to suggest or recommend what type of provider might be able to work through that.

It is an evolving, you know, world very much in healthcare always, but the way that we have historically solved is dynamically different than the way that we have to solve in the future. And as we do have a reduction in healthcare providers and not as many people are waking up deciding to become OB-GYNs, we have to think very differently and understanding what hospitals and communities are trying to solve for allows us to recommend alternative clinician types to be able to sometimes even solve for more with less. And when I think about that, I think about the hospitals that are, you know, trying to solve for their newborns in addition to their OB-GYN and women's care service line. We can provide solutions that combine that, and still are fiscally responsible and provide the highest level of safety. It's just thinking about it differently from what we've learned over the years.

Host: Right. The prevailing wisdom or old school, maybe old school, meaning like before two years ago, you know, that you have to have an OB-GYN to do certain things well. It would be great if you could, but maybe a certified nurse-midwife could do some of what they do, plus some of what this person does and some of what that person does. And, you know, as you say, you're covering bases, you're there for the community, but also being fiscally responsible, right?

Jami Walker: Absolutely. You want the safest care possible, but you also want people to work to the top of their licensure in addition to having a network of resources behind them to be able to continue to evolve. I think that's one of the scariest places we could ever be in a healthcare setting is stagnant, being able to evolve and think critically and really be thought leaders is something we take a lot of pride in.

Host: Yeah, for sure. Just before we wrap up here, Jami, I'd love to hear more about what motivates you to work in this field. What is it about this area that inspires your passion and dedication?

Jami Walker: You know something funny, I am from a tiny little map dot in southern Illinois of about 600 people and we had three bars, a gas station, a church with no stoplight, and one hospital in the entire county that had 32 beds, one family practice physician who delivered everyone in the community until the day that he passed. You know, he worked from the time that he finished residency until the literal day that he passed well beyond years that he could have stopped.

But there is a passion in people in rural communities and in smaller sectors of the healthcare space that is really admirable. And when I watched that growing up and then whenever I dove into healthcare and really, really got to know those people and their why and why they were so mission-driven and people-driven. It just became very near and dear to me, knowing that the people in my community didn't have the finances or the resources to be able to drive an hour and 15 minutes to the next hospital and to be able to get the care that that they needed if it wasn't for the physicians and the leaders in that tiny little hospital that would go above and beyond and really, really cared about people. And I think that there would be a lot more health issues and circumstances that surrounded that area.

So, I really resonate with all that they do. And I admire the people that put themselves in these settings. And I make a few jokes with some of the hospitals that I connect with that those in rural hospitals have to sincerely be able to do all of the things. And that means that some days, the CEO has to help pass out trays. And some days, the physicians also are pitching in with the nurses. And some days, everybody has to be able to do all the things, and that makes them very scrappy. They're able to solve more with less, and they are all hands on deck in certain circumstances. And there's a lot to be said about that in the way that they run their hospitals and the way that they care for their patients.

Host: That's the perfect word, scrappy, for sure, and I'm also from a little map dot in Indiana, and had similar experience of just the one little hospital, and the one person delivered everybody, and all of that. So, it's really great to meet you today, great to learn more about you, and especially to hear about some of the news, the concerns, the trends, if you will, of maternal and women's health in rural communities and what you all are trying to do to combat that. And it's hard to believe that so much has changed. You're saying, you know, in just these two years, right? It happened so fast. But as we're saying about these scrappy folks, medical professionals, whether again because of COVID or otherwise, like they're really good at pivoting and improvising and really dynamic and really scrappy. So, great to hear about all that today. Thank you so much.

Jami Walker: Absolutely.

Host: That's Jami Walker, VP of Maternal Health Access at the OB Hospitalist Group. And to learn more about the OBHG Maternal Health Access Solutions, or OB Hospitalist Medicine, you can visit obhg.com. And if you found this podcast to be helpful, please share it on your social channels and make sure to check out the entire podcast library for additional topics of interest. I'm Scott Webb. And thanks for checking out this episode of the Obstetrics Podcast from OB Hospitalist Group. Take care.