Legislative Report Card

demarais zertuche

Adrienne DeMarais Zertuche, MD/MPH graduate who led the effort to inform Georgia legislators about the shortage of ob/gyn providers

Student research influences amendment to state abortion bill

By Kay Torrance

Adrienne DeMarais Zertuche 07C 12MD/MPH knew with a strong conviction that she wanted to be an obstetrician and gynecologist.



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She liked the opportunity of having lifelong relationships with her patients and caring for them during the special time of pregnancy and birth. Now, as a medical resident at Emory, she can fully experience the varied work in her specialty. But before she graduated last spring, she learned an early lesson in how politics can affect how she practices medicine.

When DeMarais Zertuche was on her way to earning an MPH, Rollins Professor Roger Rochat was looking for students to assist the Georgia Obstetrical and Gynecological Society with an assessment of obstetric providers in the state. She signed on and helped organize the Georgia Maternal and Infant Health Research Group (GMIHRG) to recruit medical, nursing, and public health students to help with the project. What the students found was a worsening situation for pregnant women outside of metro Atlanta. In the course of their research, they also got a primer on the political process and negotiation.

The students called all 63 birthing facilities outside the metro area to gauge the obstetric provider workforce and workload. They found that 38% have no obstetricians and 70% have no certified nurse-midwives. Overall, 52% of the areas are either overburdened—too few providers and too many patients—or have no obstetric providers at all.

There are numerous reasons for the shortage, ­DeMarais Zertuche says. Georgia obstetricians face crippling malpractice insurance costs, exacerbated by the lack of tort reform, and there are too few of them in rural areas. Those that do practice in small cities and towns have crippling workloads. Moreover, Medicaid reimbursements are low—about 60% of deliveries in Georgia and up to 80% in rural areas are paid for by Medicaid.

GMIHRG used their findings to back the society's efforts to influence the outcome of a house bill proposed during the 2012 Georgia General Assembly. HB 954 prohibited abortions after a fetus reaches 20 weeks, regardless of its medical futility, and imposed a prison sentence of up to 10 years for doctors who perform them.

The students met with State Representative Sharon Cooper, chair of the House Health and Human Services Committee, who advised them that they could make the greatest impact by drafting a "report card" for each legislator's area and offered to help distribute the cards. The project coincided with Cooper's efforts to kill HB 954.

In the end, the cards helped the bill's supporters and opponents work out an amendment that made an exception for a medically unviable fetus. "We were able to make a horrific bill into just a terrible bill," Cooper says. "The cards give us a well-done study and information to take to the speaker and governor as we go forward and say to them, ‘Look what's happening and what can we do about it?'

"The students learned about the political process," she continues. "Physicians often don't get involved in it. They are busy and doing the best job they can to take care of patients. But people who have no medical background are making decisions about how doctors practice. Doctors need to get involved in the political process."

DeMarais Zertuche admits the political process was tough. Late into the last day of the legislative session, the bill was still up for vote.

"It was the last night of the session, and at 11:30 pm, they voted on it. It passed with flying colors," she says. "I think the cards helped create support for the amendment, especially among the 17 Republicans who voted for it."

The front of each card includes quotes from providers about the difficulty of running an obstetric practice. One from Americus said, "In rural Georgia, 70% to 80% of patients are Medicaid, and with today's reimbursement rates, no matter how smart you run your business, it's hard to get by." Another provider from Moultrie commented, "We are the only obstetrical practice in town. With one ob and a midwife, we did 550 deliveries last year. Sometimes we see 60 women in a day. It's difficult to recruit physicians of any kind to this area."

Student adviser Roger Rochat is impressed by what GMIHRG accomplished. "This has been one of the most remarkable student practicum experiences with which I have been associated in 42 years," he says. "The enthusiastic, professional student response to a community request directly and positively affected state legislation."

In the future, DeMarais Zertuche would like to do a study on how residents decide where to practice because "there is nothing on the horizon to improve the statistics on obstetricians/gynecologists," she says. "If Georgia does not act now, by 2020, 75% of the counties outside the Atlanta metro area will be severely overburdened or have no ob/gyn providers at all." 

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