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Julia Resil is leaving Virginia.
At this stage in her career, the chapter of being a medical resident is naturally coming to a close and she will move on to become an attending physician in Rhode Island. Resil has spent the past three years at Johnston Memorial Hospital in Abingdon, in Southwest Virginia. She’s excited that she’ll be closer to her family in Boston and nearer to metropolitan areas, though practicing family medicine in a rural area was attractive to her as a medical resident.
Family medicine practice can include obstetrics — the delivery of babies — and the exodus of doctors like Resil comes at a time where several rural hospitals in Virginia have suspended their obstetrics programs. Within the past year, Sentara Halifax Regional Hospital, Sovah Health in Martinsville and LewisGale Hospital-Montgomery in Blacksburg have stopped offering obstetrics.
President of Sentara Halifax Regional Hospital Dr. Brian Zwoyer said that there was a 33% decrease in births there over the past five years. In a recent email, he attributed this to “changing demographics, aging populations and a national declining birth rate.”
With hospitals already less accessible in rural areas of the state than urban areas, Resil noted that patients end up traveling further for check-up appointments or to give birth.
“And as you get closer to your due date, you have more appointments,” Resil said.
About 15% of people in Virginia don’t have a birthing hospital within a 30-minute drive, according to a report from the March of Dimes.
Danville-based doula Roshay Richardson works with clients around Virginia’s South Side and occasionally some from North Carolina. She said that she’s seen patients travel to Danville from elsewhere to give birth and wonders how much of a strain that could put on labor and delivery doctors with an uptick in clients. Richardson works with the Virginia Rural Health Association, which advocates to lawmakers about rural healthcare needs.
While doulas aren’t obstetricians, they provide companionship and patient advocacy to their clients. A U.S. Department of Health study noted doulas’ role in positive health outcomes and they’ve been particularly helpful for Black parents.
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Likewise, Resil described a patient traveling about three hours because they wanted to see a doctor of color. Resil is among a diverse cohort of medical residents in a predominantly white part of the state.
“They were a little bit scared because they had providers that were white in the past and they felt uncomfortable because they felt like they weren’t being heard,” Resil said of the patient.
As a woman of color with family from Haiti, Resil knows this feeling. She shared that anecdotally, she and members of her family have felt this way when they’ve gone to the doctor.
“Then seeing that in some of my patients. They’ve been hopping around from doctor to doctor saying ‘something is wrong but I can’t figure it out; but no one is listening to me,” Resil said. “And then we find out, ‘oh yeah, there is. Let’s make sure we get you to the high-risk OB-GYN.”
OB-GYN care can be deadly at times, with pregnancy-related medical emergencies that can arise suddenly. Such was the case for Wendy Welch’s friend.
Welch, director of the Southwest Virginia Graduate Medical Education Consortium, described how a friend developed eclampsia. The pregnancy-related blood pressure disorder is life threatening and her friend had to be flown to a different hospital across the state line and into an urban area. This saved her life, but also resulted in much higher medical bills.
She explained that her friend was unconscious when loaded onto a flight and then “woke up about $30,000 in debt.”
A funding boost
Money is both an issue and a solution, Welch explained. Her nonprofit organization works to help cover costs of bringing medical residents into Virginia.
Welch said that lower population density and declining birth rates has meant there’s not “enough people for the hospital system to consider (obstetrics) profitable.”
But funding positions could help. Most OB-GYN residencies are in other areas of the state, according to the American College of Obstetricians and Gynecologists. Though family medicine residents can work with pregnant clients, OB-GYN residents are more specialized in obstetrics and gynecology.
“(Rural areas) get screwed,” Welch said. “To catch a unicorn — to catch someone who’s that valuable and knows they’re that valuable, you need a whole lot of stuff to attract them now. If they’re a kayaker or their mom is in Southwest Virginia, you’ve got them, but if not, how are you going to get them here?”
Lawmakers have secured funding in the state budget that they hope can bolster medical residencies. Del. Chris Obenshain, R-Montgomery and Del. Jason Ballard, R-Giles pressed for one million over the next two years to fund 10 obstetric-gynecological residents. Two positions are specifically earmarked for Johnston Memorial, where Resil has worked in family medicine.
The matter is also personal to Obenshain, whose wife had to travel to give birth to their child recently when the LewisGale hospital near them stopped labor and delivery services.
He felt lucky that there is a cluster of hospitals in his portion of Southwest Virginia, but he noted how other parts of Southwest Virginia and South Side have less options.
“It’s a much bigger issue when a hospital doesn’t provide these services anymore,” Obenshain said.
Maternal health legislation
Virginia legislators in both parties worked on a variety of bills this year to improve maternal health outcomes. Some proposals, like a requirement for health insurance coverage of doulas, were signed by Gov. Glenn Youngkin.
Meanwhile, he vetoed a proposal to include unconscious bias and cultural competency training when renewing medical licenses. Black people are more likely to experience negative maternal health outcomes, in part, due to providers’ racial bias, according to a study. Black women are also more likely to die from pregnancy complications than white women, data from the Centers for Disease Control and Prevention shows.
“Women whose skin is darker than my wife’s skin have significantly worse outcomes,” Sen. Chris Head, R-Botetourt, said during a floor speech while defending the bill in the Senate. “Something needs to be examined and done about that.”
Head had carried the bill with three Democratic lawmakers who are also Black women: Sens. Lashrecse Aird, D-Petersburg; Mamie Locke, D-Hampton; and Jennifer Carroll Foy, D-Prince William.
Though he ultimately vetoed the bill, Youngkin had first sought amendments that advocates for the bill worried made the training just a “checked box.”
Youngkin signaled interest in working on more maternal health legislation so the bill could come up again next year.
In the meantime, new cohorts of medical residents will cycle through Virginia and state agencies are set to use the new budget funding to recruit some with OB-GYN specialties.
While Resil has been able to bring her perspective as a practitioner of color to rural Virginia, she has lessons learned from the more hands-on experience that she will take with her when she leaves.
“I have made countless house calls to people, and I know that’s something I would probably not do in Boston, back home,” she said. “Being able to see how people are living, you can get a better idea of a family.”
She said she plans to be “more inquisitive” with her patients going forward as a result.
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