Mississippi Today
Shortage of OB-GYNs is leaving Mississippi moms-to-be stranded for care
Kayla Dominick of Meridian knew something was not right – her periods were irregular and she felt constant pressure in her pelvis. She found a local OB-GYN who accepted Medicaid, and he performed an ultrasound of her uterus.
When it was recommended she undergo follow-up testing, including a uterine biopsy, she called the office to ask the doctor or nurse some questions and share concerns about the procedure. After leaving several messages and never hearing back, she decided to find another doctor.
But that didn’t prove simple: There are only 11 licensed OB-GYNs in Lauderdale County, home to Meridian, and its surrounding five counties, according to data from the Office of Mississippi Physician Workforce. Of those 11, only six reportedly practice obstetrics, or deliver babies.
At the same time, almost 28,000 women of reproductive age are living in that six-county area, according to U.S. Census data.
By comparison, in Rankin County, also home to about 28,000 women of reproductive age, there are 42 licensed OB-GYNs.
Mississippi as a whole is experiencing a shortage of these specialists. A recent WalletHub study ranked Mississippi as the worst state to have a baby. It came in 50th in the “midwives and OB-GYNs per capita” category, which it used data from the U.S. Bureau of Labor Statistics to determine. It also incorporated the state’s maternal and infant mortality rates – some of the worst in the nation – into the ranking.
More than half of Mississippi counties are considered maternity care deserts, or have no hospitals providing obstetric care, no OB-GYNs and no certified nurse midwives.
But the small number of OB-GYNs – particularly those still practicing obstetrics – in a metropolitan area like Meridian shows how tenuous the current workforce landscape is.
Dr. Norman Connell, market medical director for the OB Hospitalist Group and a Vicksburg-based OB-GYN, said about five years ago, the Meridian area had around 12 or 13 obstetric providers, most of them with privileges at both hospitals. Now, there are six providers on staff at both Ochsner Rush and Anderson Regional Medical Center.
In 2021, as a result of the drop in providers, both hospitals signed an agreement with Connell’s company to supply OB-GYN hospitalists, or providers from across the state, or even out of state, who work solely in an inpatient hospital setting.
“The population of Meridian didn’t shrink, but the area lost over half of the OB providers in a few short years,” Connell said.
Connell said the doctors at his company allow the local OB-GYNs to stay in their clinics more often and see patients they need to see.
“In addition to that, we’re also the doctor for patients who don’t have physicians on staff there … and for people who haven’t gotten prenatal care and show up with an obstetric problem,” he explained.
The group also has contracts with seven other hospitals all over the state, from Magnolia Regional Health Center in Corinth to Mississippi Baptist Medical Center in Jackson.
For Dominick, finding another doctor who accepts Medicaid and who would perform the procedure was a challenge – a surprising one for the native of New Orleans, where health care services are abundant.
“In the New Orleans area, we have an urgent care (clinic) on almost every corner, open 24/7,” she said of the abundance of health care services.
Dominick, like many other women in Meridian, took to a Facebook group for Meridian moms to ask for OB-GYN recommendations. There are several posts in the group from women looking for OB-GYN recommendations, either because they need a new one or because the one they’ve been seeing is too busy for routine appointments like check-ups.
“Best obgyns to go to im tired of waiting to get an appointment at my doctors office I shouldn’t have to sit there for three hours when there’s 3 people in the waiting room or waiting 6 months to even get in,” one woman wrote.
Dominick eventually landed an appointment with Dr. Jennifer Nelson, who has been an OB-GYN in the area for more than 20 years. Nelson, however, recently quit practicing obstetrics after spending the prior two years on call at the hospital 24 nights a month.
Nelson was absolutely exhausted, scrambling from the hospital to the clinic and back.
She remembers one night when several other OB-GYNs at the hospital were out of town, and she was sick with the flu. She wound up working anyway.
Anywhere from 40% to more than 75% of OB-GYNs experience burnout, studies show – in the middle to upper one-third of medical specialties.
On top of the physical and mental burnout from around-the-clock work, she had many high-risk patients to see in her clinic – patients who required a lot of time, she said, and often with insurance that did not reimburse well. About half of her patients were on Medicaid, she said.
Medicaid payments for physician services are well below Medicare payments, which are below commercial insurance rates. Mississippi also has one of the lowest average commercial reimbursement rates for both inpatient and outpatient services in the nation, according to a Milliman white paper.
“It’s expensive to do OB here. I ran my numbers one month – if every one of my OB patients had been Medicaid … I would not have been able to pay my overhead with my nurses, and that’s with me working for free, totally taking my salary out of it,” she said. “I would have been about $100,000 short.”
In her clinic now, she treats Medicaid patients when they are referred to her clinic and, on a case-by-case basis, unreferred patients. She said because the clinic is not designated a “rural health clinic” by the federal government, Medicaid reimbursements for services are very low.
“The (gynecology) side is very low reimbursement for general services if you don’t have a rural health clinic designation,” she explained.
Further compounding the issue is how sick the patient population in the area – and across the state – is.
“We have the sickest patient population, so they’re litigious, time consuming – I did a lot of high-risk pregnancies. It’s a lot of coming up at two in the morning to check on people who are super sick,” she said.
Mississippi leads the nation in areas such as obesity, high blood pressure and diabetes – all conditions that make pregnancy more dangerous and require more time and services from OB-GYNs and other maternal health practitioners. These conditions often lead to worse outcomes for women and babies.
As OB-GYNs stop practicing or retire, both in Mississippi and nationwide, they aren’t being replaced at the same rate. And it’s unknown how last year’s Dobbs decision that overturned Roe v. Wade is affecting the OB-GYN workforce in Mississippi, though other states with similar restrictive abortion laws have seen providers leave because of enhanced legal risks.
Dr. Michelle Owens, a maternal fetal medicine specialist who worked at the University of Mississippi Medical Center for nearly 20 years, said she suspects because the state’s laws have always been so restrictive in regards to abortion, Dobbs is not having an immediate effect on providers who live here.
“I think if anything, if people are concerned about the restrictive nature of practice of obstetrics and gynecology as it pertains to terminations services, that it (Dobbs) would probably be more influential on preventing people who want to provide that care. Those people aren’t going to come here (to Mississippi),” she said.
In a state with such a severe shortage, one must consider the ramifications of that, she said.
“The more we say we're in favor of allowing or condoning government interference in exam rooms, we have to also recognize there are some unintended consequences to those decisions – they don’t just happen in a vacuum,” she said.
There’s currently only one OB-GYN residency program in the state at the University of Mississippi Medical Center, and the program graduates six residents each year. Of the most recent graduates, only two stayed in Mississippi – prior years’ numbers average about the same.
On top of that, there have been changes in how OB-GYNs work over the last decade nationally. Traditionally OB-GYNs worked at private clinics and had privileges at hospitals. Now, however, many OB-GYNs are hospitalists, or OB-GYNs who work solely in the inpatient setting, according to Dr. Elizabeth Lutz, associate professor of obstetrics and gynecology and the residency program director at the University of Mississippi Medical Center.
And more OB-GYNs today wind up completing fellowships, or going into a subspecialty such as maternal fetal medicine.
“Nowadays, closer than 30 to 40% of OB-GYN residents go into fellowship – that’s grown dramatically,” said Lutz, associate professor of obstetrics and gynecology and the residency program director at the University of Mississippi Medical Center.
Both Ochsner Rush, where Nelson previously had privileges, and Anderson in Meridian began contracting with the OB Hospitalist Group in 2021 to fill in the gaps created by the shortage. About eight OB-GYNs from across the state – and even some from out of state – work shifts at both hospitals.
Anderson averages about 1,020 births per year, according to a hospital spokesperson. Ochsner Rush averages just under 1,000 births annually.
“Due to a shortage of OB-GYN’s in east central Mississippi, Anderson Regional Health System partners with a OB Hospitalist group to supplement our three practicing OB-GYN’s in providing 24-hour obstetrics coverage every day,” said Dr. Keith Everett, chief medical officer at Anderson Regional Health System.
Both hospitals also employ advanced practice nurses called certified nurse midwives – Ochsner Rush has four on staff – who manage the care of low-risk patients. The midwives are also skilled at counseling and education of patients in areas such as nutrition, childbirth preparation and breastfeeding.
The use of certified nurse midwives in Mississippi is rare: there are fewer than 30 in the state, and only a few hospitals, including the two in Meridian, allow them to deliver babies.
Connell said he thinks the company’s role in the area – and in the state – will only continue to grow.
“I think Meridian paints a picture of (why this work is important),” he said. “... It’s a work in progress. We’re at the very beginning of making things better.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Ties that bind, not lines that divide, at the heart of “Little Women” are what make Louisa May Alcott’s beloved novel such an enduring classic. More than a century and a half since its 1868 publication, the March sisters’ coming-of-age tale continues to resonate in fresh approaches, say cast and crew in a musical version opening this week at New Stage Theatre in Jackson, Mississippi.
“Little Women, The Broadway Musical” adds songs to Alcott’s story of the four distinct March sisters — traditional, lovely Meg, spirited tomboy and writer Jo, quiet and gentle Beth, and artistic, pampered Amy. They are growing into young women under the watchful eye of mother Marmee as their father serves as an Army chaplain in the Civil War. “Little Women, The Broadway Musical” performances run March 25 through April 6 at New Stage Theatre.
In a serendipitous move, the production coincides with Women’s History Month in March, and has a female director at the helm — Malaika Quarterman, in her New Stage Theatre directing debut. Logistics and scheduling preferences landed the musical in March, to catch school matinees with the American classic.
The novel has inspired myriad adaptations in film, TV, stage and opera, plus literary retellings by other authors. This musical version debuted on Broadway in 2005, with music by Jason Howland, lyrics by Mindi Dickstein and book (script) by Allan Knee.
“The music in this show brings out the heart of the characters in a way that a movie or a straight play, or even the book, can’t do,” said Cameron Vipperman, whose play-within-a-play role helps illustrate the writer Jo’s growth in the story. She read the book at age 10, and now embraces how the musical dramatizes, speeds up and reconstructs the timeline for more interest and engagement.
“What a great way to introduce kids that haven’t read the book,” director Quarterman said, hitting the highlights and sending them to the pages for a deeper dive on characters they fell in love with over the two-and-a-half-hour run time.
Joy, familial warmth, love, courage, loss, grief and resilience are all threads in a story that has captivated generations and continues to find new audiences and fresh acclaim (the 2019 film adaptation by Greta Gerwig earned six Academy Award nominations).
In current contentious times, when diversity, equity and inclusion programs are being ripped out or rolled back, the poignant, women-centered narrative maintains a power to reach deep and unite.
“Stories where females support each other, instead of rip each other apart to get to the finish line — which would be the goal of getting the man or something — are very few and far between sometimes,” Quarterman said. “It’s so special because it was written so long ago, with the writer being such a strong dreamer, and dreaming big for women.
“For us to actualize it, where a female artistic producer chooses this show and believes in a brand new female director and then this person gets to empower these great, local, awesome artists — It’s just really been special to see this story and its impact ripple through generations of dreamers.” For Quarterman, a 14-year drama teacher with Jackson Public Schools active in community theater and professional regional theater, “To be able to tell this story here, for New Stage, is pretty epic for me.”
Alcott’s story is often a touchstone for young girls, and this cast of grown women finds much in the source material that they still hold dear, and that resonates in new ways.
“I relate to Jo more than any other fictional character that exists,” Kristina Swearingen said of her character, the central figure Jo March. “At different parts of my life, I have related to her in different parts of hers.”
The Alabama native, more recently of New York, recalled her “energetic, crazy, running-around-having-a-grand-old-time” youth in high school and college, then a career-driven purpose that led her, like Jo, to move to New York.
Swearingen first did this show in college, before the loss of grandparents and a major move. Now, “I know what it’s like to grieve the loss of a loved one, and to live so far away from home, and wanting to go home and be with your family but also wanting to be in a place where your career can take off. .. It hits a lot closer to home.”
As one of four sisters in real life, Frannie Dean of Flora draws on a wealth of memories in playing Beth — including her own family position as next to the youngest of the girls. She and siblings read the story together in their homeschooled childhood, assigning each other roles.
“Omigosh, this is my life,” she said, chuckling. “We would play pretend all day. … ‘Little Women’ is really sweet in that aspect, to really be able to carry my own experience with my family and bring it into the show. … It’s timeless in its nature, its warmth and what it brings to people.”
Jennifer Smith of Clinton, as March family matriarch Marmee, found her way in through a song. First introduced to Marmee’s song “Here Alone” a decade ago when starting voice lessons as an adult, she made it her own. “It became an audition piece for me. It became a dream role for me. It’s been pivotal in opening up doors for me.”
She relishes aging into this role, countering a common fear of women in the entertainment field that they may “age out” of desirable parts. “It’s just a full-circle moment for me, and I’m grateful for it.”
Quarterman fell in love with the 1969 film version she watched with her sister when they were little, adoring the family’s playfulness and stability. Amid teenage angst, she identified with the inevitable growth and change that came with siblings growing up and moving on. Being a mom brings a whole different lens.
“Seeing these little people in your life just growing up, being their own unique versions, all going through their own arc — it’s just fun, and I think that’s why you can stay connected” to the story at any life juncture, she said.
Cast member Slade Haney pointed out the rarity of a story set on a Northeastern homestead during the Civil War.
“You’re getting to see what it was like for the women whose husbands were away at war — how moms struggled, how sisters struggled. You had to make your own means. … I think both men and women can see themselves in these characters, in wanting to be independent like Jo, or like Amy wanting to have something of value that belongs to you and not just just feel like you’re passed over all the time, and Meg, to be valuable to someone else, and in Beth, for everyone to be happy and content and love each other,” Haney said.
New Stage Theatre Artistic Director Francine Reynolds drew attention, too, to the rarity of an American classic for the stage offering an abundance of women’s roles that can showcase Jackson metro’s talent pool. “We just always have so many great women,” she said, and classics — “To Kill a Mockingbird” and “Death of a Salesman,” for instance — often offer fewer parts for them, though contemporary dramas are more balanced.
Reynolds sees value in the musical’s timing and storyline. “Of course, we need to celebrate the contributions of women. This was a woman who was trying to be a writer in 1865, ’66, ’67. That’s, to me, a real trailblazing thing.
“It is important to show, this was a real person — Louisa May Alcott, personified as Jo. It’s important to hold these people up as role models for other young girls, to show that you can do this, too. You can dream your dream. You can strive to break boundaries.”
It is a key reminder of advancements that may be threatened. “We’ve made such strides,” Reynolds said, “and had so many great programs to open doors for people, that I feel like those doors are going to start closing, just because of things you are allowed to say and things you aren’t allowed.”
For tickets, $50 (discounts for seniors, students, military), visit www.newstagetheatre.com or the New Stage Theatre box office, or call 601-948-3533.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Tracy Harden stood outside her Chuck’s Dairy Bar in Rolling Fork, teary eyed, remembering not the EF-4 tornado that nearly wiped the town off the map two years before. Instead, she became emotional, “even after all this time,” she said, thinking of the overwhelming help people who’d come from all over selflessly offered.
“We’re back now, she said, smiling. “People have been so kind.”
“I stepped out of that cooler two years ago and saw everything, and I mean, everything was just… gone,” she said, her voice trailing off. “My God, I thought. What are we going to do now? But people came and were so giving. It’s remarkable, and such a blessing.”
“And to have another one come on almost the exact date the first came,” she said, shaking her head. “I got word from these young storm chasers I’d met. He told me they were tracking this one, and it looked like it was coming straight for us in Rolling Fork.”
“I got up and went outside.”
“And there it was!”
“I cannot tell you what went through me seeing that tornado form in the sky.”
The tornado that touched down in Rolling Fork last Sunday did minimal damage and claimed no lives.
Horns honk as people travel along U.S. 61. Harden smiles and waves.
She heads back into her restaurant after chatting with friends to resume grill duties as people, some local, some just passing through town, line up for burgers and ice cream treats.
Rolling Fork is mending, slowly. Although there is evidence of some rebuilding such as new homes under construction, many buildings like the library and post office remain boarded up and closed. A brutal reminder of that fateful evening two years ago.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
George Foreman, surely one of the world’s most intriguing and transformative sports figures of the 20th century, died over the weekend at the age of 76. Please indulge me a few memories.
This was back when professional boxing was in its heyday. Muhammad Ali was heavyweight champion of the world for a second time. The lower weight divisions featured such skilled champions and future champs as Alex Arugello, Roberto “Hands of Stone” Duran, Tommy “Hit Man” Hearns and Sugar Ray Leonard.
Boxing was front page news all over the globe. Indeed, Ali was said to be the most famous person in the world and had stunned the boxing world by stopping the previously undefeated Foreman in an eighth round knockout in Kinshasa, Zaire, in October of 1974. Foreman, once an Olympic gold medalist at age 19, had won his previous 40 professional fights and few had lasted past the second round. Big George, as he was known, packed a fearsome punch.
My dealings with Foreman began in January of 1977, roughly 27 months after his Ali debacle with Foreman in the middle of a boxing comeback. At the time, I was the sports editor of my hometown newspaper in Hattiesburg when the news came that Foreman was going to fight a Puerto Rican professional named Pedro Agosto in Pensacola, just three hours away.
Right away, I applied for press credentials and was rewarded with a ringside seats at the Pensacola Civic Center. I thought I was going to cover a boxing match. It turned out more like an execution.
The mismatch was evident from the pre-fight introductions. Foreman towered over the 5-foot, 11-inch Agosto. Foreman had muscles on top of muscles, Agosto not so much. When they announced Agosto weighed 205 pounds, the New York sports writer next to me wise-cracked, “Yeah, well what is he going to weigh without his head?”
It looked entirely possible we might learn.
Foreman toyed with the smaller man for three rounds, almost like a full-grown German shepherd dealing with a tiny, yapping Shih Tzu. By the fourth round, Big George had tired of the yapping. With punches that landed like claps of thunder, Foreman knocked Agosto down three times. Twice, Agosto struggled to his feet after the referee counted to nine. Nearly half a century later I have no idea why Agosto got up. Nobody present– or the national TV audience – would have blamed him for playing possum. But, no, he got up the second time and stumbled over into the corner of the ring right in front of me. And that’s where he was when Foreman hit him with an evil right uppercut to the jaw that lifted the smaller man a foot off the canvas and sprayed me and everyone in the vicinity with Agosto’s blood, sweat and snot – thankfully, no brains. That’s when the ref ended it.
It remains the only time in my sports writing career I had to buy a T-shirt at the event to wear home.
So, now, let’s move ahead 18 years to July of 1995. Foreman had long since completed his comeback by winning back the heavyweight championship. He had become a preacher. He also had become a pitch man for a an indoor grill that bore his name and would sell more than 100 million units. He was a millionaire many times over. He made far more for hawking that grill than he ever made as a fighter. He had become a beloved figure, known for his warm smile and his soothing voice. And now he was coming to Jackson to sign his biography. His publishing company called my office to ask if I’d like an interview. I said I surely would.
One day at the office, I answered my phone and the familiar voice on the other end said, “This is George Foreman and I heard you wanted to talk to me.”
I told him I wanted to talk to him about his book but first I wanted to tell him he owed me a shirt.
“A shirt?” he said. “How’s that?”
I asked him if remembered a guy named Pedro Agosto. He said he did. “Man, I really hit that poor guy,” he said.
I thought you had killed him, I said, and I then told him about all the blood and snot that ruined my shirt.
“Man, I’m sorry about that,” he said. “I’d never hit a guy like that now. I was an angry, angry man back then.”
We had a nice conversation. He told me about finding his Lord. He told me about his 12 children, including five boys, all of whom he named George.
I asked him why he would give five boys the same name.
“I never met my father until late in his life,” Big George told me. “My father never gave me nothing. So I decided I was going to give all my boys something to remember me by. I gave them all my name.”
Yes, and he named one of his girls Georgette.
We did get around to talking about his book, and you will not be surprised by its title: “By George.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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