February 20, 2014
Adrienne Zertuche, MD, MPH, a second-year resident in Emory’s Department of Gynecology and Obstetrics, is the recipient of the Junior Fellow Rising Star in Advocacy Award, presented by the American Congress of Obstetricians and Gynecologists (ACOG).
Zertuche is the first recipient of this award, which supports advocacy projects developed and implemented by Junior Fellows. The award will be presented at ACOG’s 2014 Congressional Leadership Conference in Washington, D.C., in March.
“I plan for advocacy to remain a vital component of my career as an obstetrician/gynecologist,” Zertuche wrote in her application. “I believe it is my duty as a healthcare provider not only to evaluate and treat patients on an individual basis, but also to advocate on their behalf for changes that ensure access to services, quality care, and wellness for the population as a whole."
The award recognizes Zertuche’s work as founder, leader, and researcher of the Georgia Maternal and Infant Health Research Group (GMIHRG), which she began in 2010 while earning her MPH at Emory’s Rollins School of Public Health. GMIHRG was established to evaluate the shortage of obstetricians in rural Georgia, to explore the reasons for and consequences of the lack of providers, and to examine potential solutions that could improve Georgia’s poor maternal and infant outcomes.
The group’s research indicated that 52 percent of the areas outside Atlanta have overburdened obstetric providers, or no providers at all. They also found that providers in the state have stopped offering obstetric care due to low Medicaid reimbursement rates, high malpractice risk, and the overwhelming patient load.
Georgia’s legislators were introduced to this research when they received the group’s “obstetric report cards,” which provided a snapshot of each district’s delivering physicians and birthing facilities. The lawmakers received the report cards in the lead-up to the vote on HB 954, which prohibited abortions after 20 weeks of gestation, without exception, and threatened to imprison providers for 10 years for failure to comply. The group encouraged lawmakers to consider the state’s existing provider shortage before voting on a bill with the potential to compel even more physicians to abandon obstetric practice in Georgia.
The next priority for Zertuche and GMIHRG was a deeper dive into why Georgia faces such a shortage of obstetricians. The group surveyed the state’s ob/gyn residents to determine how interested they were in accepting a job in Georgia, and, in particular, rural Georgia, after their training. A majority of residents surveyed deemed future practice in Georgia “unlikely” or “extremely unlikely,” but other questions in the survey indicated that these residents would be willing to change their stance if financial incentives were offered.
Zertuche and GMIHRG were invited to the state capitol in November to present these findings to Governor Nathan Deal’s Joint Study Committee on Medicaid Reform. They encouraged the committee to make new ob/gyn resident slots in non-metropolitan areas a priority and to update specifications for loan repayment and tax credit programs to make positions in underserved areas more appealing and more widely available. Just a few months later, the recommendations related to financial incentives have become part of HB 998. While the incentives would apply to all physicians, GMIHRG created specialty-specific maps to help legislators understand the particular challenges of loan repayment programs and tax credits for new ob/gyns. The bill is scheduled to come to a vote during this legislative session.
Nursing leaders across the state have also responded the GMIHRG’s research. The group’s findings stressed the important role that certified nurse midwives (CNMs) can play in alleviating the obstetric provider shortage. GMIHRG has been engaged in conversations with these leaders about the prospects of a rural CNM program, and evaluating the feasibility of new training partnerships is next on the group’s research docket.
“I believe our work at the capitol is only the beginning of GMIHRG’s educational and advocacy efforts,” wrote Zertuche. “I foresee continued research, with ongoing translation of our findings into facts and figures that will be valuable in informing Georgia maternal/infant health stakeholders and in promoting change.”