Availability of Neonatal Intensive Care and Neonatal Mortality

Abstract

The article by Goodman et al. (May 16 issue)¹ and the accompanying editorial by Grumbach² criticize what these authors interpret as excessive concentrations of neonatologists in response to profit-maximizing behavior by hospitals — proof that there are too many specialists. However, a casual inspection of the maps in Figure 1 of the article reveals that most areas with high ratios of neonatologists to neonates are not hotbeds of health care competition but, rather, sparsely populated regions of the country, such as Alaska, Appalachia, northern Maine, western Texas, and the Dakotas. These higher ratios do not represent an “irrational and inequitable deployment” of specialists, as Grumbach states. Instead, this is what happens when 2275 neonatologists distribute themselves among 285 million people who are spread throughout 3000 counties — more counties than neonatologists — and they do so in units of 1. But what if, by Goodman's estimates, a community needs 0.4 or 2.2 neonatologists? It cannot be done. Even worse, some areas get none. And therein lies the difficulty of conducting geographic analyses like this one for specialties that are so small. The truth is that we are on the cusp of progressively worsening shortages of specialists.^3,4 Responding to these shortages will be difficult and costly. What is needed now is rigorous and objective workforce planning.