Why Should Delaware Care?
Sussex County’s growing pains go beyond concerns about congested roads. The county has also lost several women’s health doctors in recent years just as tens of thousands of newcomers arrived, including retirees and immigrants.
Recent closures of women’s health clinics in Sussex County have exacerbated longstanding problems facing people across southern Delaware who for years have struggled to find OB-GYN doctors nearby.
Seaford resident Barbara Hedges-Goettl has recently dealt with that problem, struggling for over a year and a half to see a women’s health doctor.
Following an initial referral from her primary care doctor in 2023, she scheduled an appointment four months out with an OB-GYN clinic about 30 miles away in Rehoboth Beach.
When the time came for the appointment, the clinic canceled. She rescheduled – again four months out. When that new appointment came, they again canceled.
“I was super frustrated,” Hedges-Goettl said. “What’s the good in having an appointment if when the time comes, then you just cancel it.”
Her primary care doctor then referred her to another practice, but they had just lost a physician and were scheduling appointments 17 months out, she said. In January, Hedges-Goettl finally saw a doctor at a Milford clinic run by Dedicated to Women – the same company that operates the Rehoboth Beach office.
The appointment occurred nearly two years after she first sought care. And the problem persists.
In November, Dedicated to Women shuttered its Rehoboth Beach location, two years after it sounded the alarm about what already was a shortage of women’s health services in the area. The concern then came after five OB-GYN practices closed or stopped providing obstetrics care in Delaware and Maryland in the span of six months.
“This decision was made after careful consideration, and while it was not an easy choice, we believe it will allow us to better serve you in the future,” read an October Facebook post announcing the Rehoboth closure.
Dedicated to Women still maintains offices in Milford, Dover and Middletown. The clinic did not respond to requests for comment.
The barriers to access were exacerbated after Planned Parenthood of Delaware’s Seaford clinic closed in September, largely leaving Sussex County residents without access to abortion and reproductive health care services.
Planned Parenthood officials say the closure is temporary but have not announced a reopening date.
Health care barriers in Sussex
Delawareans in the mostly rural Sussex County have long faced barriers to accessing care, especially women’s health care. Federal health officials call the county a high-priority shortage area for health professionals.
It’s difficult to recruit early career OB-GYNs – who are often saddled with thousands of dollars of student loan debt – to practice in rural areas in Sussex County where housing prices have skyrocketed, said Dr. Margaret Chou, division chief of obstetrics at Nemours Children’s Health and obstetrics medical director at Nemours Advanced Delivery Program.
“The doctors there are doing the best they can, but I do think that Sussex County is underserved,” Chou said.
An increase in the county’s population has also put a strain on women’s health care services. Elderly retirees moving in require routine gynecological care, while recently arrived immigrants are in need of time-sensitive prenatal care.
“There are people who need you and there may not be infrastructure that helps support what we do,” Chou said.
Both new populations pull on the time and resources of the handful of OB-GYNs available. More demand and fewer doctors can lead to increased burnout among OB-GYNs who are taking on more patients and longer hours, said Lisa Butterworth, women’s health director and midwife at La Red Health Center, a low-cost health clinic in Georgetown for uninsured and underinsured patients.
The barriers come as the entire country is experiencing a national shortage of OB-GYNs, with a projected shortfall of 5,000 by 2030. About 35% of counties in the U.S. are considered maternity care deserts, or areas where there is not a single birthing facility or obstetrician clinician, according to a 2024 report from March of Dimes, a nonprofit organization focused on maternal health care.
The rising costs of liability insurance also contributed to the OB-GYN shortages, according to a 2023 Medscape malpractice report. OB-GYN doctors in Pennsylvania pay nearly $120,000 in annual medical malpractice insurance premiums, while New Jersey doctors pay about $90,000, according to NerdWallet.
“There is a fear of liability insurance,” Chou said. “It certainly is something that we always keep in mind.”
The overall costs of providing care also was cited in January 2022 when TidalHealth Nanticoke in Seaford lost nearly all of its OB-GYN doctors following a merger with a health system in Salisbury, Maryland.
Most doctors who left did so because TidalHealth officials announced plans to shutter the obstetrics department if it didn’t improve its finances within the year.
No abortion access in Sussex during pause
In Seaford, services at Planned Parenthood’s clinic have been on pause since early September due to a staffing shortage, with no reopening date in sight, according to Phoebe Lucas, development director of Planned Parenthood of Delaware.
Abortion remains legal in Delaware, and Planned Parenthood continues to offer services beyond abortion — including birth control, health screenings and sexually transmitted disease testing — in Kent and New Castle counties.
“Services at our Seaford clinic remain on pause while we continue our search for a clinician to fill our vacant position,” Lucas said in a statement. “Until such a candidate is identified and trained, we do not have a planned date to resume services.”
Separately, Planned Parenthood in 2015 permanently closed its clinic just south of the Delaware state line in Salisbury, Maryland. At the time, it said it was consolidating operations from there with its clinic in Easton Maryland.
Lucas encouraged people seeking care in southern Delaware to visit their Dover location. In the new year, Planned Parenthood intends to launch a program to transport Sussex residents seeking care to their Dover health center, Lucas added.
The Seaford clinic was embroiled in debate before it even opened its doors in 2021, a decade after the Planned Parenthood in Rehoboth Beach was shuttered due to a lack of patients. The closure just leaves Planned Parenthood’s Wilmington, Newark and Dover locations to offer abortion services in the state.
Increase in patients as practices close
With the wait for women’s health service so long in Sussex County, La Red Health Center has seen an increase in prenatal patients inquiring about and receiving care, said Butterworth, the women’s health director there.
The center has had to hire a fourth midwife to help respond to the increase in need.
“It puts a strain on us and then a strain on the population who needs us desperately,” Butterworth said.
The uptick in patients is due to the lack of medical providers in Sussex County, she added. There’s been a shortage of OB-GYN providers in the county since she moved to Delaware six years ago, and the strain has only worsened in the past two years.
OB-GYNs in Sussex County have had to adapt their practices for various personal reasons, but the net effect has been longer wait times for patients, according to Chou, the chief of obstetrics at Nemours.
“It’s pretty bad,” Chou said regarding the wait times in Kent and Sussex.
If maintaining a practice in rural parts of the state becomes unsustainable, doctors will often close up shop and look for opportunities elsewhere, leaving patients “holding the bag,” Chou added.
In December, Bayhealth’s Sussex Campus website for its women’s care department stated that the hospital had a temporary pause on accepting new patients after the hospital lost two physicians in that practice.
The hospital has since taken down the statement from its website. Currently, Bayhealth OB-GYN practices in Milford and Milton are actively accepting new patients, said Victoria Luttrell, Bayhealth media spokesperson, in an email.
Bayhealth announced plans to open a new OB-GYN practice in Dover in mid-2025.