Greater Supply of Neonatolgists Does Not Reduce Infant Deaths, Study Finds
Regions with a large number of physicians and hospital units specializing in caring for sick newborns generally do not have lower rates of infant mortality, according to a new study that suggests that the United States has a "wasteful oversupply" of neonatal intensive care units and neonatologists. The Philadelphia Inquirer reports that the study, which appears in today's New England Journal of Medicine, found that only in regions with "very few" neonatologists -- 2.7 per 10,000 births -- were newborn deaths higher, up 7% compared to other areas (McCullogh, Philadelphia Inquirer, 5/16). Researchers at Dartmouth Medical School -- who had previously established that there are wide disparities nationwide in the availability of specialized neonatal care -- found that areas ranging from 4.3 to 11.6 neonatologists per 10,000 births "all had about the same death rate." Likewise, the number of available of neonatal hospital beds made no difference in mortality rates. "Enough may be enough," Dr. David Goodman, the study's lead author, said, adding, "There does not seem to be a reason to further expand the supply" of neonatal units and neonatologists.
The growth of the neonatal specialty began in the 1970s following the development of technologies such as ventilators for premature babies and prenatal drugs (AP/Las Vegas Sun, 5/16). That growth, the researchers say, may have come "at the expense of preventative measures aimed at healthier births" (Armstrong, Wall Street Journal, 5/16). Having too many neonatologists, for example, can reduce quality of care because individual doctors "might not treat enough patients annually to develop and maintain their expertise" (Spice, Pittsburgh Post-Gazette, 5/16). The study also found that the oversupply can lead to unnecessary tests and overtreatment of newborns. The researchers said that the growth of neonatology -- a field that is "exciting and well-paying" for doctors and "lucrative and prestigious" for hospitals -- may be attributable to "social and economic factors" (AP/Las Vegas Sun, 5/16). In a NEJM editorial accompanying the study, Kevin Grumbach, a doctor at the University of California-San Francisco, wrote, "This uncontrolled growth has less to do with the true need of communities for effective clinical services than with the financial incentives promoting specialization" (Wall Street Journal, 5/16). "The saga of neonatology is emblematic of how a market-driven health care system with inadequate public planning produces too much of a good thing," he added. Goodman recommended that states increase their regulation of hospital growth in order to reduce the disparity in neonatal units.
Neonatologists said the study had one "weakness," which the authors acknowledged: infant mortality is a "crude measure of medical care." Jay Greenspan, director of neonatology at Thomas Jefferson University in Philadelphia and AI duPont Hospital for Children in Wilmington, Del., concurred with the study that financial concerns have played a role in the oversupply but said, "I think everybody would agree that mortality is not the best indicator of the success of failure of (neonatal) medicine" (Philadelphia Inquirer, 5/16). According to Dr. Charles Bender, a Pittsburgh-area neonatologist, other factors to consider include children's quality of life, which might be better in areas with more neonatologists, and the number of personnel on newborn ICU teams, which can vary from hospital to hospital (Pittsburgh Post-Gazette, 5/16).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.