The Changing Business of OB/GYN: A Comprehensive Overview

Part 1

First in an AIMIS series examining the clinical, economic, and technological forces reshaping women's health practice.

For decades, the traditional OB/GYN practice model was straightforward. Physicians cared for women throughout their reproductive lives. They provided prenatal care, delivered babies, managed routine and complex gynecologic conditions, performed surgery when necessary, and often built practices that lasted for generations.

That model has not disappeared. But it is changing.

Today's OB/GYNs practice at the intersection of forces that extend well beyond clinical medicine. These include increasing economic pressure, workforce shortages, hospital consolidation, changing physician expectations, new technologies, evolving sites of care, and a patient population that increasingly expects greater convenience, access, and choice.

For many physicians, the question is no longer simply how to practice medicine.

It is becoming: what should an OB/GYN practice look like in the years ahead?

The Economics of Practice Are Changing

The independent physician practice has become less common. Across medicine, only 42.2% of physicians were working in private practice in 2024, compared with 60.1% in 2012, according to the American Medical Association. Increasing numbers of physicians are employed by hospitals, health systems, and other corporate entities.

The reasons for this shift are clear. Practices face rising labor and operating costs, reimbursement pressures, administrative complexity, prior authorization requirements, and the ongoing investment required for technology and infrastructure. MedPAC has noted that increases in clinicians' input costs have exceeded increases in Medicare payment rates in recent years.

For the practicing OB/GYN, these pressures can affect decisions that were once considered almost entirely clinical. Decisions include which services to provide, which procedures to perform, where those procedures should take place, whether to remain independent, whether to join a larger organization, and how much time can realistically be devoted to obstetrics, gynecology, and surgery.

Increasingly, practice design itself has become a strategic decision.

The Workforce Is Changing Too

OB/GYN remains a demanding specialty. AMA data indicate that OB/GYN physicians worked an average of approximately 58 hours per week in 2024. Meanwhile, workforce concerns are becoming increasingly difficult to ignore. A recent national analysis estimated that the supply of OB/GYN physicians met approximately 93% of demand in 2025 and projected significant geographic disparities over the coming decade.

ACOG has identified strengthening the OB/GYN workforce as a policy priority, particularly as access becomes more difficult in underserved communities. At the same time, physicians are reconsidering what they want from their careers.

Call schedules, lifestyle, administrative burden, family considerations, and professional autonomy increasingly influence decisions about where and how physicians practice.

Will the physician who enters OB/GYN today practice the same way as the physician who entered the specialty 20 or 30 years ago?

Almost certainly not.

The Patient Is Changing

The transformation is occurring on the other side of the examination table as well. Patients increasingly approach health care as informed consumers. They research their symptoms and physicians before arriving at the office. They compare treatment alternatives. They expect convenient scheduling, digital communication, and greater involvement in decisions about their care.

Women are increasingly seeking care for issues that historically have not received sufficient attention within the traditional model of women's health. These include menopause, endometriosis, fibroids, pelvic health, obesity and metabolic health, sexual health, fertility, preventive health, and healthy aging.

These are not necessarily new conditions. What is changing is the degree to which patients expect answers, treatment options, and coordinated care.

For OB/GYN practices, this creates both a challenge and an opportunity.

Technology Is Expanding What Is Possible

Technology is also redefining the boundaries of the specialty. Artificial intelligence is beginning to affect documentation, workflow, and clinical decision support. Digital health tools are changing patient communication and monitoring. New diagnostics and therapeutics are creating additional treatment options.

Procedural innovation continues to advance.

Minimally invasive surgery, robotics, hysteroscopy, and office-based technologies have created alternatives to procedures that historically required larger incisions, hospital admission, or longer recovery times. This is where an important distinction should be made.

The future of OB/GYN is not a choice between the office and the operating room. The more interesting question is how the two fit together. The successful women's health practice of the future may integrate preventive care, medical management, emerging therapeutics, diagnostics, and surgery into a more complete continuum of care.

And What About Surgery?

For a specialty whose history includes both medicine and surgery, this may be one of the most important questions ahead. Not every OB/GYN will perform the same volume or complexity of surgery. Some physicians will concentrate increasingly on obstetrics. Others will emphasize office-based gynecology. Some will develop highly specialized surgical practices. Still others will participate in larger integrated groups in which patients move between physicians according to expertise.

At the same time, minimally invasive surgery will remain essential to the treatment of many gynecologic conditions. The issue, therefore, is not whether surgery remains important. It is how surgery fits into a changing OB/GYN practice model - and who will perform it, where it will be performed, and how patients will gain access to the right level of expertise.

Those questions have implications for physicians, hospitals, ambulatory surgery centers, technology companies, and, most importantly, patients.

A Broader Conversation About the Future of OB/GYN

These changes are interconnected. Workforce pressure affects practice structure. Practice economics affect clinical choices. Technology changes where and how care can be delivered. Patient expectations accelerate adoption. Changes in all four ultimately influence the role of the physician.

That is why AIMIS believes it is time for a broader conversation about the changing business of OB/GYN.

Over the coming months, this series will explore issues ranging from the sustainability of the traditional OB/GYN practice model and the economics of gynecologic surgery to artificial intelligence, office-based procedures, obesity and GLP-1 therapies, menopause, emerging technologies, and the changing expectations of both physicians and patients.

Some of these changes will present challenges. Others will create entirely new opportunities.

But one conclusion is already becoming clear:

The OB/GYN practice of the future will not simply be a more technologically advanced version of the practice of the past. It is likely to be structured differently, operate differently, and offer women a broader continuum of care. Understanding that transformation - and helping physicians navigate it - will be the focus of this series.

Next in the series: The Modern OB/GYN: Clinician, Surgeon - and Business Operator.

Selected Sources

• American Medical Association. Physician Practice Benchmark Survey, 2024.

• American Medical Association. Physician work hours and EHR burden reporting, 2024.

• Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Medicare Payment Policy, March 2025.

• American College of Obstetricians and Gynecologists (ACOG). Policy priorities and workforce access materials.