Dr. Anthony Milicia has needed to find a new place to deliver his patients' babies three times in the past six years.

The Northeast Philadelphia obstetrician and gynecologist feels fortunate to have found a new location each time.

With the number of obstetric departments in the region dwindling, obstetricians are finding it's increasingly difficult to gain staff privileges at another hospital. Many of the remaining local obstetrics departments are at, near or above capacity.

"I didn't want to leave this area or the patients I have developed relationships with," said Milicia, who is leaving his Jeanes Hospital affiliation for Northeastern Hospital. "I'm like a cat; I have nine lives. But if this doesn't work out, I'm probably out of luck."

Milicia, 54, had spent most of his career in Center City at Hahnemann University Hospital when, in 2001, Tenet Healthcare Corp. -- Hahnemann's owner -- cut loose its employed physicians as part of a corporate cost-cutting action.

Unable to afford the escalating malpractice premiums hitting his specialty particularly hard, Milicia took a job with Frankford Hospitals' Torresdale division. Frankford was covering the malpractice insurance premiums for its obstetrician/gynecologists, which Milicia estimated at between $140,000 and $160,000 a year.

Frankford announced in late 2005 it was closing its obstetrics unit because of changing demographics resulting in more older patients and rising professional liability costs. Milicia then switched to Jeanes, where he became an employee of Temple Physicians Inc. -- the physician practice arm of the Temple University Health System.

He was among a growing number of obstetricians that helped Jeanes increase its deliveries to more than 1,300 a year, but the doctors became victims of their own success.

"We were told Jeanes was losing $2 million a year on its OB services and that it could not afford to spend the $10 million needed for renovations" to create more space for the department, Milicia said.

After Jeanes announced earlier this year it was closing its obstetrics department effective the end of May, Milicia moved quickly to secure one of two open slots at Northeastern -- which is also part of the Temple system.

Under the new arrangement, Milicia is keeping his practice open on Bustleton Avenue in the Northeast, but he'll be delivering babies at Northeastern in the Port Richmond section of the city.

The response from his pregnant patients has been mixed.

"About half have said they'll follow me to Northeastern; another 25 percent have said, 'Forget it, I'm not going down there,' and the other 25 percent are still looking around to see what their options are," he said.

Five or six of his colleagues from Jeanes are still searching for new hospitals with which to affiliate.

"I think they thought it would be easy to go out and find another hospital, but now they are starting to get panicky because there's nothing out there," he said.

Milicia said for now there is still an adequate supply of obstetricians left in Northeast Philadelphia. "Finding [an obstetrician] is not a problem," he said. "The problem is when you can be seen. Some women have to wait two months for a visit. I think what you are going to see is more women coming into hospital emergency rooms unregistered and in labor. The doctor won't know her and she won't know the doctor. It's a scary time to have a baby."

Hospital OB capacity has shrunk by 28 percent in southeastern Pennsylvania during the past decade, according to the Pennsylvania Department of Health. The medical journal Health Affairs released a study last week that the number of ob/gyns is down 8 percent during the same time period.

Letty Thall, public policy director for the Philadelphia-based Maternity Care Coalition, said the access problem is exacerbated for Medicaid patients because not all of the hospitals still in the baby-delivery business have contracts with all of the region's Medicaid managed-care plans.

"Insurance is the gateway to access," Thall said. "Patients will follow their doctor [to a new hospital], but they have to hope that hospital takes their insurance."

Dr. Rick Mankin, executive director of Temple Physicians Inc., said the health system is working with the Jeanes doctors to help them affiliate with other hospitals.

If those doctors end up moving out of the region or limiting their practice to gynecology, Mankin said, access to obstetrical care will become even more limited than it already is -- particularly in the Northeast.

"I view this as a looming public-health crisis," Mankin said. "The problem is virtually no [hospitals] remain in the business of delivering babies in Northeast Philadelphia. It's not possible to be an ob/gyn unless you have a hospital, so the doctors have to move somewhere else.

"I'm quite concerned about where woman are going to go to get obstetrical care, particularly in Northeast Philadelphia," he said. "One option might be going to New Jersey. I think that is an unacceptable solution."

Learn about the childbirth crisis through our Maternity Care in Southeastern PA pages, or visit our Maternity Services Advocacy pages to find out how communities are advocating and how you can take action!

MCC's full Childbirth at a Crossroads report can be viewed here.