Hospital Privileges Research Articles

Pediatric Dentistry Program Directors as stakeholders in the process of Board certification.

Board certification is an important credential for pediatric dentists to achieve for purposes of career advancement, hospital privileges, and reputation. The purpose of this pilot study was to assess the engagement of residency Program Directors (PDs) with the Board certification process in terms of criteria for clinical readiness, curriculum development, and value. An additional objective was to identify challenges and ways in which PDs may need support as they prepare residents for Board certification. Eighty-seven PDs were invited to participate in this study, out of which 32 agreed to participate (36% response rate). The study included a digital non-validated survey and verbal interviews. Digital and verbal survey results were analyzed using descriptive statistics. PDs had recurrent themes in their descriptions of clinical readiness, including information gathering, application of knowledge, and professional awareness. Half of the participants used the American Board of Pediatric Dentistry (ABPD) exam domains as a guideline in their curriculum development. Of the verbal interview participants (N=32), 30(94%) felt that Board certification was very important to their residents and program. Many barriers to successful completion of the Board exam were discussed, and a diverse array of suggestions were made for mechanisms to better support PDs as they prepare residents for Board certification. Board certification is valued by PDs and influences their criteria for clinical readiness. Increased engagement with the ABPD will facilitate better support for PDs and will enhance the consistency of training standards in residency programs.

Interventional Radiology Awareness Among Family Physicians and General Practitioners in Jazan Region, Saudi Arabia.

Background Interventional radiology (IR) utilizes minimally invasive procedures guided by imaging to diagnose and treat various conditions, offering less invasive alternatives to traditional surgery. Despite its importance, awareness among family medicine practitioners can vary, affecting patient care. While IR has advanced in Saudi Arabia, there are limited data on family medicine practitioners' understanding of IR. This study assesses awareness of IR procedures among family medicine doctors in Jazan and their perceived need for further education. Methods A cross-sectional interview-administered survey was conducted online among family medicine doctors in Jazan via social media. The survey assessed demographic data, awareness of IR procedures, self-rated knowledge, and attitudes towards IR. Participants' understanding of IR training, hospital privileges, outpatient clinics, and recognition by the Saudi Commission for Health Specialties (SCHS) was evaluated. Data were analyzed using descriptive statistics and chi-square tests. Results Out of 395 respondents, the age distribution was as follows: 20-29 years (44.3%), 30-39 years (32.9%), and 40 years or older (22.8%). Gender distribution was as follows: females (44.6%) and males (55.4%). Specialties included family medicine consultants (10.6%), residents (32.4%), specialists (22.8%), and general practitioners (34.2%). Awareness of IR procedures varied: uterine fibroid embolization (58.7%), coronary angiography (57.5%), vascular angioplasty (63.5%), radiofrequency ablation (61.3%), peripheral vascular bypass (61.8%), brain biopsy (56.2%), nephrostomy tube placement (59.5%), varicose veins treatment (63.0%), and cystoscopic tumor resection (54.7%). Self-rated knowledge was as follows: poor (46.8%), adequate (27.1%), good (15.7%), and excellent (10.4%). Most believed that interventional radiologists' training was in radiology (62.8%), with fewer attributing it to vascular surgery (20.5%) or a combination (16.7%). Regarding privileges and facilities, 248 (62.8%) reported hospital admitting privileges for IRs, 251 (63.5%) reported outpatient clinics, and 45 (11.4%) were unsure about admitting privileges. SCHS recognition was confirmed by 267 (67.6%). Referrals to IRs were made by 283 (71.6%), and 260 (65.8%) would increase referrals with more knowledge. The perceived benefit of additional education was as follows: no benefit (48.4%), some benefit (30.6%), and significant benefit (21.0%). Conclusion The study reveals gaps in awareness and knowledge of IR among family medicine doctors in Jazan. While there is recognition of IR's value and a willingness to refer patients, variations in knowledge highlight the need for targeted educational interventions. Improving education on IR could enhance integration into patient care and optimize outcomes.

Who Do We Serve? Role Conflict in Ontario Midwifery

The integration of midwifery into the Ontario health care system has posed challenges to the role of the midwife. The pressure to maintain hospital privileges and the fear of litigation can place midwives in opposition to their role of advocate and support for childbearning women. Additionally, collaborative maternity care models may also create conflicting demands on midwives. Midwives can experience these challenges as role conflict which can have a detrimental effect on midwifery care and lead to work stress and attrition in the profession. Open dialogue, further research, education, consumer involvement and improved interdisciplinary communication are among the strategies that could be used to better understand and address role conflict amongst midwives.

Exploring the Demands of Urology: On-Call Compensation, Frequency, and Variability.

We investigate and analyze the available information regarding on-call patterns among urologists in the US. The AUA Workforce Workgroup collaborated with the AUA Data Team to analyze information from the 2022 AUA Census. Extracted data were analyzed to identify variability across gender, subspecialty, hours worked per week, AUA section, salary, and practice setting. We used χ2 tests to compare the groups with respect to each factor and defined statistical significance as a P value less than .05. There were significant differences by gender and several other on-call factors including being required to take call to maintain hospital privileges (reported by 76% of female urologists vs 67% of male urologists; P = .026), getting paid for weekend call (28% of females vs 38% of males; P = .030), and making over $500 per day when taking weekend call (18% of females vs 32% of males; P < .001). Other differences existed between AUA sections in percentage of physicians receiving over $500 for weekday or weekend calls (P < .001). Lastly, practice setting differed in likelihood of being paid over $500 for weekday call (44% reported by private practice urologists, 7% reported by academic urologists, 14% reported by institutional urologists; P < .001). These results underscore the substantial variability in on-call responsibilities and structure within the AUA workforce. Further research and regular participation in future censuses are recommended to continue to characterize these trends.

The impact of funding models on the integration of Ontario midwives: a qualitative study

BackgroundNearly 30 years post legalisation and introduction, midwifery is still not optimally integrated within the health system of Canada’s largest province, Ontario. Funding models have been identified as one of the main barriers.MethodsUsing a constructivist perspective, we conducted a qualitative descriptive study to examine how antepartum, intrapartum, and postpartum funding arrangements in Ontario impact midwifery integration. We conceptualized optimal ‘integration’ as circumstances in which midwives’ knowledge, skills, and model of care are broadly respected and fully utilized, interprofessional collaboration and referral support the best possible care for patients, and midwives feel a sense of belonging within hospitals and the greater health system. We collected data through semi-structured telephone interviews with midwives, obstetricians, family physicians, and nurses. The data was examined using thematic analysis.ResultsWe interviewed 20 participants, including 5 obstetricians, 5 family physicians, 5 midwives, 4 nurses, and 1 policy expert. We found that while course-of-care-based midwifery funding is perceived to support high levels of midwifery client satisfaction and excellent clinical outcomes, it lacks flexibility. This limits opportunities for interprofessional collaboration and for midwives to use their knowledge and skills to respond to health system gaps. The physician fee-for-service funding model creates competition for births, has unintended consequences that limit midwives’ scope and access to hospital privileges, and fails to appropriately compensate physician consultants, particularly as midwifery volumes grow. Siloing of midwifery funding from hospital funding further restricts innovative contributions from midwives to respond to community healthcare needs.ConclusionsSignificant policy changes, such as adequate remuneration for consultants, possibly including salary-based physician funding; flexibility to compensate midwives for care beyond the existing course of care model; and a clearly articulated health human resource plan for sexual and reproductive care are needed to improve midwifery integration.

In-Hospital Methadone Enrollment: a Novel Program to Facilitate Linkage from the Hospital to the Opioid Treatment Program for Vulnerable Patients with Opioid Use Disorder.

Methadone ameliorates opioid withdrawal among hospitalized patients with opioid use disorder (OUD). To continue methadone after hospital discharge, patients must enroll in an opioid treatment program (OTP) per federal regulations. Uncontrolled opioid withdrawal is a barrier to linkage from hospital to OTP. Describe a federally compliant In-Hospital Methadone Enrollment Team (IN-MEET) that enrolls hospitalized patients with OUD into an OTP with facilitated hospital to OTP linkage. Seven hundred-bed university hospital in Aurora, CO. A physician dually affiliated with a hospital's addiction consultation service and a community OTP completes an in-hospital, face-to-face medical assessment required by federal law and titrates methadone to comfort. An OTP-affiliated nurse with hospital privileges completes a psychosocial evaluation and provides case management by arranging transportation and providing weekly telephone check-ins. IN-MEETenrollments completed, hospital to OTP linkage, and descriptive characteristics of patients who completed IN-MEET enrollments compared to patients who completed community OTP enrollments. Between April 2019 and April 2023, our team completed 165 IN-MEET enrollments. Among a subset of 73 IN-MEET patients, 56 (76.7%) presented to the OTP following hospital discharge. Compared to community OTP enrolled patients (n = 1687), a higher percentage of IN-MEET patients were older (39.7years, standard deviation [SD] 11.2years vs. 36.1years, SD 10.6years) and were unhoused (n = 43, 58.9% vs. n = 199, 11.8%). Compared to community OTP enrolled patients, a higher percentage of IN-MEET patients reported heroin or fentanyl as their primary substance (n = 53, 72.6% vs. n = 677, 40.1%), reported methamphetamine as their secondary substance (n = 27, 37.0% vs. n = 380, 22.5%), and reported they injected their primary substance (n = 46, 63.0% vs. n = 478, 28.3%). IN-MEET facilitates hospital to OTP linkage among a vulnerable population. This model has the potential to improve methadone access for hospitalized patients who may not otherwise seek out treatment.

The Joint Commission’s Ongoing Professional Practice Evaluation Process: Costly, Ineffective, and Potentially Harmful to Safety Culture

ObjectiveTo evaluate the estimated labor costs and effectiveness of Ongoing Professional Practice Evaluation (OPPE) processes at identifying outlier performers in a large sample of providers across multiple health care systems and to extrapolate costs and effectiveness nationally. MethodsSix hospital systems partnered to evaluate their labor expenses related to conducting OPPE. Estimates for mean labor hours and wages were created for the following: data analysts, medical staff office professionals, department physician leaders, and administrative assistants. The total number of outlier performers who were identified by OPPE metrics alone and that resulted in lack of renewal, limitation, or revoking of hospital privileges during the past annual OPPE cycle (2022) was recorded. National costs of OPPE were extrapolated. Literature review of the effect of OPPE on safety culture in radiology was performed. ResultsThe evaluated systems had 12,854 privileged providers evaluated by OPPE. The total estimated annual recurring labor cost per provider was $50.20. Zero of 12,854 providers evaluated were identified as outlier performers solely through the OPPE process. The total estimated annual recurring cost of administering OPPE nationally was $78.54 million. In radiology over the past 15 years, the use of error rates based on score-based peer review as an OPPE metric has been perceived as punitive and had an adverse effect on safety culture. ConclusionOPPE is expensive to administer, inefficient at identifying outlier performers, diverts human resources away from potentially more effective improvement work, and has been associated with an adverse impact on safety culture in radiology.

Constitutional Violations by the Health Care Quality Improvement Act (HCQIA) and the Reporting by the National Practitioner Databank (NPDB): Focusing on the Preservation of the Civil Rights of Physicians

In 1986, the US Congress passed the Health Care Quality Improvement Act of 1986. (HCQIA) was designed to protect the health and safety of the public by 1) enhancing the Peer Review process through protection for peer review members from lawsuits, and 2) providing a national repository for reported information regarding medical malpractice payments and adverse actions involving physicians, which among other things, would monitor the movement of incompetent or unprofessional physicians. The framers of HCQIA did not foresee that in 2023, hospitals and employers will invariably deny employment and/or hospital privileges based on an NPDB report outlining loss of hospital privileges or relinquishment of hospital privileges under investigation. Such an adverse report by NPDB results in the inability of the physician to obtain employment or practice in a hospital. Therefore, in 2023, the unintended consequence of the reporting of adverse peer review actions by NPDB, an agency of the Federal Government, can violate the constitutional and civil rights of the said physicians.

Constitutional Violations by the Health Care Quality Improvement Act (HCQIA) and the Reporting by the National Practitioner Databank (NPDB): Focusing on the Preservation of the Civil Rights of Physicians

In 1986, the US Congress passed the Health Care Quality Improvement Act of 1986. (HCQIA) was designed to protect the health and safety of the public by 1) enhancing the Peer Review process through protection for peer review members from lawsuits, and 2) providing a national repository for reported information regarding medical malpractice payments and adverse actions involving physicians, which among other things, would monitor the movement of incompetent or unprofessional physicians. The framers of HCQIA did not foresee that in 2023, hospitals and employers will invariably deny employment and/or hospital privileges based on an NPDB report outlining loss of hospital privileges or relinquishment of hospital privileges under investigation. Such an adverse report by NPDB results in the inability of the physician to obtain employment or practice in a hospital. Therefore, in 2023, the unintended consequence of the reporting of adverse peer review actions by NPDB, an agency of the Federal Government, can violate the constitutional and civil rights of the said physicians. The NPDB reporting provision of HCQIA violates 5th, 8th, 9th and 10th amendments of the Constitution.

Disadvantaged Physicians: The Ill-fated Connection between Hospital Immunity and Sham Peer Review

An important responsibility of hospitals is to assure the quality of the medical care they provide. One of the key pillars of quality assurance is a committee of local peers to determine the professional competence of physicians. On occasion, incompetence or disruptive behavior of a clinician is found to have caused patient harm. The peer review committee holds the deficient physician accountable and the hospital uses their authority to impose swift corrective action ranging from remedial education, proctoring or the restriction or revocation of hospital privileges [1].

Mechanisms of Peer Review and Their Potential Impact on Neurosurgeons: A Pilot Survey.

Physician peer review is a universal practice in U.S. hospitals. While there are many commonalities in peer review procedures, many of them established by law, there is also much institutional variation, which should be well understood by practicing neurosurgeons. A 13-question pilot survey was conducted of a sample of 5 hospital systems with whom members of the Council of State Neurosurgical Societies Medico-Legal Committee are affiliated. Survey questions were constructed to qualitatively assess 3 features of hospital peer review: 1) committee composition and process, 2) committee outcomes, and 3) legal protections and ramifications. The most common paradigm for a physician peer review committee was an interdisciplinary group with representatives from most major medical and surgical subspecialties. Referrals for peer review inquiry could be made by any hospital employee and were largely anonymous. Most institutions included a precommittee screening process conducted by the physician peer review committee leadership. The most common outcomes of an inquiry were resolution with no further action or ongoing focused professional practice evaluation. Hospital privileges were only rarely reported to be revoked or terminated. Members of the physician peer review committee were consistently protected from retaliatory litigation related to peer review participation. Most hospitals had a multilayered decision process and availability of appeal to minimize potential for punitive investigations. According to a recent study, only 62% of hospitals consider their peer review process to be highly or significantly standardized. This pilot survey provides commentary of potential areas of commonality and variation among hospital peer review practices.

Nephrology Education in Private Practice: My Perspective.

I have been in a small private nephrology practice in Southwestern Michigan for the past 15 years. My community hospital started an internal medicine residency program about 10 years ago. My 2 partners and I serve as the entire nephrology faculty for the program. The work is largely uncompensated, since the hospital updated their bylaws requiring resident teaching as a condition for hospital privileges. Nevertheless, I have come to view resident education as a pleasure, an opportunity to continually update my own knowledge base, and a way to position my practice for future growth.

Searching for the Family Doctor

Searching for the Family Doctor

Downstream Impact for Plastic Surgeons in the United States from the "No Surprises Act".

Background:The No Surprises Act, signed into the US federal law in 2020, establishes a floor for reimbursement determined by insurance payors for out-of-network charges rendered by providers in emergency services. Physicians are not permitted to balance bill patients for the difference. An arbitration process is outlined for mediation between provider and payor if needed.Methods:Policy analysis demonstrates many plastic surgeons utilize a revenue stream including both fee-for-service cosmetic work and insurance-covered reconstructive intervention. For Maintenance of Certification from the American Board of Plastic Surgery and/or membership to the American Society of Plastic Surgeons, plastic surgeons must operate only in accredited facilities, which in turn require that similar privileges are held in a hospital.Results:Given rapidly developing economic pressures, hospitals no longer remain neutral sites for surgical privileging as they seek strategies to mitigate financial loss by directly competing for patients. A downstream consequence of the requirement for hospital privileging is that plastic surgeons are forced to manage increasing on-call responsibilities despite shrinking reimbursement. Plastic surgeons whose board certification was the first to be time-limited are now reaching the stage of practice where they may transition exclusively to out-patient services.Conclusions:Plastic surgeons in independent solo or small group practices are rendered vulnerable since they may not be able to find coverage of in-patient responsibilities at lower reimbursement rates. Rather than allowing loss of board certification in this population, rational alternatives on an organizational level are proposed for keeping the process equitable as plastic surgeons progress along the practice pathway.

Time for a Change in Hospital Governance

No abstract available. Article truncated after 150 words. The SWJPCCS has been following the case of nine oncologists who filed a lawsuit against the Anne Arundel Medical Center (AAMC), in Annapolis, Maryland, last year (1). The oncologists claimed that the hospital chose profit over the needs of cancer patients, as it slashed oncology care services to cut costs, and both fired and denied them hospital privileges when they complained. At that time, the oncologists were not free to respond because of the ongoing litigation, but now that the lawsuit is over and the dust has settled, they are free to speak, and they contacted Medscape Medical News to tell their side of the story (2). AAMC is a private, not-for-profit corporation that operates a large acute care hospital in Annapolis, Maryland. It is affiliated with Luminis Health, the parent company of the medical center. Until October 23, 2020, the nine oncologists were employed by the Anne Arundel Physician …

Longitudinal Comparison of Continuing Medical Education Learning Objectives and Intent-to-Change Statements of Participants.

Successful completion of continuing medical education (CME) activities is often required for ongoing physician board certification, licensure, and hospital privileges. CME activities are designed to address professional knowledge or practice gaps. The authors examined participants' "intent to change" after CME activities to evaluate whether CME activity content was suitably linked with the stated learning objectives. The authors performed a retrospective mixed-methods thematic content analysis of written and electronic records from American Association of Neurological Surgeons-sponsored CME activities. Data from 2011 through 2016 were analyzed using a quantitative, deductive content analysis approach. Data were examined for each year separately as well as longitudinally over the six consecutive years. Intent-to-change data that did not align with meeting objectives were analyzed inductively using a qualitative content analysis approach to explore potential unintended learning themes. The authors examined 85 American Association of Neurological Surgeons CME activities (424 CME objectives). The objectives were compared with 1950 intent-to-change statements. Thematic patterns of recurrent intent-to-change statements that matched with CME objectives included topics of resident education, complication avoidance, clinical best practices and evidence, new innovations, and novel surgical techniques. Just over a third of intent-to-change statements (37.3%) were not related to any meeting objective. Approximately a quarter of these unmatched statements led to new learning objectives in subsequent years. An examination of CME learning objectives and participant intent-to-change statements provides information for examination of both meeting planner and learner attitudes for future CME activity planning.

Victories in NY Show That Our Advocacy Works!

Features| August 2021 Victories in NY Show That Our Advocacy Works! Rose Berkun, MD, FASA Rose Berkun, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor August 2021, Vol. 85, 27. https://doi.org/10.1097/01.ASM.0000768808.24519.26 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Rose Berkun; Victories in NY Show That Our Advocacy Works!. ASA Monitor 2021; 85:27 doi: https://doi.org/10.1097/01.ASM.0000768808.24519.26 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu nav search search input Search input auto suggest search filter All ContentAll PublicationsASA Monitor Search Advanced Search Topics: advocacy Ever since the 2018 New York State budget came out with language that proposed to lift physician supervision of nurse anesthetists and allow them to practice chronic pain management independently, the New York State Society of Anesthesiologists (NYSSA) has been holding its collective breath each January when new bills are introduced. The 2021 budget's proposed expansions of scope of practice included pharmacists and nurse practitioners, but not nurse anesthetists. Unfortunately, despite the fact that the CRNA independent practice was not included, Governor Cuomo's fiscal year 2022 budget bill included proposals that, if passed, would be detrimental not only to anesthesiologists but to all New York physicians. One such proposal was a 50% physician cost sharing of excess medical liability insurance. This program was created in the mid-1980s by New York State and allowed an additional layer of $1 million of coverage to be provided to physicians with hospital privileges who... You do not currently have access to this content.

Modifying phrases in surgical pathology reports: introduction of Standardized Scheme of Reporting Certainty in Pathology Reports (SSRC-Path).

Pathologists often incorporate modifying phrases in their diagnosis to imply varying levels of diagnostic certainty; however, what is implied by the pathologists is not equivalent with what is perceived by the referring physicians and patients. This discordance can have significant implications in management, safety, and cost. We intend to identify lack of consistency in interpretation of modifying phrases by comparing perceived level of certainty by pathologists and non-pathologists, and introduce a standard scheme for reporting uncertainty in pathology reports using the experience with imaging reporting and data systems. In this study, a list of 18 most commonly used modifying phrases in pathology reports was distributed among separate cohorts of pathologists (N = 17) and non-pathology clinicians (N = 225) as a questionnaire survey, and the participants were asked to assign a certainty level to each phrase. All the participants had practice privileges in Brown University-affiliated teaching hospitals. The survey was completed by 207 participants (17 pathologists, 190 non-pathologists). It reveals a significant discordance between the interpretations of the modifying phrases between the two cohorts, with significant variations in subgroups of non-pathology clinicians. Also there is disagreement between pathologists and other clinicians regarding the causes of miscommunication triggered by pathology reports. Pathologists and non-pathology clinicians should be mindful of the potential sources of misunderstanding of pathology reports and take necessary actions to prevent and clarify the uncertainties. Using a standard scheme for reporting uncertainty in pathology reports is recommended.

Access to Point-of-Care Ultrasound in Maine Emergency Departments

Introduction: Point-of-care ultrasound (POCUS) is an essential tool in emergency medicine. We evaluated access to bedside ultrasound machines and characterized POCUS use in Maine emergency departments (EDs). Methods: We conducted a cross-sectional electronic survey of all ED medical directors in Maine. The survey included questions on ED characteristics, access to ultrasound machines, POCUS use patterns, POCUS administration, and barriers to use. Results: Thirty-four EDs were identified, and 24 medical directors completed the survey, yielding a response rate of 71%. EDs were predominantly small and rural. Only 21% identified as urban, and 54% reported less than 20 000 annual visits. Surveys showed that 88% of EDs had immediate access to a bedside ultrasound machine in the ED. Also, 76% used ultrasound guidance to place more than 75% of internal jugular central venous catheters, while 24% used ultrasound to place less than 10% of catheters. Of EDs with ultrasound access, 90% had hospital privileges for providers, 71% had a credentialing process, 52% had quality assurance processes, and 48% had a designated ultrasound director. Discussion: Compared to other states, Maine EDs were lower-volume and more rural but had similar access to ultrasound machines. Previous studies showed poor adherence to national guidelines for ultrasound quality assurance practices and provider credentialing. Our results demonstrate that this issue is ongoing. Conclusions: Maine’s predominantly rural EDs have excellent access to ultrasound machines. Areas for improvement in POCUS use and administration were identified, including enhancing quality assurance practices, boosting provider credentialing, and increasing the use of ultrasound guidance for vascular access.

Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine

The incidence of opioid use during pregnancy is increasing, and drug overdoses are a leading cause of postpartum mortality. Most women who are pregnant do not receive medications for treatment of opioid use disorder, despite the mortality benefit that these agents confer. Furthermore, buprenorphine is associated with milder symptoms of neonatal abstinence syndrome (NAS) compared with methadone. To describe the prevalence and geographic distribution across the US of obstetrician-gynecologists who can prescribe buprenorphine (henceforth described as X-waivered) in 2019. A cross-sectional, nationwide study linking physician-specific data to county- and state-level data was conducted from September 1, 2019, to March 31, 2020. Data were obtained on 31 211 obstetrician-gynecologists who accept Medicaid insurance through the Centers for Medicare & Medicaid Services Physician Compare data set and linked to the Drug Addiction Treatment Act buprenorphine-waived clinician list. State-level NAS incidence and county-level uninsured rates and rurality. Prevalence and geographic distribution of obstetrician-gynecologists who are trained to prescribe buprenorphine. Among the 31 211 identified obstetrician-gynecologists, 18 710 (59.9%) were women. Most had hospital privileges (23 236 [74.4%]) and worked in metropolitan counties (28 613 [91.7%]). Only 560 of the identified obstetrician-gynecologists (1.8%) were X-waivered. Obstetrician-gynecologists in counties with fewer than 5% uninsured residents had nearly twice the odds of being X-waivered (adjusted odds ratio [aOR], 1.59; 95% CI, 1.04-2.44; P = .04) compared with those in counties with greater than 15% uninsured residents. Compared with those located in metropolitan counties, obstetrician-gynecologists in suburban counties (eg, urban population of ≥20 000 and adjacent to a metropolitan area) were more likely to be X-waivered (aOR, 1.85; 95% CI, 1.26-2.71; P = .002). Compared with states with an NAS rate of 5 per 1000 births or less, obstetrician-gynecologists in states with an NAS rate of 15 per 1000 births or greater had nearly 5 times the odds of being X-waivered (aOR, 4.94; 95% CI, 3.60-6.77; P < .001). Obstetrician-gynecologists without hospital privileges were more likely to be X-waivered (aOR, 1.32; 95% CI, 1.08-1.61; P = .007). Fewer than 2% of obstetrician-gynecologists who accept Medicaid are able to prescribe buprenorphine, and their geographic distribution appears to be skewed in favor of suburban counties. This finding suggests that there is an opportunity for health systems and professional societies to incentivize X-waiver trainings among obstetrician-gynecologists to increase patients' access to buprenorphine, especially during pregnancy.