When I went into private practice, our small place was doing about 1000 deliveries a year - that's 3 a day. It was sustainable.
When I retired, it was down to about 450 a year.
They closed the unit about a year after that.
As @jolly said, it's a staffing issue.
You're going to need 2-3 nurses per shift per day. The OB has to be within 15 minutes, 24/7. If you're delivering babies, you gotta be prepared to do a c-section within 30 minutes. Now you need a gas-passer and a neonatologist.
Gets pricey - fast. Neonatologist and gas-passer are gonna cost $600K a year - or more. Nurses get, what, $40 an hour? That's $120 an hour for 365 days. You're looking at another $1.75 million in salaries.
The OB docs? No way you're going to have only 2-3 now. No one wants to be on call every third night with every other if someone goes on vacation. Granted OB docs supplement their income by doing GYNE surgery, and that alone can sustain a nice lifestyle. So, why do the hard work of OB? I know three guys that quit delivering babies in their late forties, and they're happier for it - and better rested.
Equipment - OB beds are not regular hospital beds. Fetal monitors cost money, and maintenance of hospital-grade electronics needs to be considered. Gotta have an ultrasound machine handy too. Gotta have a fully-equipped OR available at all times. OR tables and anesthesia machines are pricey AF. Ive seen situations where the C-section is done in the main OR, but if your main OR is in use, gotta have one free.
Then, there's the liability. I'm just guessing that a hospital that doesn't do OB has a lower malpractice premium that one that does. But, if the insurance biz for hospitals is like it is for docs, I'd say I'm probably right.
Looks like at least $2.5 million in salaries, probably another million for equipment and maintenance (though that's a one-time cost other than PM) and insurance.
How many deliveries do you need to do to clear $2.5 million?
