Depending on where you live in the United States, it could already be tough to find an obstetrician/gynecologist—almost half of U.S. counties lack one, according to the U.S. Bureau of Labor Statistics. But recent studies show that the problem is only going to get worse, with some cities at risk for a severe shortage in the coming years.

In July, Doximity, a social networking site for health care providers, released a study identifying 10 metropolitan areas that are most at risk for an ob/gyn shortage. After surveying 30,000 ob/gyns across the country and considering their age and workload, they found that the top five cities deemed most “at risk” are Las Vegas; Orlando, Florida; Los Angeles; Miami; and Riverside, California.

Doximity’s study is hardly the only research on the shortage. The American College of Obstetrics and Gynecologists (ACOG) recently estimated that by 2020, there will be up to 8,000 fewer ob/gyns than needed across the country.

“One of the reasons we put this report together was because of anecdotal stuff we were hearing,” Joel Davis, vice president of strategic analytics and growth at Doximity, tells SELF. “We wanted to bring transparency to the trend, because through that, policy decisions can be made. It can take a while to do things like open up new medical school residencies, so by making the overall market more transparent, it makes it easier to help saturate areas.”

Fewer ob/gyns means that women’s health would take a hit.

“If you don’t have quality prenatal care, you’re more likely to have adverse health outcomes,” Ellen Hartenbach, vice-chair of the department of obstetrics and gynecology at the University of Wisconsin Medical School, tells SELF. “So by not having ob/gyns in a community, you’re putting women and babies lives’ at risk, which in turn impacts the overall health of a community.”

In medicine, there’s a trend towards a team-based approach in care—the idea is that your primary care doctor, pharmacist, and mental health provider should work in tandem to help you live your healthiest life. And this is also true in obstetrics—the childbearing part of the practice—with more certified nurse midwives and maternal fetal medicine specialists working together with ob/gyns to bring their specialized skills to make childbirth a safer and overall better experience for mother and baby.

However, while it’s better to have a certified nurse midwife than no reproductive health expert, there is no replacing a skilled obstetrician in a medical emergency. “If you’re hemorrhaging, you need an obstetrician, period,” Valerie Jones, a former ob/gyn in Maryland who retired last year, tells SELF.

While an ob/gyn easily pulls a six figure salary, it’s a subspecialty with high burnout, high risk for lawsuits, and few opportunities for training. Here are the main factors contributing to the shortage, and how some are trying to turn the tide and get more people into the profession.

Burnout is a major problem for ob/gyns—one that needs to be addressed early on in residency.

The average age for an ob/gyn to stop doing the obstetrics part of the role is 48, according to the ACOG. Many ob/gyns will then transition to regular office gynecological work in their 50s, like Jones did, and retire at an average age of 56. “It’s physically demanding, and you’re up at all hours,” Jones says.

In Florida, a new residency program at North Florida Regional Medical Center will address burnout head on. The center accepted its first class of ob/gyn residents in July, and Karen Harris, the director of the program, says learning how to practice self-compassion will be a key component of the curriculum.

“Women and men going into these residencies programs are incredibly smart, but have they ever been instructed on how to take care of themselves?” Harris tells SELF. “It’s important to teach them resilience and self-care to keep them in their practice, and help them figure out how to refill their reservoir.”

They’re also sued more than other physicians.

“Ob/gyns live in fear of being sued,” Jones says. She isn’t kidding: Ob/gyns are the most commonly sued physicians. A 2012 survey from the American Medical Association found that of the approximately 4,000 medical liability lawsuits filed between 2009 and 2011, a full two-thirds involved obstetric care. It’s because of these figures that malpractice insurance is quite high for ob/gyns compared to other practitioners. This not only makes it very expensive to even open an ob/gyn practice, but also harder to recruit more medical students into the profession.

“We always want the best for our patients. Whenever there are poor outcomes in childbirth, everyone hurts,” Jones says. So even if there may not be any medical issue linked to the care, people want to assign blame.

Malpractice reform on the federal level would help, ob/gyns say. A bill passed the House of Representatives in June that would limit noneconomic damages for a malpractice case to $250,000. While some criticize that cap as unfair to patients whose lives have been forever changed by medical malpractice, the American Medical Association president David Barbe called it an “important first step.”

“By redirecting health care spending from defensive medicine, additional dollars can go to patient care, safety and quality improvements, and to health information technology systems that would help improve care and outcomes,” he said in a statement.

And despite overall population growth, the number of ob/gyn residencies has stayed flat over the past couple of decades.

According to data from the National Resident Matching Program, there are 241 ob/gyn residency programs with 1,288 spots; compare that to internal medicine, which has 467 residency programs.

That especially hurts rural women, with more than half of them not having access to an ob/gyn in a 30-minute driving distance, ACOG found. Pregnant women in rural areas are also more likely to have a high-risk pregnancy, because rates of chronic disease tend to be higher in rural areas, according to the Health Resources and Service Administration. Harris, who practices in Gainesville, Florida, says she cares for women living all the way up to the Georgia border because many of those counties lack ob/gyn care. She hopes this is alleviated once more doctors go through the North Florida Regional Medical Center’s ob/gyn program.

Hartenbach, with the University of Wisconsin Medical School, is trying to kill two birds with one stone by starting the country’s first ob/gyn rural residency. According to the Association of American Medical Colleges, 47.2 percent of doctors stay in the place they completed their residency, so by getting doctors to complete residencies in rural Wisconsin, more will stay there. The university is starting small with one resident, who begins her residency this fall.

Hartenbach says she’s already heard from other universities and state governments who are interested in creating a similar rural residency for ob/gyns.

“The way forward out of this problem is tricky, it’s going to require change in federal and state policies,” she says. “What we’re doing is a small step, but we want to be a leader.”