Effect of gender on the obstetric-gynecologic work force.

As increasing numbers of female physicians enter the specialty of obstetrics and gynecology, their productivity (defined as producing goods and services) as compared with male physicians becomes important. Data from the American Medical Association socioeconomic survey and from a survey of ACOG Fellows indicate that, as a group, female physicians in the specialty are approximately 85% as productive as male physicians in the specialty. ACOG data for physician net income validate the productivity calculations (P <.03). The increasing numbers of female physicians in the specialty will lead to a decreasing aggregate productivity. At the same time, the increasing numbers of women of all ages in the United States will lead to a decline in the available obstetrician-gynecologist work force beginning in the year 2010.

Workforce projections for subspecialists in obstetrics and gynecology.

OBJECTIVE: To project the future supply of practicing subspecialists in obstetrics and gynecology based on the most recent numbers of physicians entering fellowships. METHODS: A discrete actuarial model was developed, and supply projections were examined using 1999 subspecialty fellowship numbers from the American Board of Obstetrics and Gynecology. RESULTS: The numbers of obstetrician-gynecologists entering subspecialty fellowships in maternal-fetal medicine (MFM) and reproductive endocrinology-infertility (REI) declined sharply between 1994 and 1999. There was a slow increase in gynecologic oncology (GO) fellows. Projections show that the numbers of practicing MFM and GO subspecialists will double by 2020, but they will be serving a 20% larger female population in the United States. Numbers of practicing REI subspecialists will increase slowly. CONCLUSION: The number of fellows in GO continues to enlarge progressively though slightly, whereas those in MFM and REI have fallen sharply in recent years. Among four possible factors affecting growth or decline, the ones that seem most important are existing career opportunities for both generalist and subspecialist obstetrician-gynecologists and the length of subspecialty education.

A blueprint for academic obstetrics and gynecology.

A consensus conference sponsored by the Council of University Chairs of Obstetrics and Gynecology in February 1997 formulated the organization's response to the many external issues affecting academic medicine and obstetrics and gynecology including 1) a new practice model based on "wellness," 2) reimbursement changes that have jeopardized traditional revenue sources, 3) an emphasis on quality assurance based on outcomes research and evidence-based medicine, 4) the concept of lifelong learning dictated by an expanding knowledge base and new technology, 5) insufficient resources for basic and clinical investigation in obstetrics and gynecology, 6) workforce statistics indicating stabilization in the number of subspecialists, 7) the increasing diversity of the United States population. Recommendations were developed that are intended to foster change and contribute to the design of academic programs. These include appropriate training for residents as providers of primary care, with an emphasis on continuity clinics, an interdisciplinary curriculum in women's health for medical students; promotion of gender, racial, and ethnic diversity at all levels of medical education and academic leadership; creation of clinical trials research units; and the development of expanded opportunities for research in obstetrics and gynecology supported by the National Institutes of Health.

Modeling the future workforce of obstetrics and gynecology.

OBJECTIVE: To examine the current supply and distribution of obstetrician-gynecologists and project future supply under various scenarios. METHODS: A discrete actuarial supply model was developed, and practice patterns were analyzed. Supply projections under different scenarios, distributions, and practice profiles were examined. RESULTS: Women are expected to become the majority of practitioners by 2014. Continuation of current residency output will result in slow to no growth in obstetrician-gynecologist-to-female population ratios over the next 20 years. A minor (10%) reduction in specialty training would slow specialty growth over the next decade, followed by a slight reduction in supply. Services provided chiefly involve ambulatory reproductive health care, pregnancy, and surgical correction of conditions specific to the female genitourinary system. Even though the proportion of deliveries performed by midwives has increased and family practitioners have maintained their share, obstetrician-gynecologists provide the vast majority of obstetric care and virtually all services for perinatal complications. Generalist services represent relatively minor aspects of their practices. Care of the aged female population is highly fragmented among specialties; more than 50% of all aged Medicare beneficiaries who saw an obstetrician-gynecologist at least once failed to receive a majority of services from any one physician specialty. CONCLUSION: On the basis of trends in patient demographics and care patterns, obstetrician-gynecologists must resolve whether to provide more generalist office-based care, especially to the rapidly growing older female population, or to invest more intensively in surgical specialty care. The specialty's unique contributions to women's health should influence this decision.

Current trends in obstetric and gynecologic academic faculty manpower.

Five prior academic manpower studies were completed by ACOG and the Association of Professors of Gynecology and Obstetrics in 1977-1990. In the current survey, a similar questionnaire was sent to the 130 accredited medical school departments of obstetrics-gynecology; 127 responded. The mean number of full-time faculty members per department is 25.8, an increase of 14% over the last 4 years. Among faculty, women constitute 30.4%, an increase of five percentage points since 1990. Certified subspecialists on faculties have increased 27% in the last 4 years, but decreasing percentages of all subspecialists are in faculty positions compared with private practice settings. Chairmen remain optimistic about continued faculty growth despite the inroads of managed care.

The Commonwealth Fund Women's Health Survey: selected results and comments.

The Commonwealth Fund survey had other facets, as well. Questions were asked and answers found in such areas as access to care, health insurance, work and role stress, social support systems, self-esteem and depression, and overall health status. There are 95 million women in America age 18 and over, and there are existing barriers to care, together with insufficient attention to prevention when care is received. Understanding the health risks and problems, The Commonwealth Fund has established a Commission on Women's Health, chaired by Ellen V. Futter, President of The American Museum of Natural History, former President of Barnard College. The Executive Director of the Commission is Joan Leiman, Executive Deputy Vice President, Health Sciences Division, Columbia University. The Fund is to be commended for the detailed information gathered and for establishing a follow-up program to make these pervasive health problems more widely known to the public and to health policy makers. Copies of the survey are available from the Communications Office at The Commonwealth Fund, (212) 535-0400.

Primary and preventive care services provided by obstetrician-gynecologists.

OBJECTIVE: To determine the level and types of primary and preventive care services delivered by obstetrician-gynecologists. METHODS: A self-administered questionnaire was mailed to a random sample of 1250 obstetrician-gynecologists practicing in the United States. The response rate was 71%. RESULTS: Fifty-three percent of the respondents indicated that they provide primary and preventive care during more than half of their practice time. Although obstetrician-gynecologists provide a wide range of preventive services, the proportion of doctors providing any specific service varies. Whereas virtually all (92% or more) obstetrician-gynecologists provide or order blood pressure screening, breast examinations, mammography, and Papanicolaou tests, only six of ten report regular cholesterol screening for most of their patients. A higher percentage of female obstetrician-gynecologists, who are on average younger than their male counterparts, report that they provide primary preventive services to most of their patients. CONCLUSION: The majority of obstetrician-gynecologists provide a wide range of primary and preventive care services to their patients, although there is variability in the proportion of doctors providing any specific service to most (60% or more) of their patients.

Bright seashells on the sand.

In obstetrics and gynecology residency education is a fixed prescription, whereas the world of practice leads physicians in diverse directions. Nonetheless, obstetrics and gynecology has so far resisted the proliferation of subspecialties. The future scope of our specialty will be defined by the changing healthcare needs of women. These will be driven by changing demographics and an emphasis on preventive and primary care. Residency education and, to a lesser extent, forms of practice will have to change to meet women's needs.

Trends in obstetric and gynecologic residency education.

Residencies in obstetrics and gynecology are popular with graduating medical students, especially women, and positions are filled in excess of 100%. New Accreditation Council for Graduate Medical Education special requirements have focused on several clinical areas and require demonstration of scholarly activity by faculty and 24-hour in-house faculty coverage. Other issues of current concern are resident work hours, pregnancy among residents, and training of residents in induced abortion.

ACOGQUEST: the model phase of the IAIMS project of the American College of Obstetricians and Gynecologists.

In 1990, the American College of Obstetricians and Gynecologists (ACOG) became the first national organization to receive a model phase Integrated Academic Information Management System (IAIMS) grant from the National Library of Medicine. The goal of the ACOG model phase project is to develop and test a prototype for an integrated system that will meet the needs of ACOG and NAACOG members in patient care, research, education, and administrative information. The model phase goal will be accomplished primarily through ACOGQUEST, an integrated approach to providing accurate, current, quality-filtered information to ACOG and NAACOG members in a variety of formats. Another method of information dissemination now being tested is a heuristic-based patient management database, which will include a concise, interactive display of ACOG-reviewed information that can be incorporated into patient records.

Trends in obstetric-gynecologic academic manpower and research.

Medical school full-time faculties continue to grow, despite unchanged numbers of medical students and residents. The 136 United States schools have 2091 male and 861 female full-time faculty, an increase of 22% over the past 4 years. The mean faculty size is 21.6. While numbers of certified subspecialist faculty also continue to increase, a decreasing percentage of all subspecialists are associated with medical schools. More than 1000 additional faculty are anticipated over the next 5 years. Among all faculty, only 34% of physicians devoted 20% or greater time to research. Although total research funding averages over $1 million per department, there are wide disparities, with 59 departments receiving less than $100,000 in federal funding. Obstetric-gynecologic departments as a group receive 1.5% of all National Institutes of Health research funds.

Retirement patterns of obstetricians and gynecologists.

A sample survey of 769 ACOG Fellows who were age 60 or older in 1990 was undertaken to determine current patterns of retirement. Among 415 respondents, only 23% reported remaining in full-time practice of both obstetrics and gynecology, with an additional 16% in full-time practice of gynecology only. Full-time practice was reduced to part-time for 24% at the mean age of 63. Thirty-eight percent were fully retired at the mean age of 67.

Utilization of screening mammography--1990.

Although much has been accomplished in the last few years toward the early detection of breast cancer, we are far from a goal of universal acceptance of the recommended preventive health program of screening mammography. To take an analogy from the Papanicolaou smear, we are somewhere in the 1960s. Both women and physicians have more to learn, and they need to transfer that knowledge into practice.

The implications of Webster for practicing physicians.

KIE: Writing under the auspices of the American College of Obstetricians and Gynecologists (ACOG), the authors assess the impact on physicians of the U.S. Supreme Court's decision in the Missouri abortion case Webster v. Reproductive Health Services (3 July 1989). They see Webster as having little immediate impact on physicians' practices except in Missouri, the only state to which the decision applies. Allen and Pearse predict that the long-range impact of Webster will be greater and more widespread as it opens the door to more extensive state regulation of abortion and other reproductive services. They argue that the prevention of unwanted pregnancy, not limiting access, is the way to reduce the abortion rate. They urge physicians to become involved in a public education campaign to further ACOG's goal of preventing unwanted pregnancies through encouraging sex education and family planning programs, contraceptive research, and wider advertising of contraceptives.^ieng

Information management needs of the obstetrician-gynecologist--a survey.

A random sample survey of members of The American College of Obstetricians and Gynecologists (ACOG) was conducted to ascertain the extent to which computer technology was being used by the members, and what further computer services and applications were needed. Computers were used by 38% of the members, with an additional 13% planning on getting a computer within the year. An average of 48% of the members had no plans for computerization, although this number was lower (29%) for physicians 36-45 years of age. There was no significant variation of use by physician sex or type of practice (office- versus non-office-based). Word processing and financial management were the most frequently used computer applications; clinical patient care tasks were used much less frequently and were presumably less available, because software for these tasks was also highly desirable. The most desired information services were uniform coding and terminology, high-risk patient management, electronic access to full-text obstetric and gynecologic data bases, and online clinical management protocols. Prescription writing, patient recall by drug, and drug inventory computer applications were among the least requested. Several educational, project development, communication, and member service strategies have been formulated to integrate medical information management activities for ACOG members.

The IAIMS project of the American College of Obstetricians and Gynecologists: using information technology to improve the health care of women.

The mission of the ACOG IAIMS project is to identify the core of knowledge necessary for the practice of obstetrics and gynecology, structure it and put it in electronic form, integrate it into a national ob-gyn information network, prepare ACOG members to use it, and disseminate this core of knowledge to members in appropriate forms. This mission will be accomplished through four project objectives: educational programs on computers and information use; definition of a prototype ob-gyn knowledge base; automated access to ACOG and NAACOG membership services; and integration of ACOG IAIMS activities with other organizations. The ACOG IAIMS model phase project is a model for the role of a national specialty society in meeting the information needs of its members and for the integration of national specialty IAIMS programs with locally-developed programs.

The young obstetrician-gynecologist--1987.

By the year 2000 nearly 60% of practicing obstetrician-gynecologists will have graduated from medical school after 1975 and been in practice 20 years or less. At the midpoint of that era we estimate and examine the numbers of such specialists (more than 40,000 by the year 2000), the percentage of women obstetrician/gynecologists (26% in the year 2000), their predominant forms of practice, practice differences between men and women specialists, the changing and aging of the populations of women they will serve, and the participation of young physicians in medical organizations. All of these reflect the picture of our specialty when a new century begins.

Professional liability: epidemiology and demography.

Because of increasing numbers of claims, professional liability for obstetrician-gynecologists carries an ever-increasing cost in dollars, emotions and time. The tort system in medicine is slow and inefficient in time and dollars going to injured patients compared to dollars supporting courts and lawyers. As a result of medical liability costs and a rising number of claims, patients are losing basic access to care, especially for pregnancy and are treated defensively when the receive care.