Scientific advances, societal trends, and the education and practice of obstetrician-gynecologists

Article Abstract:

In America, specialization in medicine developed in the mid-1700s and continued to grow as the body of medical information increased and technology improved. Generalists realized that they could do more good if they concentrated in specific medical areas. In 1972, the American College of Obstetrics and Gynecology recognized subspecialties, subdivisions of general areas of expertise. The division was designed to improve teaching and patient care and to expand on research capabilities. However, physicians in various subspecialties became interested only in their specific areas, and it became impossible for the obstetrician-gynecologist to remain informed about all areas of the specialty. Currently, there is a trend toward specialization in gynecology at the expense of obstetrics. A decrease in the availability of physicians practicing preventive obstetrics and gynecology, and the fragmentation of obstetrics and gynecology have forced educators in the profession to examine potential proposals for change. Two choices are suggested. One is to reduce the number of residency programs for obstetrics and gynecology to produce the appropriate number of specialists. This is unlikely, since women's health care is already inadequate. The other proposal involves providing basic training in obstetrics and gynecology, similar to the current practice, and then selecting an appropriate number out of those entering the specialty to advance into subspecialty areas. The role of the obstetrician-gynecologist is clearly changing and residency programs will have to re-examine the education of specialists in this field. (Consumer Summary produced by Reliance Medical Information, Inc.)

Study and teaching, Gynecology, Obstetrics, editorial

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Managed are: a ball control game

Article Abstract:

Obstetrician/gynecologists should take the offensive and stop allowing themselves to be pressured into giving less than quality care. If they are to deserve the trust of their patients, they must maintain their integrity by speaking out for the needs of patients in the face of demands for cost-cutting measures by health maintenance organizations. They must also insist that the merit of new technologies and procedures be established before adopting them. If obstetrician/gynecologists can do this as a body, they will once again regain the position of leadership that their skills and training deserve.

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Ethical issues in managed care for the obstetrician and gynecologist

Article Abstract:

Physicians must continue to be the patient's advocate even when practicing in a managed care setting. Managed care results in many ethical dilemmas for physicians, especially when their financial compensation is greatest when they do the least for the patient. The concept of a primary care gatekeeper who receives a certain amount of money each month to care for patients is probably the best way to practice medicine under managed care. Managed care organizations may need to adopt different standards than other businesses.

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