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OB/GYN Editorial January 2002
Random Thoughts for the New Year
Thomas E. Nolan, MD, MBA
 It
has been a while since I've written an editorial and I have had
many thoughts over the previous six months to share. I hope that
you, the readers, have enjoyed the editorials written by our editorial
board members as well as invited guest editorials written by authors
with unique expertise in various areas.
With respect to editorials, I noticed that the new and revised
format of Obstetrics and Gyne-cology looks a little like the format
that we have used. I enjoy the look, but I am little worried about
the competition! This should keep us on our toes. I have always
thought the personal touch of an editorial relating to an article
in that issue helps the reader explore the author's impression.
I have been mulling over the following thoughts and would like
to share them with you:
Shrinking Number of OB/GYNs
Recently, I gave an ACOG course in Quebec where I made the comment
that we would probably have a shortage of OB/GYNs by the year 2010.
After I finished the lecture, several individuals came to the podium
to discuss their thoughts on this issue. Most thought I was overly
optimistic and that shortages would be widespread by 2005. And,
three physicians told me they had quit practicing for various reasons
over the past several years. Many of them complained about decreasing
reimbursements and a more consumer-oriented population whose demands
had become increasingly unreasonable to the practitioner. They also
felt that the number of female OB/GYNs who have entered the specialty
are now reaching various mileposts in their personal lives that
conflict with their professional lives. Many felt that family responsibilities
were resulting in a decreasing the number of hours in practice.
One wom-an OB/GYN from Minnesota told me that many of her colleagues
had targeted age 50 to retire or to severely limit hours of practice.
These facts reflect a study done by the Jacobs Institute that showed
female OB/GYNs were working at a .85 FTE (full time equivalent)
rate. At one of our local hospitals, half the female practitioners
decided to eliminate obstetrical care once their contracts with
a major hospital corporation expire.
Several months ago I was speaking to one of my female colleagues
on the issue of decreasing practice hours for female OB/GYNs and
her response was, "Five years ago, I probably would have given you
a lecture on what I thought was a fraudulent observation. However,
this is becoming more and more the experience that I have encountered
and that what you are saying is actually true."
I predict in the near future that there will be increasing numbers
of ancillary care providers such as midwives and nurse practitioners.
Within our own institution, the nurse practitioner program has grown
substantially over the past 5 years and the popularity of these
providers is evident. Is this all necessarily bad? No, but practitioners
need to be aware that their ability to work with ancillary personnel
is going to become more important. Issues such as credentials, oversight,
and legal liability will also become more important.
Practice Environment
Recently, an attorney who lives across the street from me commented
that physicians were once again taking a black-eye from the popular
press on the never-ending subject of patient-physician communication.
I looked at him and quickly stated, "Well, between the attorneys
and increasing litigation, the decreasing reimbursement from managed
care organizations, and the Internet becoming the arbitrator of
medical care in the United States, it's no secret to me why satisfaction
among physicians has decreased. Soon you will have a difficult time
finding a physician." This, I think, adds to the issue of individual
practitioners limiting or leaving the specialty. Fortunately in
the environment in which I work, the infamous Internet search that
patients bring with them to their appointment is blessedly infrequent.
I don't have a problem with a so-called "informed consumer." Unfortunately,
what I see is marketing crossing the line from scientific substantiated
facts in the peer literature, and is becoming a driving force behind
patient care. As a society, we don't want to return to the snake
oil merchants. There is no peer review on the Internet and anyone
that sets up a web site can place their unsubstantiated, non-peer
reviewed information on this more popular vehicle. Recently I was
asked to evaluate a potential author for an article and was directed
to that individual's web site. The author was a self-appointed expert
in PMDD with an obvious axe to grind with the healing profession.
I strongly feel that our major organizations should continue efforts
on a portal for patients to get information that has been distilled
through the organization. Having worked on several committees at
ACOG, I recognize how laborious but how good the final product is
prior to its release.
The War Effort
Having retired from the United States Navy and trained in a military
hospital, I just hope that all my colleagues realize that we do
have OB/GYNs and do serve periodically in war zones. As the number
of women has increased substantially in the military, the number
of the practitioners really hasn't grown. I hope that during your
deliberations, thoughts and concerns, you do remember our colleagues
who are serving in uniform and hope that your prayers are with them.
Thomas E. Nolan, MD, MBA
Editor-in-Chief
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