Warren H. Pearse

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.

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 specialtys unique contributions to womens health should influence this decision.

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.

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.

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 womens needs.

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.