[Obstetrics and gynecology workforce planning: the Israeli experience 1995-2025].

BACKGROUND: Currently, there is no current obstetricians and gynecologists' workforce (OBGW) planning in Israel. Forecasting the OBGW is a challenge in order to achieve optimal obstetrics and gynecology care in the next decades. OBJECTIVE: To examine the current Israeli OBGW and to describe, using an equation, the future supply of OBGW, until 2025. METHODS: A descriptive study of past (1995-2006) and future (through 2025) OBGW trends in Israel. An equation was developed to project physician supply until 2025. RESULTS: No "optimal ratio" exists regarding OBGW to female population ratio. In addition, information regarding OBGW planning is scarce. In Israel, the ratio of OBGW aged < 65 years per 1000 females aged > or = 15 years, was 0.35 in 2006, 23% more than the higher projected ratio from USA for 2005. In 2020, for comparison, the ratio in Israel will be 18% higher than the US ratio. The ratio calculated by the equation presents a plateau of the supply of Ob-Gyn specialists in Israel until 2025. A continued significant growth in the number of Ob-Gyn female specialists, compared with males, is noted. The interpretation of this data requires further evaluation. CONCLUSIONS: In order to preserve the quality of care, there is a need for continuous monitoring and structured planning of health care human resources and OBGW in particular. Research and data in this field are scarce and, therefore, there is a need to conduct many additional research studies. Furthermore, additional data collection is needed to evaluate quality of care and its availability according to the relation between manpower needs and expected demands in Israel's health system.

Private Equity Investments in Women's Health and Obstetrics and Gynecology Practices.

Private equity has evolved into a major force in health care, with deal values and volumes rising year-over-year as these firms purchase hospital systems and physician groups. Historically, these investors have played an outsized role in highly reimbursed specialties such as dermatology and anesthesia. Private equity is relatively new to women's health; when it has invested in this sector, it has typically done so in fertility services. In recent years, however, private equity firms have ventured into general obstetrics and gynecology, drawn by its promise of steady returns, its fragmented landscape, and the potential to integrate related laboratory, ultrasound, and fertility services into obstetric care. Obstetrics and gynecology practices may soon face the prospect of acquisition by private equity firms offering professional management, centralized back-office functions, streamlined customer service, and the capital needed to reach a broader patient base. However, physicians may have concerns about the tradeoffs that accompany private equity acquisitions. Private equity-owned practices have been known to increase the use of lucrative services, deploy advanced practice professionals in place of physicians, and circumvent conflict-of-interest laws, potentially distorting clinical care and driving up costs for consumers. Furthermore, firms generally aim to exit their investment within a 3- to 7-year timeframe, and short-term growth plans may leave physician-owners with uncertain long-term management. As private equity makes headway into women's health, physicians and policymakers must pay closer attention to how this activity can change practice patterns and transform local health care markets while also demanding transparency in the process.

Challenges in the Era of Coding and Corporatization.

The past 40 years have witnessed a major redesign of health care, largely driven by rampantly increasing costs and the perception of lack of better outcomes to justify those costs. Many demographic changes have also challenged the women's health care provider workforce, and evolving new payment systems are likewise a source of angst for these providers. Managed care is seeking to cut costs, and the challenge is to do so without sacrificing quality. Burnout is a new challenge in the present environment. There is now an opportunity to meet these challenges and provide the excellent care our patients deserve.

Twin goals: continuing professional development and improved patient care: report of an ACOG District I retreat focused on the future of obstetrics and gynecology.

On April 8 and 9, 2006, District I of the American College of Obstetricians and Gynecologists (ACOG) held a retreat to assess the future of the specialty. The retreat leaders were Dr. Fredric D. Frigoletto Jr, MD, and Dr. Michael Tesoro, MD. Dozens of issues were identified, analyzed, and prioritized for action. The participants identified the twin goals of continuing professional development and improved patient care as critical and central to the healthy evolution of the specialty. The participants also identified nine major issues that greatly influence our ability to realize these twin goals. The nine issues include 1) ensuring career longevity, 2) balancing family life and work life, 3) optimizing residency training and medical student recruitment, 4) developing the careers of a cadre of physician-scientists, 5) enhancing competency-based continuing professional education, 6) supporting practice development, 7) improving patient safety, 8) securing patient access to care, and 9) advancing our legislative agenda, including tort reform. The retreat leaders identified the need for the specialty to develop a "road map" to constructively address these key issues.

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.

Factors influencing recruitment and retention of academic staff in the European Union.

Academic medicine plays an essential role in the organization of health care in the European Union. Academic hospitals have been the Mecca for advanced medicine. Academic hospitals differ from country to country. Some are public institutions and others are largely private hospitals. Financial pressures on patient care are now threatening research activities in the university hospitals and universities have a responsibility to safeguard the structure of clinical academic obstetrics and gynaecology. In many European teaching hospitals, little importance is placed on research and the academic posts are a mechanism for developing private practice.

Specialization among obstetrician/gynecologists. Another dimension of physician supply.

This study uses the Herfindahl index to investigate the specialization patterns of physicians. "Specialization" is defined as the degree to which an individual doctor concentrates his practice into a narrow range of disease categories. This application is the specialization pattern of office-based obstetrician/gynecologists in the United States. Physician's age and solo practice both exhibit a systematic negative effect on specialization. Both the age and type of practice effects reflect the tendency for younger and nonsolo obstetrician/gynecologists to gear relatively more of their practice into birth-related activities. The age effect is consistent with the hypotheses that either: (1) energy and/or skills for treating pregnancy become more scarce with age, or (2) there is a life-cycle pattern in the doctor/patient relationship with pregnancy serving as an entry point. Malpractice concerns may also contribute to this age effect. The nonsolo practitioner effect suggests the efficiency of multiple doctor practices for allocating physicians' time in activities with high hourly variability in demand. The method used to measure specialization can be extended to investigate other specialty categories and important issues regarding the future supply of physicians' services. These include the effects of an aging physician population and proposed changes in physician reimbursement.

Profile and recruitment in Australasia.

There are 12 medical schools in Australia and New Zealand producing a total of 1600 graduates per year. Academic recruitment is poor as a result of lack of career paths, poor financial remuneration, problems with lack of research funding and the small size of departments. Increased demands from the clinical service and lack of 'start-up' research funds act as a deterrent to recruitment of junior academics. Clinical academics need to convince governments that, without strong and continuing academic leadership, there will be a deterioration in patient care, teaching and research in obstetrics and gynaecology.

The future of obstetrics and gynecology. Council on Long Range Planning and Development with the cooperation of the American College of Obstetricians and Gynecologists.

The American Medical Association Council on Long Range Planning and Development has identified trends in the environment of medicine that are likely to affect the future of obstetrics and gynecology practice. The professional liability crisis is among the most potent factors affecting the types and numbers of services that obstetricians and gynecologists will provide in the future. The setting for obstetrics and gynecology practice is likely to be affected by advances in technology and trends in delivery and reimbursement systems. Two factors with potential to affect the organization of practice are the high numbers of women entering the specialty and increasing practice expenses, largely associated with liability costs. Other factors affecting future patterns of delivery include the anticipated aging of the female population and the changing social and economic roles of women. In particular, the feminist movement has focused more attention on women's health care and is expected to have a continuing impact on the delivery of obstetric and gynecologic care. The Council concludes that the most salient issues for the specialty in the future will be the following: (1) the direction of the professional liability crisis, (2) medical practice competition, (3) the feminization of poverty, (4) ethical issues arising from technological and social imperatives, (5) the changing gender profile of the specialty, and (6) the impact of the feminist movement on women's health care.

[Obstetrics--a women's discipline for men]. / Fødselshjelp--et kvinnefag for mannfolk.

In recent years there has been a considerable increase in the number of female gynaecologists in Norway. This contrasts sharply with the difficulties pioneering Norwegian female physicians had in entering this specialty. Three generations ago, leading Norwegian physicians argued against female gynaecologists. This article describes the controversy in 1914 when Dr. Louise Isachsen (1875-1932) claimed discrimination when she was not appointed senior registrar at the National Hospital's Midwifery Clinic. Her case was fiercely debated, not only in the medical profession, but also in newspapers and in Parliament. The clinic's director, Professor Kristian Brandt (1859-1932), found women unsuited for operative gynaecology and emergency obstetrics. We compare his arguments against female physicians with the requirements for Norwegian midwives, all female at the time. Brandt himself played a crucial role in formulating these requirements through his teaching and textbooks.