Considerations about retirement from clinical practice by obstetrician-gynecologists.

Retirement of obstetrician-gynecologists is becoming a matter of increasing concern in light of an expected shortage of practicing physicians. Determining a retirement age is often complex. We address what constitutes a usual retirement age range from general clinical practice for an obstetrician-gynecologist, compare this with practitioners in other specialties, and suggest factors of importance to obstetrician-gynecologists before retirement. Although the proportion of obstetrician-gynecologists ≥55 years old is similar to other specialists, obstetrician-gynecologists retire at younger ages than male or female physicians in other specialties. A customary age range of retirement from obstetrician-gynecologist practice would be 59-69 years (median, 64 years). Women, who constitute a growing proportion of obstetrician-gynecologists in practice, retire earlier than men. The large cohort of "baby boomer" physicians who are approaching retirement (approximately 15,000 obstetrician-gynecologists) deserves tracking while an investigation of integrated women's health care delivery models is conducted. Relevant considerations would include strategies to extend the work longevity of those who are considering early retirement or desiring part-time employment. Likewise volunteer work in underserved community clinics or teaching medical students and residents offers continuing personal satisfaction for many retirees and preservation of self-esteem and medical knowledge.

Maternal-fetal medicine workforce in the United States.

OBJECTIVE: To identify the current supply and locations of maternal-fetal medicine (MFM) subspecialists in active practice in the United States. STUDY DESIGN: This observational study examined the membership roster of the American Congress of Obstetricians and Gynecologists in 2010 for those whose practice was in either general obstetrics and gynecology or maternal-fetal medicine. Reliable national databases were used to determine the numbers and locations of births annually, reproductive-aged (15 to 44 years old) women, and level III perinatal centers in each state. RESULTS: There were 1355 MFM subspecialists in the United States in 2010 with the highest number being in the most populous states. Nearly all (98.2%) resided in metropolitan counties with level III perinatal center(s). Nationwide, there was one MFM subspecialist for every 24 general obstetrician-gynecologists and for every 3150 births. States with the highest number of MFM subspecialists per 10,000 live births were Vermont (9.5), Connecticut (6.4), Maryland (5.8), New Jersey (5.7), Hawaii (5.7), and Massachusetts (5.6). The lowest densities were in Indiana (1.5), Mississippi (1.3), Idaho (1.2), and Arkansas (1.0), and North Dakota and Wyoming had none. CONCLUSION: Data from this population-level study will serve as a baseline to follow trends in the workforce of MFM practitioners.

Professional liability and other career pressures: impact on obstetrician-gynecologists' career satisfaction.

OBJECTIVE: To investigate the impact of career pressures on career satisfaction and satisfaction with job-specific activities among obstetrician-gynecologists. METHODS: A questionnaire was sent to 1,500 member-Fellows of The American College of Obstetricians and Gynecologists in June 2001. The analyses were designed to examine the relationship between career pressures in 3 domains on clinicians' professional satisfaction. RESULTS: Overall career satisfaction and satisfaction with job-specific activities were both inversely related to the perceived impact of career pressures. The major impact reported was that liability insurance costs would shorten the duration of the members' careers. Managed care had less impact than liability, with moderate concern surrounding the limitation of diagnostic and treatment options. Obstetrician-gynecologists were less satisfied with their careers and job-specific activities if they believed the cost or time of obtaining continuing medical education requirements to be a burden. CONCLUSION: Career pressures produced by liability insurance costs have more negative impact on clinicians' satisfaction with their professional lives and job-specific activities than managed care and requirements for continuing medical education.

Medicolegal considerations in the diagnosis of breast cancer.

From the standpoint of the obstetrician, gynecologist, failure to diagnose breast cancer is a significant medicolegal issue in terms of the number of claims initiated and the indemnity awards paid to successful plaintiffs. The incidence of breast cancer may continue to increase. Without quality care and good risk management on the part or health care providers, claims for failure to diagnose cancer in a timely manner will also increase. The challenge for the health care provider is to formulate a plan that promotes early detection and treatment while allowing for independent clinical judgment. Ideally, the plan should be written and followed for every patient in whom complaints of a breast mass have been documented. It is incumbent upon the physician and office staff to create an atmosphere in which patient complaints are not minimized, the limitations of mammography are recognized. follow-up procedures are in place and strictly followed, and a definitive diagnosis within 4 to 6 weeks of the initial presentation is the ultimate goal. Following these suggestions will improve the quality of health care for the patient and significantly decrease the likelihood of litigation alleging a failure to diagnose breast cancer. In the event breast cancer is diagnosed and a lawsuit is brought for failure to diagnose in a timely fashion, the best defense a physician can have is to be able to demonstrate that the patient's complaints were taken seriously, a consistent treatment plan was followed and documented, and the patient received appropriate care.

Profiles about practice settings of American College of Obstetricians and Gynecologists fellows.

Selection of a practice setting affects duty hours, practice autonomy, institutional relationships, administrative responsibilities, personal finances, and professional satisfaction. To identify national trends in practice settings reported by the College, we evaluated responses by Fellows (and Junior Fellows) in active practice from six College surveys on professional liability issues between 1992 and 2012. Although half of Fellows remained in an independent private practice, a decline was observed among solo health care practitioners (from 32% in 1992 to 19% in 2012). Direct employment increased either in hospital systems (from 5% to 15%) or as academic faculty (from 9% to 12%). The proportion of Fellows employed by either health maintenance organizations (from 4% to 2%) or the government (2%) remained low. We anticipate that practice settings will be increasingly influenced by health care reform, team-based care with use of nonphysician clinicians, physician age, and increasing subspecialization. Future surveys of Fellows about their practice settings, preferably required at the time of Maintenance of Certification, will aid in evaluating practice settings and their influence on quality of care, cost containment, and health care provider satisfaction.

Distribution of American Congress of Obstetricians and Gynecologists fellows and junior fellows in practice in the United States.

OBJECTIVE: To develop effective policies addressing access to health care for all women in the United States, we report the distribution of the American Congress of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in practice at county and state levels. METHODS: Data were gathered from the 2010 U.S. County Census File for adult women (aged 15 years or older) and reproductive-aged women (15-44 years old) and from the 2010 membership roster of ACOG. The number of postresidency, actively practicing physicians trained in general obstetrics and gynecology per targeted population were recorded at state and district levels and mapped at county levels using uDig GIS software and U.S. Census TIGER/Line Shapefiles. RESULTS: In 2010, the 33,624 general obstetrician-gynecologists (ob-gyns) in the United States, comprised 5.0% of the total 661,400 physicians. There were 2.65 ob-gyns per 10,000 women and 5.39 ob-gyns per 10,000 reproductive-aged women. The density of ob-gyns declined from metropolitan to micropolitan and to rural counties. Approximately half (1,550, 49%) of the 3,143 U.S. counties lacked a single ob-gyn, and 10.1 million women (8.2% of all women) lived in those predominantly rural counties. Such counties, located especially in the central and mountain west regions, were commonly in designated Health Professional Shortage Areas. CONCLUSION: An uneven distribution of ACOG Fellows and Junior Fellows in practice exists throughout the United States and may worsen if resident graduates continue to cluster in metropolitan areas. Meeting the needs of women in underserved areas requires creative innovations in enhancing a more uniform geographic distribution of providers. LEVEL OF EVIDENCE: III.

Study on defensive medicine practices among obstetricians and gynecologists who provide breast care.

The purpose of this study was to assess malpractice concerns, career satisfaction, defensive medicine, experience with liability lawsuits, and changes in breast care practices among obstetricians and gynecologists (ob-gyns) who provide breast care. Four hundred ACOG Fellows were randomly selected and invited to participate, 247 (62%) responded. A majority of responders had increased the number of referrals for the diagnosis of breast abnormalities (58.9%) and treatment of breast disease (53.6%) due to fears and concerns regarding malpractice. On average, there was a high level of career satisfaction (M=8.5 [SD=2.5] on a scale from 0 to 10); however, those who had been sued were significantly less satisfied than those who had not. Physicians who had decreased breast surgical procedures and increased referrals for diagnosis and treatment of breast disease reported practicing defensive medicine more frequently. In a regression analysis, having been sued was a significant predictor of practicing defensive medicine more often. Physicians from states with malpractice crisis reported practicing defensive medicine more frequently and more lawsuits than physicians from stable states. Malpractice fears and defensive medicine continue to affect the practices of ob-gyns, most specifically, as this study shows, ob-gyns who provide breast care.

Special requirements of electronic medical record systems in obstetrics and gynecology.

There is growing recognition of the importance and potential benefit of information technology and electronic medical records in providing quality care for women. Incorporation of obstetrician-gynecologist-specific requirements by electronic medical record vendors is essential to achieve appropriate electronic medical record functionality for obstetrician-gynecologists. Obstetricians and gynecologists record and document patient care in ways that are unique to medicine. Current electronic medical record systems are often limited in their usefulness for the practice of obstetrics and gynecology because of the absence of obstetrician-gynecologist specialty-specific requirements and functions. The Certification Commission on Health Information Technology is currently the only federally recognized body for certification of electronic medical record systems. As Certification Commission on Health Information Technology expands the certification criteria for electronic medical records, the special requirements identified in this report will be used as a framework for developing obstetrician-gynecologist specialty-specific criteria to be incorporated into the Certification Commission on Health Information Technology endorsement for electronic medical records used by obstetrician-gynecologists.