Guild interests: an insidious threat to professionalism in obstetrics and gynecology.

Powerful incentives now exist that could subordinate professionalism to guild self-interest. How obstetrician-gynecologists respond to these insidious incentives will determine whether guild self-interests will define our specialty. We provide ethically justified, practical guidance to obstetrician-gynecologists to prevent this ethically unacceptable outcome. We describe and illustrate 2 major incentives to subordinating professionalism to guild self-interest: demands for productivity; and compliance and regulatory pressures. We then set out the professional responsibility model of ethics in obstetrics and gynecology to guide obstetrician-gynecologists in responding to these incentives so that they preserve professionalism. Obstetrician-gynecologists should identify guild interests affecting their group practices, set ethically justified limits on self-sacrifice, and prevent incremental drift toward dominance of guild self-interests over professionalism. Guild self-interests could succeed in undermining professionalism, but only if obstetrician-gynecologists allow this to happen. When guild self-interest becomes the deciding factor in patient care, professionalism withers and insidious incentives flourish.

Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest.

Professional medical associations (PMAs) play an essential role in defining and advancing health care standards. Their conferences, continuing medical education courses, practice guidelines, definitions of ethical norms, and public advocacy positions carry great weight with physicians and the public. Because many PMAs receive extensive funding from pharmaceutical and device companies, it is crucial that their guidelines manage both real and perceived conflict of interests. Any threat to the integrity of PMAs must be thoroughly and effectively resolved. Current PMA policies, however, are not uniform and often lack stringency. To address this situation, the authors first identified and analyzed conflicts of interest that may affect the activities, leadership, and members of PMAs. The authors then went on to formulate guidelines, both short-term and long-term, to prevent the appearance or reality of undue industry influence. The recommendations are rigorous and would require many PMAs to transform their mode of operation and perhaps, to forgo valuable activities. To maintain integrity, sacrifice may be required. Nevertheless, these changes are in the best interest of the PMAs, the profession, their members, and the larger society.

Outlook for the future of the obstetrician-gynecologist workforce.

OBJECTIVE: The objective of the study was to assess the future physician workforce with a sample of obstetrician-gynecologists. STUDY DESIGN: Two separate surveys regarding career satisfaction and retirement plans were sent to random samples of obstetrician-gynecologists under age 50 years (n = 2,000) and over the age of 50 (n = 2,100). RESULTS: Obstetrician-gynecologists over the age of 50 years who were working part time or were female were more satisfied than those working full time or were male. Obstetrician-gynecologists (under and over age 50 years) who were concerned about liability and unable to balance their work and personal lives were more dissatisfied. Obstetrician-gynecologists retired earlier than planned because of rising malpractice costs and later than planned because of high career satisfaction. CONCLUSION: Low career satisfaction may be adding to the already shrinking physician workforce. Offering part-time work opportunities and alleviating liability concerns may increase career satisfaction and help to combat a future of the physician workforce shortage.

Obstetrician-gynecologists and primary care: training during obstetrics-gynecology residency and current practice patterns.

PURPOSE: To assess obstetrician-gynecologists' perceptions of their residency training in primary care, document health issues assessed at annual visits, and identify practice patterns of both generalist and specialist obstetrician-gynecologists. METHOD: Questionnaires were mailed to a random sample of 1,711 American College of Obstetricians and Gynecologists Young Fellows in September 2005. Information was gathered on perceptions about adequacy of residency training, how well training prepared obstetrician-gynecologists for current practice, and typical practice patterns for various medical diagnoses. Data were analyzed using univariate analysis of variance, t tests, and chi-square tests. RESULTS: Of 935 respondents (55% response rate), physicians estimated that 37% of private, nonpregnant patients rely on them for routine primary care. Approximately 22% report that they needed additional primary care training, specifically for metabolism/nutrition and dermatologic, cardiovascular, and psychosexual disorders. A wide range of topics, except for immunizations, were typically discussed at annual visits. Patients with pulmonary diseases, vascular diseases, and nongenital cancers were most often referred to specialists, whereas patients with urinary tract infections, sexually transmitted infections, or who are menopausal are most often managed totally. Self-identification as a generalist or specialist was associated with some practice patterns. Respondents were neutral about the role of primary care in obstetrics-gynecology residency training. CONCLUSIONS: For several primary care issues, obstetrician-gynecologists assumed sole management for obstetric patients but deferred to a primary care physician for gynecological patients. There is a continuing need for primary care training in obstetrics-gynecology residency, although it is unclear whether current training is adequate to meet their needs.