Comparisons betweenFamily Medicine and Ob-Gyn

William F. Rayburn MD, MBA

Professor and Chair, Dept. of Obstetrics & GynecologyUniversity of New Mexico

Consultant, Workforce Studies and PlanningAmerican Congress of Obstetricians & Gynecologists

Anticipated Shortages of Physicians

Objectives

After today’s session, the participant will gain more knowledge in comparing between family medicine and general ob-gyn for:

Pursuit of residencies Resident demographics Residency graduates Demographics of practitioners Access to care Consequences of shortages

American College of Surgeons

General surgery Obstetrics and gynecology Orthopedics Otolaryngology Opthalmology Neurosurgery Urology Plastic surgery

Data Sets

AAMCAssociation of American Medical Colleges

ACOGAmerican College of Obstetricians and Gynecologists

AHAAmerican Hospital Association

Merritt Hawkins Search Firm

NRMPNational Resident Matching Program

U.S. Census Bureau

Percent U.S. Medical Graduates and Specialty Salary

AAMC

Residency Programs, 2011

Programs Positions

Family medicine 453 2,708

General surgery 296 1,179

Ob-gyn 237 1,205

NRMP

Ob-Gyn Residents and Programs

NRMP

Female Residents in Accredited Programs

Average 46.0%

Family medicine 55.6%

Ob-gyn 79.7%

General surgery 35.0%

NRMP

African American, American Indian or Alaska Native, or Native Hawaiian or Pacific Islander Residents in Accredited Programs

Average 6.3%

Family medicine 8.0%

Ob-gyn 11.2%

General surgery 7.2%

NRMP

Hispanic Residents in Accredited Programs

Average 8.0%

Family medicine 9.7%

Ob-gyn 9.0%

General surgery 8.3%

NRMP

Abdominal hysterectomyVaginal hysterectomyLaparoscopic hysterectomyTreatment of incontinence/pelvic floor repairLaparoscopyOperative hysterectomyAbortionTreatment on invasive cancer

Gyn Procedures Performed by Residents

ACOG

Active Physicians Practicing in Same State as Residency Training

Average 47.4%

Family medicine 55.6%

Ob-gyn 47.4%

General surgery 44.4%

AAMC

Trends in Graduates from Residency Programs in Ob-Gyn

YearGraduates

(N)

U.S. Population (100,000)

Graduates per 100,000

Population (n)

1995 1,248 2,670 4.7

2000 1,234 2,820 4.4

2005 1,107 2,960 3.7

2010 1,168 3,100 3.8

AAMC

Patients in the General PopulationPer Active Physician

Internal medicine 2,875

Family medicine 2,919

Pediatrics 5,579

Ob-Gyn 7,600

Psychiatry 7,661

Specialties With the Largest Numbers of Active Physicians

Internal medicine 104,904

Family medicine 103,315

Pediatrics 54,061

Ob-Gyn 39,689

Psychiatry 39,371

None 0.1 to 1.0 1.1 to 2.0 2.1 to 3.0 3.1 to 4.0 4.1 or more

per 10,000 women

ACOG

per 10,000 women

Densities of Ob-Gyns

per 10,000 women

ACOG

Active Female Physicians by Medical Specialty, 2007

Average 28.3%

Family medicine 31.3%

Ob-gyn 43.2%

General surgery 13.6%

AAMC

Average Age at Which FellowsStop Practicing Obstetrics

YearAll Fellows

(Years)Males

(Years)Females (Years)

1985 49.4 No data No data

1987 49.3 No data No data

1990 49.8 No data No data

1992 48.9 50.2 39.5

1996 46.6 48.4 39.2

1999 48.2 51.2 40.8

2003 48.0 51.0 42.0

2006 48.0 51.7 43.1

2009 48.0 51.9 43.8

ACOG

Hospitals with Maternity Services

AHA

Hospitals with Maternity Services60-Minute Drive

AHAUSCB

Hospitals with Maternity Services30-Minute Drive

AHAUSCB

Mean Ages of Male/Female Fellows at ACOG

ACOG

Age Intervals of the Fellows of ACOG

ACOG

Active Physicians Aged 55 Years or Older Categorized by Medical Specialty, 2007

Average 37.6%

Family medicine 36.7%

Ob-gyn 38.5%

General surgery 42.4%

AAMC

Change in Number of Active Physicians1996-2006

General surgery -1.0%

Ob-gyn 10.2%

Family medicine 33.0%

AAMC

Physician Revenue by Payment Source

Medical Specialty Medicare (%)

Medicaid (%)

Insurance (%)

Self-pay (%)

Other (%)

All physicians 29 12 43 12 4

Family practice 23 12 44 17 4

Surgery 35 8 43 12 2

Obstetrics and gynecology 11 20 54 13 2

MH

Topics Assessed at a Typical Women’s Annual Visit

Cervical cytologyBreast examination

Pelvic examination

Alcohol, tobacco, or drug use

Sexuality concerns

Fitness and nutrition

Psychologic well-being

Cardiovascular risk factors

Immunizations

ACOG

YearShortest

TimeLongest

TimeAverage

TimeAccepting

Medicaid (%)

2004

2009

3.0 days

2.5 days

65.1 days

98.7 days

23.3 days

27.5 days

60

41

15 cities, 17 offices per city

Wait Times Before Next Well-Woman Gynecologic Examination

MH

Ten Most Sought After Physicians

1. Family practice

2. Internal medicine

3. Hospitalist

4. Radiology

5. Orthopedic surgery

6. Obstetrics and gynecology

7. Cardiology

8. General surgery

9. Emergency medicine

10. Psychiatry

MH

ACOG

Advanced Ob-Gyn Training

Maternal-Child health fellowship

Women’s Health training in internal medicine

Re-entry of Ob-Gyns in the workforce

Nonphysician Practitioners

Types of Nonphysician Practitioners

Training Programs in the United States (N)

EstimatedNonphysician

Practitioners (N)

Certified nurse-midwives 38 11,546

Nurse practitioners 350 135,000

Physician assistants 140 85,345

ACOG

Visits to Retail Clinics

URI, sinusitis 32%Immunizations 24%

Pharyngitis 16%

Otitis 8%

UTI 5%

Conjunctivitis 4%

BP check 2%

Other 10%

Claims: National Ambulatory Medical Care Survey National Hospital Ambulatory Medical Care Survey, 2007