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    Maintaining excellence in obstetrics and gynecology

    A call to action from leaders in the field.

     

    2. Student debt

    Student debt is having a major impact on the medical profession. The ability to quickly pay off student loans likely plays a role in students’ career choices. The median medical school debt is now $160,000 for public and $190,000 for private schools.14 Students entering training for primary care, with its inherently lower salaries, have the worst tuition-to-annual-earnings ratio, but ob/gyn residents are not far behind.15,16

    In addition, young physicians with high debt loads who choose to practice ob/gyn may be drawn to more lucrative subspecialties rather than generalist careers.

    3. Excessive documentation

    Excessive documentation, a challenge faced by the entire medical profession, is contributing to ob/gyns leaving the workforce in mid-career or taking early retirement.17

    Regulations imposed by the Centers for Medicare & Medicaid Services (CMS) and by commercial payers increase the time required to deal with authorization and increasingly complicated coding documentation. Contemporary electronic health records (EHRs) have been fashioned to link together patient data, order entry, coding, compliance, charge capture, and billing, and to meet regulations to ensure thoroughness of care. However, the need to be “comprehensive” is often at odds with the equally important goal of simplification, resulting in EHR products that challenge even the most computer-savvy provider.

    Recommended: Is surgical training in ob/gyn residency adequate?

    One study reported that emergency room doctors can spend 43% of their time entering data (requiring as many as 4000 mouse clicks per 10-hour shift), versus 28% talking to patients.18

    4. High professional liability insurance costs

    An ob/gyn is the 7th-most-likely specialist to be a defendant in a professional liability suit, resulting in elevated liability insurance premiums.19 This heightens practice overhead and contributes to the overall cost of medical care. Defensive medicine further escalates cost. A 2012 survey17 showed that 15% of obstetricians increased their cesarean delivery rate, 12% left private practice, and 4% moved to another state because of fear of possible litigation. That survey also indicated that the professional liability cloud has driven 1 in 20 ob/gyns out of active obstetrical practice altogether.

    This adversarial aspect of the work environment also leads to physician burnout, further exacerbating shortages.

    Solutions

    1. Improve specialist training

    The focus of all ob/gyn training programs should be to create more “all-pro” specialists. Specialists should be hired to teach and to provide clinical care. Academic medical centers also could establish a nontraditional faculty model to populate affiliated hospitals. In that model, nontraditional faculty would focus primarily on patient care along with a cadre of traditional academic faculty appointees.20,21

    Nontraditional faculty members help maintain clinical volume and revenue, allowing traditional faculty more time to pursue academic activities. Additional support would be needed from health systems or hospitals that benefit from revenue generated by these physicians.

    2. Recycle expertise

    Another source of clinical expertise is the large cohort of retired or soon-to-be-retired ob/gyns. As part-time faculty members, they could educate students/residents while providing clinical expertise developed through years of experience. Strategies to minimize professional liability insurance costs should be pursued to retain this vital intellectual capital without draining department funds needed for research.

    NEXT: Improving patient safety

    John C Hobbins, MD
    Dr Hobbins is Professor of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, Colorado.
    E. Albert Reece, MD, PhD
    DR. REECE is Vice Chancellor and Dean of the College of Medicine and Professor, Departments of Obstetrics and Gynecology, Internal ...
    Nathan Kase, MD, MS
    Dr Kase is Dean Emeritus, Professor of Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai Health System, New York, New York.
    Hugh Taylor, MD
    Dr Taylor is Chair and Anita O’Keefe Professor of Obstetrics, Gynecology and Reproductive Sciences and Professor of Molecular, Cellular, ...
    Thomas Hanson, MD
    Dr Hanson is Clinical of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
    Joshua A. Copel, MD
    DR. COPEL is Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Director of ...

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