Federal legislation has recently been proposed to designate obstetrician-gynecologists (ob-gyns) as primary care physicians. Many managed care programs already allow women to see their ob-gyns for routine gynecologic care without referrals. Few studies have measured the degree to which ob-gyns already provide primary care and have focused mostly on surveys of women in their reproductive years. A recent study of elderly women reveals that most ob-gyns in Washington State in 1994 provided very little nongynecologic care to elderly women, a finding consistent with other studies examining the scope of ob-gyns' practices.
Designating ob-gyns as primary care providers could affect the way general medical services are delivered to elderly women. Many elderly women may have nongynecologic medical conditions that require treatment and monitoring. If most ob-gyns do not routinely provide these services, these women will require referral to medical specialists. This could lead to increasing costs, inconvenience, and fragmentation of care, according to the researchers.
In a study cosponsored by the Agency for Healthcare Research and Quality (290-93-0136), the Office of Rural Health Policy, and the Robert Wood Johnson Foundation, the researchers examined the degree to which ob-gyns in the State of Washington offered primary care to elderly women in 1994. They used Medicare claims data for Washington residents to identify visits made by women 65 years of age and older to ob-gyns and nine other types of specialists.
About 12 percent of visits made by elderly women to ob-gyns had nongynecologic diagnoses. The median percentage of nongynecologic visits for individual ob-gyns was 7 percent. Patients who saw ob-gyns received over 15 percent of their overall health care from an ob-gyn compared with the 43 percent of total health care received by elderly women who saw family physicians. The researchers recommend studies to evaluate how the practices of ob-gyns have changed since the 1996 initiation of ob-gyn residency requirements for primary care, as well as studies on the impact of how Federal legislation designating ob-gyns as primary care doctors affects the health care received by elderly women.
More details are in "The role of gynecologists in providing primary care to elderly women," by Kenneth S. Fink, M.D., M.G.A., Laura-Mae Baldwin, M.D., M.P.H., Herschel W. Lawson, M.D., and others, in the February 2001 Journal of Family Practice 50(2), pp. 153-158.
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