"Workloads rising for ob/gyns"
Here's an interesting article in the current issue of the Medical Post. Interesting excerpts from this article include the fact that while there are 1500 Ob/GYN's in Canada, only two-thirds (1000) are actually practising obstetrics. Obstetrics providers had almost double the annual billings of non-obstetrics providers ($364,000 vs $187,000), but take vastly more call (105 days vs 13).
Ob/GYN physicians tend to take on more obstetrics when they are younger as a way of building their practices. In general, as their practices start to fill up, there is often a shift away from obstetrics (and the difficult on call schedule that it entails), and towards gynecology, which is more often electively scheduled, and therefore has more regular hours with less on call demands.
One thing is certain, and that is that new graduates in Ob/GYN will have more than enough patients and work if they decide they want it.
Workloads rising for ob/gyns
Trend related to changing demographics, attitude of physician pool
By Karen Richardson
March 30, 2004 Volume 40 Issue 13
TORONTO – Many obstetrician-gynecologists got out of the business of delivering babies over the last decade, leaving a heavier workload for their colleagues, a new study from the Institute for Clinical Evaluative Sciences (ICES) shows.
ICES researchers examined physician billings from Ontario and found the percentage of Ontario ob/gyns delivering babies dropped to 77% (445 of 581) in 2002, from 82% (463 of 563) in 1993.
This decline in obstetrical participation resulted in a 5.6% increase in the annual number of deliveries per physician among those performing deliveries.
"What we're seeing here is partially related to the changing demographics and attitudes of the physician pool," wrote Dr. Ben Chan, a senior scientist at ICES and lead author of the study, in a prepared statement.
Participation in obstetrics declined with age and there was an accelerated decline after age 65. Ninety-six per cent of ob/gyns younger than 35 years of age practised obstetrics versus only 34% of those older than age 64.
Researchers said the decline occurred partly because women doctors were less likely than men of the same age to perform obstetrics.
"As more women enter the specialty and as there is more emphasis on work and life balance in general by all physicians, fewer of them wish to continue with the rigorous on-call schedule of obstetrics," according to Dr. Chan.
Among practising ob/gyns, women performed 11% fewer deliveries per physician in the fiscal year 2001/02 than did men.
The fact that female physicians were more likely than males to relinquish obstetrics, particularly in the prime years in the middle of their career, raises the issue of how to balance quality-of-life issues for women in the workforce, researchers said.
Even more worrisome than the statistics showing the decline in obstetrical practice is that in the next 10 years there will be two cohorts of ob/gyns leaving obstetrics, according to Dr. André Lalonde, executive vice-president of the Society of Obstetricians and Gynecologists of Canada (SOGC).
Dr. Lalonde, who commented on the study for the Medical Post, said the first cohort will be retiring. "Not too many people over 65 do obstetrics compared to other branches of medicine."
In addition, there is a cohort of younger GPs and ob/gyns opting out of obstetrics well before they used to historically.
"This is very worrisome for us," said Dr. Lalonde, who added GPs are moving out of the practice faster than obstetricians. "There are medico-legal issues, obstetrics is not valued that much and there is no financing for supporting obstetricians in their offices, for example (with) nurse practitioners, midwives and nurses."
The SOGC is examining the idea of collaborative practice, and they have recently submitted an application to the federal government to conduct research on the topic, said Dr. Lalonde.
One possible solution might be to have family practice residents rotate in obstetrics and community hospitals. "If they rotate in a large urban centre, they will be less likely to do deliveries in the future," he said.
Family physicians should also be encouraged to work in group practices with a minimum of two or three physicians performing obstetrics to help maintain a reasonable lifestyle, he said.
"In addition, certainly a better collaboration among all those involved—nurses, midwives, family physicians, gynecologists—would help retain young people in this specialty."
In Canada, there are an estimated 1,530 ob/gyns, and just slightly more than 1,030 who practise obstetrics. "Fully one-third of the obstetrician-gynecologists in this country are not even in the field of obstetrics."
The study also showed:
n Once a physician has abandoned obstetrical practice, the likelihood of returning to obstetrics is very low, approximately 1% per year.
n The number of ob/gyns increased by 3.2% from 563 in 1992/93 to 581 in 2001/02.
n Obstetrics providers had almost double the annual billings of non-providers ($364,000 vs. $187,000), but more on-call days worked (105 versus 13).
The findings of the study raise concerns about who will provide obstetrical services for the population in the future.
"Fortunately for obstetrical planners in Ontario, total births declined by 13% in the past decade," the researchers noted.
While alternatives to care by ob/gyns include family physicians and midwives, recent trends in the U.S. and Canada have shown a declining participation of family physicians in obstetrics, possibly related to fear of malpractice lawsuits or the desire for a balanced lifestyle.
"Our study has revealed some important trends that policy-makers need to be aware of in order to adequately plan for future obstetrical requirements in Ontario," said Dr. Chan. "Although midwives will increasingly play an important role in the delivery of routine obstetrical care, there still needs to be a sufficient number of obstetricians to deal with the more complex cases."
There is also concern that midwives are opting out of the profession, according to Dr. Lalonde. "A large number of Ontario midwives are not renewing their licences. This is worrisome because we are counting on them being able to absorb more obstetrics."
Dr. Chan and researchers acknowledged the study was limited, as they were not able to determine physicians' underlying motives for withdrawing from obstetrics. They were also unable to track whether doctors relinquishing obstetrics moved into the practice of assisted reproductive technologies, such as in vitro fertilization.
Dissatisfaction with the speciality due to a difficult lifestyle, however, is the most likely reason for the declining numbers, said Dr. Lalonde. "A difficult delivery at 2:30 a.m. is nothing compared to the glamour of daytime surgery, where they are paid a lot more than to deliver a complicated obstetrical case."
The study, "Factors Influencing Participation in Obstetrics by Obstetrician-Gynecologists," is published in the March issue of Obstetrics & Gynecology.