Comparisons between Family Medicine and Ob-Gyn William F. Rayburn MD, MBA Professor and Chair, Dept. of Obstetrics & Gynecology University of New Mexico Consultant, Workforce Studies and Planning American 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: m Pursuit of residencies m Resident demographics m Residency graduates m Demographics of practitioners m Access to care m Consequences of shortages

American College of Surgeons m General surgery m Obstetrics and gynecology m Orthopedics m Otolaryngology m Opthalmology m Neurosurgery m Urology m Plastic surgery

Data Sets AAMC Association of American Medical Colleges ACOG American College of Obstetricians and Gynecologists AHA American Hospital Association Merritt Hawkins Search Firm NRMP National Resident Matching Program U.S. Census Bureau

Percent U.S. Medical Graduates and Specialty Salary AAMC

Residency Programs, 2011 ProgramsPositions Family medicine4532,708 General surgery2961,179 Ob-gyn2371,205 NRMP

Ob-Gyn Residents and Programs NRMP

Female Residents in Accredited Programs Average46.0% Family medicine55.6% Ob-gyn79.7% General surgery35.0% NRMP

African American, American Indian or Alaska Native, or Native Hawaiian or Pacific Islander Residents in Accredited Programs Average6.3% Family medicine8.0% Ob-gyn11.2% General surgery7.2% NRMP

Hispanic Residents in Accredited Programs Average8.0% Family medicine9.7% Ob-gyn9.0% General surgery8.3% NRMP

Abdominal hysterectomy Vaginal hysterectomy Laparoscopic hysterectomy Treatment of incontinence/pelvic floor repair Laparoscopy Operative hysterectomy Abortion Treatment on invasive cancer Gyn Procedures Performed by Residents ACOG

Active Physicians Practicing in Same State as Residency Training Average47.4% Family medicine55.6% Ob-gyn47.4% General surgery44.4% AAMC

Trends in Graduates from Residency Programs in Ob-Gyn Year Graduates (N) U.S. Population (100,000) Graduates per 100,000 Population (n) 19951,2482, ,2342, ,1072, ,1683, AAMC

Patients in the General Population Per Active Physician Internal medicine2,875 Family medicine2,919 Pediatrics5,579 Ob-Gyn7,600 Psychiatry7,661

Specialties With the Largest Numbers of Active Physicians Internal medicine104,904 Family medicine103,315 Pediatrics54,061 Ob-Gyn39,689 Psychiatry39,371

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 Average28.3% Family medicine31.3% Ob-gyn43.2% General surgery13.6% AAMC

Average Age at Which Fellows Stop Practicing Obstetrics Year All Fellows (Years) Males (Years) Females (Years) No data No data No data ACOG

Hospitals with Maternity Services AHA

Hospitals with Maternity Services 60-Minute Drive AHA USCB

Hospitals with Maternity Services 30-Minute Drive AHA USCB

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 Average37.6% Family medicine36.7% Ob-gyn38.5% General surgery42.4% AAMC

Change in Number of Active Physicians General surgery-1.0% Ob-gyn10.2% Family medicine33.0% AAMC

Physician Revenue by Payment Source Medical Specialty Medicare (%) Medicaid (%) Insurance (%) Self-pay (%) Other (%) All physicians Family practice Surgery Obstetrics and gynecology MH

Topics Assessed at a Typical Women’s Annual Visit Cervical cytology Breast examination Pelvic examination Alcohol, tobacco, or drug use Sexuality concerns Fitness and nutrition Psychologic well-being Cardiovascular risk factors Immunizations ACOG

Year Shortest Time Longest Time Average Time Accepting Medicaid (%) days 2.5 days 65.1 days 98.7 days 23.3 days 27.5 days 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) Estimated Nonphysician Practitioners (N) Certified nurse- midwives3811,546 Nurse practitioners350135,000 Physician assistants14085,345 ACOG

Visits to Retail Clinics URI, sinusitis32% Immunizations24% Pharyngitis16% Otitis8% UTI5% Conjunctivitis4% BP check2% Other10% Claims: National Ambulatory Medical Care Survey National Hospital Ambulatory Medical Care Survey, 2007