So, is OB/GYN primary care or not?

[Metamorphosis.DO]

Heard it is. Heard it isn’t.

As an M2 seriously interested since my youth in OB/GYN and having considered FM for a second in M1 year because of my interest in doing “a little of everything”, hope much primary care things do you get in OB/GYN?

When do you defer back to PCP? Or do you? Would you refer to a specialist? Do many women list their OB/GYN as PCP? Is it Physician dependent?

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[anonperson]

Heard it is. Heard it isn’t.

As an M2 seriously interested since my youth in OB/GYN and having considered FM for a second in M1 year because of my interest in doing “a little of everything”, hope much primary care things do you get in OB/GYN?

When do you defer back to PCP? Or do you? Would you refer to a specialist? Do many women list their OB/GYN as PCP? Is it Physician dependent?

The party line from ACOG is that we're primary care. This manifests in inservice exams etc.

In reality, it depends on the practice setting.

Most will routinely refer back to the PCP for management of HTN, DM, hypothyroidism etc. We are not versed into the latest guidelines. Could you take care of this stuff? Sure, with some additional reading etc.

My thought is I'm paid to specialize in gynecologic and urogynecologic disorders. That's why patients are sent to me. The pcp isn't interested in my ability to manage primary care stuff. They want my knowledge on abnormal bleeding, pelvic pain, incontinence, prolapse etc. If I do that well, the patient is happy and the referring physician is happy.

 

[gyngyn]

Heard it is. Heard it isn’t.

You heard right.

 

[Dr G Oogle]

It is only in this country. Everywhere else it’s a consulting service. ACOG believes an obgyn should be a surgeon, obstetrician and PCP all in one, in reality you end up being at best average at all 3, unless you focus on something

 

[gyngyn]

It is only in this country. Everywhere else it’s a consulting service. ACOG believes an obgyn should be a surgeon, obstetrician and PCP all in one, in reality you end up being at best average at all 3, unless you focus on something

Long ago (I believe it was in the 80's), there was a move to create primary care "homes" that would not permit access to specialty care without a referral from a PCP. In order to keep self-referral intact, ACOG developed the strategy of identifying OBG as a primary care specialty. Even though the medical homes never fully came to pass, we have been stuck with the watered-down PCP curriculum ever since. I can remember going to give the oral boards every year, dreading the primary care questions. We all had to rely on the APGO-CREOG crowd to give us the answers! It has gotten much better since then, at least at the boards...

OBG has always been recognized as a centrally important specialty by the NHSC.

 

[Dr G Oogle]

Long ago (I believe it was in the 80's), there was a move to create primary care "homes" that would not permit access to specialty care without a referral from a PCP. In order to keep self-referral intact, ACOG developed the strategy of identifying OBG as a primary care specialty. Even though the medical homes never fully came to pass, we have been stuck with the watered-down PCP curriculum ever since. I can remember going to give the oral boards every year, dreading the primary care questions. We all had to rely on the APGO-CREOG crowd to give us the answers! It has gotten much better since then, at least at the boards...

Some people are still super insistent that OBG tx HLD and HTN and do non-gyn screening, but in my mind that’s as potentially fraught as FM doing OB. Specialty training exists for a reason

 

[gyngyn]

Some people are still super insistent that OBG tx HLD and HTN and do non-gyn screening, but in my mind that’s as potentially fraught as FM doing OB. Specialty training exists for a reason

That would be the same CREOG folks I referred to. They drank their own Kool Aid...

 

[Dr G Oogle]

There people on the local level, my former chair was super into it, he was an MFM and said everyone should do everything but US should be left to fellowship trained people…clearly it is harder to master than a sacrocolpopexy