Re: TIC - US OB's beware!
From: D. Ashley Hill (dahmd@cfl.rr.com)
Wed Sep 22 22:00:39 2004
Anna-
I realize Dr. Joe's comments were TIC, but I agree with Anna that there
are many underserved areas in the US where obstetricians are not readily
available to perform cesarean deliveries (or, in fact, any delivery). In
some parts of the country an obstetrician would have to fly in to help.
We train one obstetrics fellow a year. These are board-certified family
physicians who wish to learn operative obstetrics. Our most recent
fellow performed over 250 cesareans, including several cesarean
hysterectomies. I recently recruited several ob/gyn faculty. Our
fellow had "numbers" very comparable to the ob/gyn recruits graduating
from residency within the last two years, and in many cases exceeded the
operative experience of most applicants. Typically family physicians
choose areas where they can participate in deliveries for communities
that could not support an obstetrician (for example, rural Colorado or
rural Oregon). Unfortunately, those days may be coming to a close, as
liability insurance premiums escalate for anyone delivering babies.
Family physicians generally make a lot less than obstetricians, and they
may not be able to generate enough income to overcome the cost of
liability insurance for the obstetrics portion of their practice.
Thanks,
Ashley
At Wed, 22 Sep 2004, Anna Meenan, MD wrote:
>
>Actually, we do have a couple of FP's in our department who are trained
>to do c-sections, and I'm sure that quite a bit of the backup will fall
>to them. One is actually a guy who trained in OB in Argentina and
>decided to become an FP when he came here. Here's the thing, though.
>Most of the folks delivered through the residency program here are
>Public Aid patients, those which the local OB's have sort of declined to
>deliver. We used to have several hospital-based clinics in this town
>that were staffed by rotating OB's, but over the years, things have
>pretty much consolidated into the residency program and the local
>federally-funded clinic for the Underserved. The private docs have
>pretty much dropped out of the picture, the perinatologists have
>declined to take on the complete care of any high-risk patients (they
>will consult only and bounce them right back to the FP's). Basically,
>we now have HUNDREDS of pts, many of them high-risk (alcoholics,
>addicts, sicklers, diabetics, hypertensives, etc) being cared for by
>FP's and FP residents, because no one else will. We have a small group
>of OB's in the University department who provide our backup, but not
>enough to provide 24/7 in-house coverage. The hospital is trying to
>find locum tenens guys for nighttime coverage, but that's not gonna come
>cheap, and this particular hospital is already shouldering quite a bit
>of the burden of OB care for the underserved in this town (almost all of
>it, in fact).
>
>And yes Joe, we are continuing to train about one resident a year to do
>c-sections, Amazingly, not everyone in this country is able to have
>their baby in a major metropolitan hospital, and with folks dropping OB
>due to malpractice increases, it's getting even harder to find someone
>who can do a c-section in rural areas, so these guys (and gals) are
>filling a need. It would be nice if we could, for instance, tell every
>woman in Louisiana that she will have to come to New Orleans to have her
>baby, but then I suspect that we would begin to see an increase in the
>number of babies born halfway across the causeway over Lake
>Ponchartrain.
>
>Basically, we're not trying to erode anyone's power. We're just
>stepping in where others have stepped out. If the L&D unit in this
>particular hospital has to close due to lack of coverage for inductions,
>it will create a HUGE gap in this town that no one is willing to fill.
>
>--
> Anna Meenan, MD, FAAFP
>
>At Sat, 18 Sep 2004, DoctorJoe@aol.com wrote:
>>
>>Ah, another sneaky conspiracy by FPs to have THEM trained (at the 3rd year
>>level) to be able to do C-sections. Another erosion of the OB's power. Next
>>thing you know, MIDWIVES will have C-section privileges, just to keep JCAHO
>>accreditation (and ability to collect all that federal money, etc., etc. - Follow
>>the money.")
>>
>>Joe P.
>
--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, Florida
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