Re: TIC - US OB's beware!
From: D. Ashley Hill (dahmd@cfl.rr.com)
Fri Sep 24 13:05:49 2004
We have had mixed success. Several of our fellowship-trained family
physicians are doing more obstetrics than local obstetricians in their
rural communities. One is the chair of an academic department and an
instrumental part of his institution's maternity services. Another is
the director of obstetrics at her residency program. However, others
have attempted to use their training, even in fairly rural areas, and
have been unable to do so due to either obstruction from obstetrician
colleagues, or inability to see enough overall patients to generate
revenue to pay for liability premiums. The next 3-5 years should be
very intersting. Thanks,
Ashley
At Fri, 24 Sep 2004, Braun, R. Daniel wrote:
>
>I have seen two of the people trained in these programs. One never
>wanted privileges for C/S and actually gave up OB 2 years later. The
>other one got privileges, but never did them and 2 years later gave up
>OB. Both gave up on OB because they couldn't sdo enough deliveries to
>pay their Insurance costs.
>
>R. Daniel Braun, MD
>
>"If everyone likes you, you're doing something wrong."
>
>Kinky Friedman
>
>I believe a self-righteous liberal or conservative with a cause is more
>dangerous than a Hell's Angel with an attitude.
>
>Andy Rooney
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]
>Sent: Thursday, September 23, 2004 3:20 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: TIC - US OB's beware!
>
>..
>
>It might be of some interest to know that there are currently a number
>of programs in the country now that offer OB fellowships to FP's. They
>learn to do cesarean deliveries and spend a year (? maybe two ?) doing
>OB exclusively. (Perhaps some GYN, too, I do not know).
>
>Interesting idea.
>
>- - - -
>
>At 12:24 PM 9/22/2004 -0500, you 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
|
|
