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The less you know the betterFrom: douglas krell (douglas.krell@nsionline.com)Sat Nov 30 05:55:31 1996
Michael Rice wrote:
> BTW, how do specialists feel about seeing well women for routine smears etc? Speaking for myself, I've always derived quite alot of the pleasure of medical practice from seeing the same patient back year after year and managing both prevention and treatment of those disorders for which women are at risk. The complexity of the condition, within the scope of my own particular interests, would determine when I would refer to other specialists. This is the model that most of us were taught and probably still believe in. It evolved quite naturally in an environment where patients were deemed intelligent enough to know which physician to choose and physicians were held accountable for their expertise. But today, by virtue of managed care practices, OB/GYNs are being strictly limited in the areas for which they can be reimbursed. If a patient has a fibroid uterus...no problem, she has approval for 2 visits. But if she presents with abnormal uterine bleeding, she's got to go through her primary physician first. If they can't figure it out, then and only then (usually 6 months later) the patient will get approval to see us. This is not a trend away from specialization, as some interpret it, but rather a quantum leap ahead. It's that access to the OB/GYN level of expertise is being controlled. If these trends continue, the irony is that as more and more medical students are opting for OB/GYN residencies, we will need fewer and fewer OB/GYNs. Which of you in academic medicine are ready to close down your residency programs? ... ....See the problem?
-- ---------- Douglas Krell MD FACOG Santa Fe
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