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Re: Urogynecology/Reconstructive Pelvic Surgery FellowshipsFrom: A.C. (A.C.Evans@m.cc.utah.edu)Tue Oct 28 13:07:41 1997
On Sun, 26 Oct 1997 23:50:24 -0600, elvis@llano.net (Michael J. Wolpmann, M.D.) wrote:
>A Woolean poll: I haven't fully appreciated the need for another subspecialty. I felt that I received adequate training in residency (Duke University) to perform the procedures that these specialists do. I clearly benefited from doing an oncology fellowship (in that I learned special surgical, chemotherapy, and XRT principles) and I think the Onc/REI/MFM fellowships are all reasonable as there is an expertise gained that one does not acquire in residency (at least the way that residencies are currently formatted). However, in my opinion, if finishing chief residents cannot do Burch/MMK/parvaginal repair/ss lig suspension/colpectomy-colpoceisis/abd sacral colpopexy/colpoplastic repairs, then there is something wrong with the numbers at that program. Most of these procedures are necessary for generalists to have in their armamentarium because of the prevalence of prolapse problems. Furthermore, the work up and decision about who needs operation and who doesn't should be part of training as well. I think it is unacceptable to think that a patient should have to travel a long distance to see a "specialist" for a condition that has been adequately treated by generalists for decades. It is all part of the "conspiracy" to convert Ob-Gyn into a glorified primary care specialty where providers cannot give general care as well as family practitioners and have less than adequate training in surgery. I, for one, would have chosen general surgery rather than Ob-Gyn if I had to do all of the primary care B.S. that is part of residency training these days. Sorry for the ranting but I am a strong proponent of training outstanding general Ob-Gyns who can provide the bulk of specialty-related care necessary for their patients. It is a shame that recent graduates are often forced to call internists or FPs for curbside consults because they are expected to provide "primary care" but have not been fully trained to do so. Furthermore, it is a terrible shame that these same docs are often calling me with *very basic* questions about pap smear management or other disorders that residency training used to give them an adequate background to manage. This dilution of specialty-related knowledge in favor of general knowledge has to stop. With regard to another recent topic on the list, there are definitely too many OB-Gyns being trained. There should be a dissolution or merger of programs with inadequate "numbers" (I won't argue what those numbers should be). We are not doing the patients any favor by unleashing inadequately trained specialists on the populace. Furthermore, we are not doing these docs any favors by putting them in situations they are too often inadequately trained to manage. Let's put primary care back in the hands of the internists and FP's and pride ourselves in providing excellent SPECIALTY care of patients in need of our services! A.C. Evans, M.D., Ph.D. Division of Gynecologic Oncology Univ. of Utah, Salt Lake City (801) 581-7640 A.C.Evans@m.cc.utah.edu acevans@hsc.utah.edu
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