Obstetrics and gynaecology

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Overview

Obstetrics and Gynaecology (often abbreviated to OB/GYN or O&G) are the two surgical specialties dealing with the female reproductive organs, and as such are often combined to form a single medical speciality and postgraduate training program. This combined training prepares the practicing OB/GYN to be adept at the surgical management of the entire scope of clinical pathology involving female reproductive organs, and to provide care for both pregnant and non-pregnant patients. The training for physicians in this field is often quite arduous: in Australia, for example, the residency training period is among the longest at six years, matched only by neurosurgery. In the United States, however, OB/GYN specialists require four years of secondary education at an accredited college or university, followed by four years of medical school and four years in residency. Some OB/GYN surgeons elect to do further subspecialty training in programs known as 'fellowships' after completing their residency training, although the majority choose to enter private or academic practice as general OB/GYNs. Fellowship training in an obstetric or gynaecologic subspeciality can range from one to four years in duration, and these 'fellowship' programs usually have a research component involved with the clinical and operative training.

Examples of subspecialty training available to physicians in the US are:

  • Maternal-Fetal Medicine - an obstetrical subspecialty that focuses on the medical and surgical management of high-risk pregnancies
  • Reproductive Endocrinology and Infertility - gynaecologic subspecialty focusing on the medical and surgical evaluation of women with problems related to the menstrual cycle and fertility
  • Gynaecological Oncology - gynaecologic subspecialty focusing on the medical and surgical treatment of women with cancers of the reproductive organs
  • Urogynaecology and Pelvic Reconstructive Surgery - gynaecologic subspecialty focusing on the diagnosis and surgical treatment of women with urinary incontinence and prolapse of the pelvic organs. Sometimes referred to (incorrectly) by laypersons as "Female Urology"
  • Advanced Laparoscopic Surgery
  • Family Planning - gynaecologic subspecialty offering training in contraception and (sometimes) pregnancy termination
  • Pediatric and Adolescent Gynaecology
  • Menopausal and Geriatric Gynaecology

Of these, only the first four are truly recognized sub-specialties by the Accredited Council of Graduate Medical Education (ACGME) and the American Board of Obstetrics and Gynecology (ABOG.) The other sub-specialities are recognized as informal concentrations of practice. To be recognized as a board-certified subspecialist, a practitioner must have completed an ACGME-accredited fellowship and obtained a Certificate of Added Qualifications (CAQ) which requires an additional standardized examination. [1]

In rural areas of the United States, particularly in areas west of the Mississippi River, it is not uncommon for general practitioners to offer obstetrical services to their patients. However, these generalists are most often not trained in the surgical aspects of obstetrics, nor have they been trained in gynaecology, and as such, they should not be confused with residency trained and board-certified OB/GYNs. All gynaecologists, therefore, are trained obstetricians, although the reverse is not necessarily true. However, some OB/GYNs may choose to drop the obstetric component of their practice and focus solely on gynaecology, especially as they get older. This decision is often based on the double burden of very late hours and, depending on the country, high rates of litigation.

In the last few years, medical malpractice suits and skyrocketing insurance premiums have forced many American obstetricians and gynaecologists to leave or limit their practice. From 2000 through 2 increasingly choosing not to specialize in obstetrics (see Bower 2003). This led to a critical shortage of obstetricians in some states and often, fewer health care options for women - although it did lead to higher average salaries, as an article by Medical Economics points out. [1]. However, beginning in 2004, increasing state legislation mandating tort reform combined with the ACGME's decision to limit resident work hours lead to a gradual resurgence in the number of medical students choosing OB/GYN as a specialty. In the medical residency match for 2007, only six spots in OB/GYN training programs remained vacant throughout the entire United States; a record low number, and one that puts OB/GYN on-par in terms of competitiveness with other surgical specialties. [2]

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