Should OB training remain a residency requirement? -- February 2002 -- FP Report

February 2002 • Volume 8 • Number 2

Should OB training remain a residency requirement?

BY SHERI PORTER

Lisa Corum, M.D., of Louisville, Ky., was surprised by the blizzard of e-mails that ensued after she posed a simple question to an AAFP e-mail discussion group: "Has anyone heard of a grassroots effort to eliminate OB as part of the residency requirement?" The topic had generated lively discussion at the December meeting of the Jefferson County chapter of the Kentucky AFP.

"None of our local members seemed to think limiting our scope of practice was an issue," said Corum, an alternate delegate from the new physicians' constituency and a firm supporter of mandatory maternity training in residency.

Here's a sampling from that blizzard of e-mail responses.

MEMBERS SPEAK OUT

"Even if we decide not to do OB, we still need to be knowledgeable about the pregnant patient, as often we will need to provide them care during their pregnancy." Robert Reneker, M.D., of Grandville, Mich.
"I think one of the most important things our OB experience teaches us is to respect pregnancy, but not to fear it." Glenn Loomis, M.D., of Fishers, Ind.
"A large mission of our specialty remains care for the rural and underserved populations. OB skills are essential to meet that need." Patrice Burgess, M.D., of Boise, Idaho
"Exposure to many areas of medicine makes our residents more flexible in looking for new practices." Melissa Behringer, M.D., of Owens Cross Roads, Ala.
"Even if we do not provide OB, we still have pregnant women walk into our offices, and I know I am better prepared to care for their sinusitis than an internal medicine/pediatrics graduate." Derek Anderson of Baton Rouge, La.
"I've been doing OB in my practice for 21 years. I'd hate to have been told as a resident that it was optional, and in a tired, post-call moment have decided to opt out!" Judy Chamberlain, M.D., of Brunswick, Maine
"I feel strongly that family medicine should not change its identity in order to attract people who are uninterested in obstetrics." Chris Gaynor, M.D., of Seattle
"OB is a beacon of light among the ocean waves of EMTALA regulations, HIPAA deadlines and diminishing returns on charges covered by insurance carriers." Sabine Maas, M.D., of Linville, N.C.

CALLS FOR CHANGE

While the e-mails generated by Corum's question all reflect similar sentiments, there is another side to the issue.

Daniel Hafendorfer, M.D., of Louisville, Ky., president of the Jefferson County chapter, said the number of unfilled family practice residencies nationwide is climbing. "We're seeing a significant number of young medical students going into internal medicine/pediatrics," said Hafendorfer, "and many of them have said to me, 'Well, I would have gone into family practice if I didn't have to do the extensive OB work.'"

Couple that with the shrinking number of FPs who actually do maternity care, said Hafendorfer, and the need for change becomes clear. (According to AAFP's 2001 edition of Facts About Family Practice, 30 percent of members include obstetrics in their practices.)

"Why are we spending all the time and training on maternity care, potentially alienating residents who might consider family practice, when the majority of FPs don't do OB?" asked Hafendorfer. Make OB training optional, not mandatory, for the specialty's residents, he suggested.

THE BOTTOM LINE

"OB care in family practice isn't going away," said Perry Pugno, M.D., director of the AAFP Division of Medical Education. "Both the Residency Review Committee for Family Practice and the Residency Assistance Program concur that training in maternity care is still a core curriculum element of family practice residency education."

AAFP President-elect James Martin, M.D., of San Antonio said the current dialogue about maternity care "has been very rewarding for those of us who see maternity care as an important part of the family physician education." Martin directs the Christus Santa Rosa Family Practice Residency Program in San Antonio.

"There are groups of people in family medicine who say we shouldn't be providing maternity care, and there are others who say it's an integral part of what we do," said Martin. "This issue is being pushed by some programs and will be discussed by the Future of Family Medicine committee -- a panel exploring options for the specialty and ways to involve many FPs in the ongoing discussion. As we work through the FOFM project, hopefully we'll be able to come to some conclusions, and that will influence the type of curriculum we include in our training."

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