Obstetrics and Gynecology
Obstetrician-gynecologists (OB/GYN) are physicians who possess special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders, such that it distinguishes them from other physicians and enables them to serve as consultants to other physicians and as primary physicians for women. Over the years of practice, each obstetrician-gynecologist builds upon this broad base of knowledge and skills and may develop a unique type of practice and changing professional focus. Such diversity contributes to high-quality health care for women.
Resident education in obstetrics-gynecology must include four years of accredited, clinically-oriented graduate medical education, which must be focused on reproductive health care and ambulatory primary health care for women, including health maintenance, disease prevention, diagnosis, treatment, consultation, and referral.
There are also subspecialties in obstetrics and gynecology, which require additional training: maternal-fetal medicine specialists are obstetricians/gynecologists who are prepared to care for, and to consult on, patients with high-risk pregnancies; and reproductive endocrinologists are capable of managing complex problems related to reproductive endocrinology and infertility, including aspects of assisted reproduction, such as in vitro fertilization (IVF).
The description of this surgical specialty was adapted from a description set forth by the American Board of Medical Specialties (ABMS).
Obstetrics and Gynecology as a Career
Obstetrics and gynecology is a broad and diverse branch of medicine, including surgery, management of the care of pregnant women, gynecologic care, oncology, and primary health care for women.
Most OB/GYNs are generalists and see a variety of medical conditions in the office, perform surgery, and manage labor and delivery. Office practice consists of providing women with preventive examinations and other primary care and identifying gynecologic problems. OB/GYNs typically evaluate infertility, abnormal uterine bleeding, leiomyomato, pelvic masses, pelvic organ prolapse, abnormal Pap smears, pelvic pain, endometriosis, breast disorders, and urinary incontinence. Examples of minor office procedures are colposcopy, endometrial biopsy, Pap smears, and vulvar biopsy. Office ultrasound is performed for both obstetrics and for gynecologic conditions. Some generalists provide considerable primary care in addition to the typical gynecologic procedures. Examples of outpatient procedures include laser surgery, diagnostic laparoscopy, operative laparoscopy such as laparoscopic ovarian cystectomy, tubal ligation, diagnostic and operative hysteroscopy, and endometrial ablation. Inpatient surgical procedures include hysterectomies performed vaginally, abdominally, and laparoscopically. Other examples of inpatient procedures include abdominal or laparoscopic myomectomies. Obstetrical procedures include cervical cerclage, dilation and curretage, amniocentesis, Cesarean section, circumcision, and forceps and vacuum deliveries.
There are four primary subspecialty fellowships in OB/GYN: gynecologic oncology, reproductive endocrinology and infertility, maternal fetal medicine, and female pelvic medicine and reconstructive surgery. These fellowships run three years following completion of the initial four-year core residency program, with one of the fellowship years committed to research. Other fellowships are available in genetics and pediatric and adolescent gynecology.
Gynecologic oncology deals primarily with neoplasias of the uterus, ovary, cervix, and vulva. Reproductive endocrinology and infertility encompasses the entire field of infertility with procedures such as IVF, GIFT, ZIFT, and embryo transfer.
The field of female pelvic medicine and reconstructive surgery evaluates and treats women with pelvic organ prolapse, fecal/urinary incontinence, and other urinary disorders. MFM specialists treat pregnant women with complicated medical conditions such as HTN, DM, renal disease, preterm labor, and coagulopathies.
Approximately 90 percent of OB/GYNs are generalists and begin practice after completing a four-year residency in OB/GYN. Private practice typically consists of office hours two to four days a week, surgery one to one and one half days a week, and management of labor and delivery. Generalists most commonly practice in small or large groups. A small number of OB/GYNs are in solo practice. Call is usually dependent on practice size.
The specialty of OB/GYN covers a variety of health care for women. As such an OB/GYN can perform primary care, have continuity of care, and provide surgical services.
Attribution: American College of Surgeon, Val Y. Vogt, MD, FACS, Germantown, TN