Anticipated Shortages of Physicians
Comparisons between
Family Medicine and Ob-Gyn
William F. Rayburn MD, MBA
Professor and Chair, Dept. of Obstetrics & Gynecology
University of New Mexico
Consultant, Workforce Studies and Planning
American Congress of Obstetricians & Gynecologists
Objectives
After today’s session, the participant will gain
more knowledge in comparing between
family medicine and general ob-gyn for:
Pursuit of residencies
 Resident demographics
 Residency graduates
 Demographics of practitioners
 Access to care
 Consequences of shortages

American College of Surgeons
General surgery
 Obstetrics and gynecology
 Orthopedics
 Otolaryngology
 Opthalmology
 Neurosurgery
 Urology
 Plastic surgery

Data Sets
AAMC
Association of American Medical Colleges
ACOG
American College of Obstetricians and Gynecologists
AHA
American Hospital Association
Merritt Hawkins Search Firm
NRMP
National Resident Matching Program
U.S. Census Bureau
Percent U.S. Medical Graduates and Specialty Salary
AAMC
Residency Programs, 2011
Programs
Positions
Family medicine
453
2,708
General surgery
296
1,179
Ob-gyn
237
1,205
NRMP
Ob-Gyn Residents and Programs
NRMP
Female Residents in Accredited Programs
Average
46.0%
Family medicine
55.6%
Ob-gyn
79.7%
General surgery
35.0%
NRMP
African American, American Indian or Alaska Native, or Native
Hawaiian or Pacific Islander Residents in Accredited Programs
Average
6.3%
Family medicine
8.0%
Ob-gyn
11.2%
General surgery
7.2%
NRMP
Hispanic Residents in Accredited Programs
Average
8.0%
Family medicine
9.7%
Ob-gyn
9.0%
General surgery
8.3%
NRMP
Gyn Procedures Performed by Residents
Abdominal hysterectomy
Vaginal hysterectomy
Laparoscopic hysterectomy
Treatment of incontinence/pelvic floor repair
Laparoscopy
Operative hysterectomy
Abortion
Treatment on invasive cancer
ACOG
Active Physicians Practicing in Same State
as Residency Training
Average
47.4%
Family medicine
55.6%
Ob-gyn
47.4%
General surgery
44.4%
AAMC
Trends in Graduates from Residency
Programs in Ob-Gyn
Year
Graduates
(N)
U.S.
Population
(100,000)
Graduates per
100,000
Population (n)
1995
1,248
2,670
4.7
2000
1,234
2,820
4.4
2005
1,107
2,960
3.7
2010
1,168
3,100
3.8
AAMC
Patients in the General Population
Per Active Physician
Internal medicine
2,875
Family medicine
2,919
Pediatrics
5,579
Ob-Gyn
7,600
Psychiatry
7,661
Specialties With the Largest Numbers of
Active Physicians
Internal medicine
104,904
Family medicine
103,315
Pediatrics
54,061
Ob-Gyn
39,689
Psychiatry
39,371
None
0.1 to 1.0
1.1 to 2.0
per 10,000 women
2.1 to 3.0
3.1 to 4.0
4.1 or more
ACOG
Densities of Ob-Gyns
per 10,000
10,000 women
women
per
ACOG
Active Female Physicians by Medical
Specialty, 2007
Average
28.3%
Family medicine
31.3%
Ob-gyn
43.2%
General surgery
13.6%
AAMC
Average Age at Which Fellows
Stop Practicing Obstetrics
Year
All Fellows
(Years)
Males
(Years)
Females
(Years)
1985
49.4
No data
No data
1987
49.3
No data
No data
1990
49.8
No data
No data
1992
48.9
50.2
39.5
1996
46.6
48.4
39.2
1999
48.2
51.2
40.8
2003
48.0
51.0
42.0
2006
48.0
51.7
43.1
2009
48.0
51.9
43.8
ACOG
Hospitals with Maternity Services
AHA
Hospitals with Maternity Services
60-Minute Drive
AHA
USCB
Hospitals with Maternity Services
30-Minute Drive
AHA
USCB
Mean Ages of Male/Female Fellows at ACOG
ACOG
Age Intervals of the Fellows of ACOG
ACOG
Active Physicians Aged 55 Years or Older
Categorized by Medical Specialty, 2007
Average
37.6%
Family medicine
36.7%
Ob-gyn
38.5%
General surgery
42.4%
AAMC
Change in Number of Active Physicians
1996-2006
General surgery
-1.0%
Ob-gyn
10.2%
Family medicine
33.0%
AAMC
Physician Revenue by Payment Source
Medicare
(%)
Medicaid
(%)
Insurance
(%)
Self-pay
(%)
Other
(%)
All physicians
29
12
43
12
4
Family practice
23
12
44
17
4
Surgery
35
8
43
12
2
Obstetrics and gynecology
11
20
54
13
2
Medical Specialty
MH
Topics Assessed at a Typical Women’s
Annual Visit
Cervical cytology
Breast examination
Pelvic examination
Alcohol, tobacco, or drug use
Sexuality concerns
Fitness and nutrition
Psychologic well-being
Cardiovascular risk factors
Immunizations
ACOG
Wait Times Before Next Well-Woman
Gynecologic Examination
Year
Shortest
Time
Longest
Time
Average
Time
Accepting
Medicaid (%)
2004
3.0 days
65.1 days
23.3 days
60
2009
2.5 days
98.7 days
27.5 days
41
15 cities, 17 offices per city
MH
Ten Most Sought After Physicians
1. Family practice
2. Internal medicine
3. Hospitalist
4. Radiology
5. Orthopedic surgery
6. Obstetrics and gynecology
7. Cardiology
8. General surgery
9. Emergency medicine
10. Psychiatry
MH
ACOG
Advanced Ob-Gyn Training
Maternal-Child health fellowship
Women’s Health training in internal medicine
Re-entry of Ob-Gyns in the workforce
Nonphysician Practitioners
Types of
Nonphysician
Practitioners
Training
Programs in the
United States (N)
Estimated
Nonphysician
Practitioners (N)
Certified nursemidwives
38
11,546
Nurse practitioners
350
135,000
Physician assistants
140
85,345
ACOG
Visits to Retail Clinics
URI, sinusitis
Immunizations
Pharyngitis
Otitis
UTI
Conjunctivitis
BP check
Other
32%
24%
16%
8%
5%
4%
2%
10%
Claims: National Ambulatory Medical Care Survey
National Hospital Ambulatory Medical Care Survey, 2007