The role of gynecologists in providing primary care to elderly women.
BACKGROUND
Federal legislation has recently been proposed to designate obstetrician-gynecologists (OBGs) as primary care physicians. The Institute of Medicine identifies care unrestricted by problem or organ system as an essential characteristic of primary care. We examined the degree to which OBGs in the state of Washington offer this aspect of primary care to their elderly patients by investigating the type and amount of nongynecologic care they provide.


METHODS
Using 1994 Part B Medicare claims data for Washington residents, we identified visits made by women aged 65 years and older to OBGs (N=10,522) and 9 other types of specialists. Diagnoses were classified as in or out of the domain of care traditionally provided by each specialty. Visit volumes, proportion of out of domain visits, and the frequency of diagnoses were reported.


RESULTS
Of the patient visits to obstetrician-gynecologists, 12.2% had nongynecologic diagnoses. The median percentage of nongynecologic visits for individual OBGs was 6.7%. Patients who saw OBGs received 15.4% of their overall health care from an OBG; patients who saw family physicians received 42.9% of their total health care from a family physician.


CONCLUSIONS
In 1994, a small amount of the care that Washington OBGs provided to their elderly patients was for nongynecologic conditions. Studies are needed to evaluate how the practices of OBGs have changed since the 1996 implementation of a primary care requirement in obstetrics-gynecology residencies, and if adopted, how legislation designating OBGs as primary care physicians affects the health care received by elderly women.
Fink
K S
KS
Department of Family Medicine, School of Medicine, University of Washington, Seattle,  USA. kenneth_fink@unc.edu
Baldwin
L M
LM
Lawson
H W
HW
Chan
L
L
Rosenblatt
R A
RA
Hart
L G
LG
D000367:Age Factors; D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D016345:Medicare Part B / Q000706:statistics & numerical data; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D010819:Physician's Role; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States; D014861:Washington; D016387:Women's Health