1. 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 Anticipated Shortages of Physicians

3. Objectives After today’s session, the participant will gain more knowledge in comparing between family medicine and general ob-gyn for: m Pursuit of residencies m Resident demographics m Residency graduates m Demographics of practitioners m Access to care m Consequences of shortages

4. American College of Surgeons m General surgery m Obstetrics and gynecology m Orthopedics m Otolaryngology m Opthalmology m Neurosurgery m Urology m Plastic surgery

5. 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

6. Percent U.S. Medical Graduates and Specialty Salary AAMC

7. Residency Programs, 2011 ProgramsPositions Family medicine4532,708 General surgery2961,179 Ob-gyn2371,205 NRMP

8. Ob-Gyn Residents and Programs NRMP

9. Female Residents in Accredited Programs Average46.0% Family medicine55.6% Ob-gyn79.7% General surgery35.0% NRMP

10. African American, American Indian or Alaska Native, or Native Hawaiian or Pacific Islander Residents in Accredited Programs Average6.3% Family medicine8.0% Ob-gyn11.2% General surgery7.2% NRMP

11. Hispanic Residents in Accredited Programs Average8.0% Family medicine9.7% Ob-gyn9.0% General surgery8.3% NRMP

12. Abdominal hysterectomy Vaginal hysterectomy Laparoscopic hysterectomy Treatment of incontinence/pelvic floor repair Laparoscopy Operative hysterectomy Abortion Treatment on invasive cancer Gyn Procedures Performed by Residents ACOG

13. Active Physicians Practicing in Same State as Residency Training Average47.4% Family medicine55.6% Ob-gyn47.4% General surgery44.4% AAMC

14. Trends in Graduates from Residency Programs in Ob-Gyn Year Graduates (N) U.S. Population (100,000) Graduates per 100,000 Population (n) 19951,2482,6704.7 20001,2342,8204.4 20051,1072,9603.7 20101,1683,1003.8 AAMC

15. Patients in the General Population Per Active Physician Internal medicine2,875 Family medicine2,919 Pediatrics5,579 Ob-Gyn7,600 Psychiatry7,661

16. Specialties With the Largest Numbers of Active Physicians Internal medicine104,904 Family medicine103,315 Pediatrics54,061 Ob-Gyn39,689 Psychiatry39,371

17. per 10,000 women ACOG

18. per 10,000 women Densities of Ob-Gyns per 10,000 women ACOG

19. Active Female Physicians by Medical Specialty, 2007 Average28.3% Family medicine31.3% Ob-gyn43.2% General surgery13.6% AAMC

20. Average Age at Which Fellows Stop Practicing Obstetrics Year All Fellows (Years) Males (Years) Females (Years) 198549.4No data 1987 49.3No data 1990 49.8No data 199248.950.239.5 199646.648.439.2 199948.251.240.8 200348.051.042.0 200648.051.743.1 200948.051.943.8 ACOG

21. Hospitals with Maternity Services AHA

22. Hospitals with Maternity Services 60-Minute Drive AHA USCB

23. Hospitals with Maternity Services 30-Minute Drive AHA USCB

24. Mean Ages of Male/Female Fellows at ACOG ACOG

25. Age Intervals of the Fellows of ACOG ACOG

26. Active Physicians Aged 55 Years or Older Categorized by Medical Specialty, 2007 Average37.6% Family medicine36.7% Ob-gyn38.5% General surgery42.4% AAMC

27. Change in Number of Active Physicians 1996-2006 General surgery-1.0% Ob-gyn10.2% Family medicine33.0% AAMC

28. Physician Revenue by Payment Source Medical Specialty Medicare (%) Medicaid (%) Insurance (%) Self-pay (%) Other (%) All physicians291243124 Family practice231244174 Surgery35843122 Obstetrics and gynecology112054132 MH

29. 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

30. Year Shortest Time Longest Time Average Time Accepting Medicaid (%) 2004 2009 3.0 days 2.5 days 65.1 days 98.7 days 23.3 days 27.5 days 60 41 15 cities, 17 offices per city Wait Times Before Next Well-Woman Gynecologic Examination MH

31. 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

32. ACOG

33. Advanced Ob-Gyn Training Maternal-Child health fellowship Women’s Health training in internal medicine Re-entry of Ob-Gyns in the workforce

34. Nonphysician Practitioners Types of Nonphysician Practitioners Training Programs in the United States (N) Estimated Nonphysician Practitioners (N) Certified nurse- midwives3811,546 Nurse practitioners350135,000 Physician assistants14085,345 ACOG

36. Visits to Retail Clinics URI, sinusitis32% Immunizations24% Pharyngitis16% Otitis8% UTI5% Conjunctivitis4% BP check2% Other10% Claims: National Ambulatory Medical Care Survey National Hospital Ambulatory Medical Care Survey, 2007