Choosing An OB-GYN For Primary Care
According to the most recent data available from the American College of Obstetricians and Gynecologists (ACOG), over half of women surveyed (54%) consider their ob-gyns to be their primary physician – the first doctor they see for all their health care needs.
When women select their ob-gyns as their PCPs, what should they keep in mind to ensure that this is the best choice for their health? We asked several experts to weigh in on this issue.
Background and Training
“One of the first things women need to be aware of is that the training requirements for ob-gyns have changed,” says Amy Young, M.D., director of the division of medical education at Baylor College of Medicine in Houston. “During 48 months of residency, ob-gyn residents must complete 4 to 6 months of primary care training. And, 20% of the exam for Board certification in ob-gyn is devoted to primary care of women.
These training requirements were developed in 1995 and revised again in 2000 to continue to support the teaching of primary care to ob-gyn residents, says Dr. Young. That means physicians who completed their training in ob-gyn prior to that time will not have formal training in primary care. “An earlier generation of physicians will not be trained in primary care,” she says. “Women need to establish that with their physicians,” she notes.
Even physicians who went through training before the primary care requirement was instituted for ob-gyns often provide primary care by default, Dr. Young points out. “We’ve always been doing primary care, because once patients became pregnant no other physicians wanted to take care of them anyway,” she observes.
Some of her patients are surprised when she addresses primary care issues with them. “There is still a culture change going on,” she says. “When I recommend a colonoscopy or talk about a lipid profile, some patients, especially if they are older and not used to having an ob-gyn who provides primary care, are surprised that I even know about these things.”
It is important to find out if your ob-gyn is comfortable providing primary care – not all are completely at ease in that role. “Ask your ob-gyn what percentage of his or her patients are primary care patients,” advises Naomi Stotland, M.D., clinical instructor in ob-gyn at the University of California, San Francisco.
“If it is a very small fraction, you might want to see a family physician or internist in addition to your gynecologist.”
She points out, “Many internists and family practice doctors are skilled at gynecologic care, just as many ob-gyns are skilled at primary care. Just ask your doctor.” She adds, “If the doctor is not comfortable with some aspect of your care, he or she will generally tell you this, and refer you to someone else for that care.”
Some ob-gyns prefer that their patients establish a relationship with another physician for primary care. Kathleen Ober, M.D., an ob-gyn at Partners for Women’s Health in Exeter, New Hampshire says, “There is so much to know about primary care. I feel completely confident as a specialist, knowing what I know and knowing when to refer.”
However in her view, the primary care training she completed is inadequate to manage many primary care issues, “Personally, I don’t feel that my 6 months of training makes me competent to manage hypertension, hypercholesterolemia, or type II diabetes,” she says. “And I don’t really want patients with a 103 temperature and a sore throat calling my office.” Women are better off in the hands of a family practice or internal medicine physician, per Dr. Ober.
There are Advantages
In general, ob-gyns are “very good at prevention of diseases that women get fairly regularly” says Michelle P. Warren, M,D., professor of medicine and obstetrics and gynecology at Columbia University. “There are advantages to seeing an ob-gyn from that perspective, because they will screen for osteoporosis and order regular mammograms,” she says.
In addition, an ob-gyn will understand hormonal changes and the diseases that can surface as a result of these changes, per Dr. Warren. A case in point is polycystic ovarian syndrome (PCOS), she says. “PCOS often goes undiagnosed in general medicine, especially in young women. It is a premorbid condition and medical people should be diagnosing it, but they’re not.”
Timing is Important
In deciding who is best suited to provide your primary care, keep in mind that your health needs change over time. “During a woman’s reproductive years, before menopause, most of a woman’s health care needs are easily addressed by her ob-gyn,” says Dr. Naomi Stotland. “After menopause, women are at higher risk for diseases like hypertension and heart disease.”
Dr. Ober who prefers not to treat sore throats or sprains, acknowledges that younger women with no chronic conditions may well seek primary care from their ob-gyn. “When a young patient comes to me for PAP smears and birth control pills, I don’t encourage her to see another physician,” she says. “But when a woman gets into her mid – 40s or 50s and isn’t seeing someone besides myself, I let her know that she needs to establish herself with a primary care physician.”
The focus of a woman’s primary care will change after she reaches 60, says Dr. Warren. The key to determining where to get the best care is to ask plenty of questions, she points out. “If you have a specific condition or concern, ask up front whether the doctor treats it,” she recommends. “Certain medical practices are more women’s health friendly than others.”
Getting What You Need
You will also need to take an active role in ensuring that you are being offered recommended health screenings at the appropriate age. Talk with your prospective doctor about the tests and procedures you may need, given your age, current health status, and family history. Your doctor may refer to the guidelines developed by the U.S. Preventive Services Task Force in 1996. This review and discussion will help to safeguard your health, whether you select a family practice physician or an ob-gyn to provide your primary care.
Before You Choose
- Ask your ob-gyn what percentage of his or her practice is primary care.
- If you have a specific condition or concern, (menopause, diabetes, other) talk with the doctor about prevention and treatment for that issue.
- If your ob-gyn is providing primary care, clarify what to do and whom to call when you have a routine illness or minor injury (e.g., sore throat, sprain).
- Review the health screenings you need, and talk with your doctor about scheduling these tests.