Consultant obstetricians/gynecologists' practice profiles in an ontario community

There is a perceived shortage of obstetricians/gynecologists in Canada. One recommendation to address this shortage is for obstetricians/gynecologists to restrict their practice to consultation. Such a move would have a direct effect on family physicians' patterns of practice. This paper compares the practice profiles of four consultant obstetricians/gynecologists working in an Ontario community of 150,000 people served by 82 family doctors and one community hospital, with the profiles of their provincial counterparts. The four consultants performed substantially more consultative and procedural services, particularly surgery, and on average earned approximately 25% more than other Ontario obstetricians/gynecologists. The Hospital Medical Records Institute data obtained from the community hospital demonstrated that the 82 family doctors performed over 90% of the uncomplicated and 60% of the complicated deliveries. The authors conclude that a shift to a consultant type of practice by obstetricians/gynecologists could significantly alter the specialist-to-population ratio required for this specialty, but that further study is needed to determine the impact of this shift on the quality of care.