Subspecialisation in obstetrics and gynaecology--whither (or wither) the generalist

In 1987, Council of the Royal Australian College of Obstetricians and Gynaecologists (RACOG) established its subspecialisation committee who identified subspecialty groups. It was the belief of the subspecialty committee that specialty training was necessary if haphazard evolution of the subspecialties and fragmentation within the discipline of obstetrics and gynaecology was to be avoided. The major issues of such training are manpower considerations and the time committed to the subspecialty, its effect on research and whether the generalist obstetrician and gynaecologist has been disadvantaged by such an initiative. Research initiatives must not suffer and the subspecialist should be prominent in the respective fields informing colleagues of important clinical and research advances. Undoubtedly the workload of the generalist will be eroded but their importance in the practice of obstetrics and gynaecology must be strengthened. The generalist should be encouraged to assist in the management of the patient in association with the subspecialist and referral should be on a tertiary basis. The limits of subspecialisation must be clearly defined and the availability and distribution of subspecialists determined. The numbers should be carefully monitored and training and accreditation and certification of subspecialists should remain within a central body such as the RACOG.