Declining surgical case-load of the obstetrician-gynecologist

The National Hospital Discharge Survey indicates that rates of obstetric and gynecologic operations in the United States plateaued from 1979 to 1984, despite an increase in the number of obstetricians-gynecologists. Thus, the average surgical case-load of the obstetrician-gynecologist has declined. During this interval, rates of diagnostic dilation and curettage fell by nearly one-third, while rates of cesarean delivery and infertility operations continued to increase. As surgical case-loads decrease, obstetricians-gynecologists are likely to direct greater attention toward primary prevention, including prevention of cervical neoplasia, tubal infertility, unplanned pregnancy, and osteoporosis. In the years ahead, social gynecology may emerge as a discipline of equal stature as surgical gynecology in the United States.