Looking down the prospectoscope: obstetrics/gynecology in the year 2000 and beyond

It should be emphasized that the American College of Obstetricians and Gynecologists is advocating that those Obstetrician/Gynecologists who wish to be included under this new designation primary care physician "provide only ambulatory primary care," states the Executive Director, Dr. Ralph W. Hale. Thus, we enter a new era and must understand the lexicons, including HMO, independent provider organization, PPO, managed care organization, exclusive provider organization, IPA, hospital-physician organization, health plan provider data and information set, physician-hospital organization and utilization management--all these have become words with increased meaning for all clinicians. It is a rare physician lounge without physicians preoccupied by discussions regarding managed care, "Have you heard the latest reimbursement schedule?" or "It's less than Medicaid," and the discussions continue indefinitely. There has been a continued effort to have physicians be cost-efficient in their approach to all aspects of obstetrical and gynecological care. Capitation has proven to be the virtually exclusive method of reimbursement. Continued care with respect to clinical outcome, resource utilization, patient satisfaction, and quality care restructuring of practice/personnel/patient approach is based on the quarterly patient surveys, which have been evaluated and carefully reviewed. Patient satisfaction with a sincere effort to provide quality of care remains the underlying theme with respect to obstetrical and gynecological patient care. These are basic tenets. What is the future of obstetrics/gynecology with respect to managed health care? It does make sense to have a planned and well-coordinated approach to delivery of obstetrical as well as gynecological care with the goal of "quality" delivered at a "lower cost" having an overall positive impact on OB/GYN health care delivery. Currently, there are a number of states which have specific legislation enabling a patient to proceed to secure gynecological without going through a "gatekeeper." As we approach the year 2000 and beyond, clearly the prediction is that this will be an ever-increasing goal and objective of state medical societies to provide easy access for women's health care. Thus, we have awakened into a new era that is hallmarked by efficient, quality medical care provided by a physician who initially trained to be a subspecialist and now is an ambulatory primary care physician.