Obstetrician-gynecologists as primary care physicians: the perspectives of health maintenance organization medical directors and obstetrician-gynecologists

Obstet Gynecol. 1997 Aug;90(2):291-5. doi: 10.1016/S0029-7844(97)00224-X.


Objective: To survey the interest of obstetrician-gynecologists in serving as primary care physicians and their perceived preparedness for that role from the view points of managed care plans and obstetrician-gynecologists.

Methods: A sample of obstetrician-gynecologists was asked to describe their preferred physician roles in managed care plans. Managed care medical directors were asked to define the obstetrician-gynecologist's role in their health plans. The mailed survey questions focused on 1) obstetrician-gynecologists' interest in serving as primary care physicians and/or gatekeepers, 2) direct access to obstetrician-gynecologists, and 3) additional training needed to serve as primary care physicians.

Results: Thirty-seven percent of obstetrician-gynecologists expressed little or no interest in serving as primary care physicians, and 37% had some or high interest. Fifty-six percent were not interested in serving as gatekeepers, and 45% believed that physicians in the specialty should not do so. Almost all believed women should be allowed direct access to obstetrician-gynecologists. Over half of the managed care plans allowed women to refer themselves to obstetrician-gynecologists, and one-third allowed these physicians to serve as primary care gatekeepers. Most plans believed that extensive additional training is needed for obstetrician-gynecologists to serve as gatekeepers, whereas 70% of specialists believed that little or no additional training is needed.

Conclusion: Obstetrician-gynecologists do not all agree on their appropriate and preferred role as physicians in the managed care environment; 37% see themselves as primary care physicians, whereas 37% would rather act as consultative specialists. Nearly all, however, support direct access to obstetrician-gynecologists. Most (69.7%) believe that they are capable of serving as primary care gatekeepers with little or no additional training, but managed care plans believe otherwise.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Female
  • Gynecology*
  • Health Maintenance Organizations*
  • Humans
  • Male
  • Middle Aged
  • Obstetrics*
  • Physician Executives*
  • Physician's Role*
  • Primary Health Care*
  • Referral and Consultation
  • United States