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Discusses the implications of the U.S. Supreme Court's decision in 'Webster v. Reproductive Health Services,' for practicing physicians. Four distinct issues addressed in the actual ruling of the court, in the opinion written by Chief Justice Rehnquist; Supreme Court's upholding of the Missouri prohibitions against performance of abortions in public facilities and against public employees' performing or assisting abortions.

Objective: To determine the level and types of primary and preventive care services delivered by obstetrician-gynecologists., Methods: A self-administered questionnaire was mailed to a random sample of 1250 obstetrician-gynecologists practicing in the United States. The response rate was 71%., Results: Fifty-three percent of the respondents indicated that they provide primary and preventive care during more than half of their practice time. Although obstetrician-gynecologists provide a wide range of preventive services, the proportion of doctors providing any specific service varies. Whereas virtually all (92% or more) obstetrician-gynecologists provide or order blood pressure screening, breast examinations, mammography, and Papanicolaou tests, only six of ten report regular cholesterol screening for most of their patients. A higher percentage of female obstetrician-gynecologists, who are on average younger than their male counterparts, report that they provide primary preventive services to most of their patients., Conclusion: The majority of obstetrician-gynecologists provide a wide range of primary and preventive care services to their patients, although there is variability in the proportion of doctors providing any specific service to most (60% or more) of their patients.

In obstetrics and gynecology residency education is a fixed prescription, whereas the world of practice leads physicians in diverse directions. Nonetheless, obstetrics and gynecology has so far resisted the proliferation of subspecialties. The future scope of our specialty will be defined by the changing healthcare needs of women. These will be driven by changing demographics and an emphasis on preventive and primary care. Residency education and, to a lesser extent, forms of practice will have to change to meet women's needs.

Residencies in obstetrics and gynecology are popular with graduating medical students, especially women, and positions are filled in excess of 100%. New Accreditation Council for Graduate Medical Education special requirements have focused on several clinical areas and require demonstration of scholarly activity by faculty and 24-hour in-house faculty coverage. Other issues of current concern are resident work hours, pregnancy among residents, and training of residents in induced abortion.

In 1990, the American College of Obstetricians and Gynecologists (ACOG) became the first national organization to receive a model phase Integrated Academic Information Management System (IAIMS) grant from the National Library of Medicine. The goal of the ACOG model phase project is to develop and test a prototype for an integrated system that will meet the needs of ACOG and NAACOG members in patient care, research, education, and administrative information. The model phase goal will be accomplished primarily through ACOGQUEST, an integrated approach to providing accurate, current, quality-filtered information to ACOG and NAACOG members in a variety of formats. Another method of information dissemination now being tested is a heuristic-based patient management database, which will include a concise, interactive display of ACOG-reviewed information that can be incorporated into patient records.

Although much has been accomplished in the last few years toward the early detection of breast cancer, we are far from a goal of universal acceptance of the recommended preventive health program of screening mammography. To take an analogy from the Papanicolaou smear, we are somewhere in the 1960s. Both women and physicians have more to learn, and they need to transfer that knowledge into practice.

Medical school full-time faculties continue to grow, despite unchanged numbers of medical students and residents. The 136 United States schools have 2091 male and 861 female full-time faculty, an increase of 22% over the past 4 years. The mean faculty size is 21.6. While numbers of certified subspecialist faculty also continue to increase, a decreasing percentage of all subspecialists are associated with medical schools. More than 1000 additional faculty are anticipated over the next 5 years. Among all faculty, only 34% of physicians devoted 20% or greater time to research. Although total research funding averages over $1 million per department, there are wide disparities, with 59 departments receiving less than $100,000 in federal funding. Obstetric-gynecologic departments as a group receive 1.5% of all National Institutes of Health research funds.

A sample survey of 769 ACOG Fellows who were age 60 or older in 1990 was undertaken to determine current patterns of retirement. Among 415 respondents, only 23% reported remaining in full-time practice of both obstetrics and gynecology, with an additional 16% in full-time practice of gynecology only. Full-time practice was reduced to part-time for 24% at the mean age of 63. Thirty-eight percent were fully retired at the mean age of 67.

A geographically stratified sample of Fellows and Junior Fellows of The American College of Obstetricians and Gynecologists (ACOG) responded to a questionnaire, describing the source, coverage, and cost of their professional liability insurance, and the effects this had on patterns of practice. Most physicians carry primary professional liability coverage, although 6% do not. The majority pay less than $8000/year for a wide variety of dollar coverages. Less than half of the surveyed obstetrician-gynecologists carry excess/umbrella liability insurance, and a majority pay less than $2000/year for this coverage. The liability problem has not had a substantial effect on restricting the number of obstetrician-gynecologists, but it has had a major effect on patterns of practice.

A cooperative study between the University of Southern California Division of Research in Medical Education and the American College of Obstetricians and Gynecologists represents one subset of a large-scale study of manpower supply in obstetrics-gynecology. A stratified random sample of all obstetrician-gynecologists was obtained from the AMerican Medical Association's "Master File of Physicians." A total of 879 respondents (56 per cent of the sample) completed a detailed, one-week log of practice activities and self-descriptive questionnaire. This initial report describes these physicians by practice arrangement as related to age and geography. Practice work load is identified by encounter time per patient, work hours per day and week, and variations related to geographic location and population served. The descriptive findings may have important implications for manpower planning.

A further report from the cooperative manpower study of the University of Southern California American College of Obstetricians and Gynecologists has identified characteristics of patients and their diagnoses and classified types of patient-physician encounters. Obstetrician-gynecologists care for women mainly between the ages of 20 and 44, deal two thirds of the time with only five diagnostic categories in the office and 10 in the hospital, and provide primary care in 78.2% of all patient encounters.

Since 1980 medical school faculty growth has essentially ceased, in comparison to earlier substantial increases. Women are represented in full-time faculty positions in a larger proportion than among practicing obstetrician-gynecologists. Subspecialist numbers on faculties have increased, with a small decline in generalist obstetrician-gynecologists. Despite the current plateau, medical school departments project a 36% increase in faculty members during the next five years, and an even larger increase in faculty involved in research.

An excess of physicians ranging from 21,000 to 70,000 has been predicted for 1990, including a "surplus" of 10,450 obstetrician-gynecologists. Published supply figures have been overestimated. In 1990, the supply of and the demand for obstetrician-gynecologists should be essentially in balance. The classic law of supply and demand is beginning to operate in medical care.

Both the precepts and the impact of regional planning for maternity care are often misunderstood. Here, a summary of 8 separate studies in 5 geographic regions describes the reactions of obstetrician-gynecologists to systems of regional planning, as well as their use of the system and the impact of regional planning on their practices. Overall, few physicians acquired new obstetric privileges, and closure of maternity services had limited impact on their practices. Approximately 50% of the physicians referred some patients to level 2 or 3 units, but only 25% actually transferred patients in a given year. The perceptions of a majority of physicians were of improvement in patient services and physician education as a result of regional planning activities. Recommendations are offered for additional needed studies of regional planning efforts.

By the year 2000 nearly 60% of practicing obstetrician-gynecologists will have graduated from medical school after 1975 and been in practice 20 years or less. At the midpoint of that era we estimate and examine the numbers of such specialists (more than 40,000 by the year 2000), the percentage of women obstetrician/gynecologists (26% in the year 2000), their predominant forms of practice, practice differences between men and women specialists, the changing and aging of the populations of women they will serve, and the participation of young physicians in medical organizations. All of these reflect the picture of our specialty when a new century begins.