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Residency training in obstetrics and gynecology may need to change to meet the changing health care needs of women. Emphasis on health maintenance and preventive care has increased. Different demographic changes will also change the patient population treated by obstetricians and gynecologists. Some types of subspecialization have been incorporated into obstetrics and gynecology, but others have been resisted. The resistance to increased subspecialization may be higher in obstetrics and gynecology than in other medical specialities. One problem with the proliferation of subspecialties in medicine is reduced attention to primary health care needs. Many women expect their gynecologists to have a broad range of knowledge. Residency training may need to encompass both subspecialty training and the provision of primary health care to women.

Several letters to the editor are presented in response to articles in previous issues including an article on the preference of home delivery in the August 29, 1977 issue, an essay on van as a means of transportation and another article on the failure of students to pass the U.S. Scholastic Aptitude Tests (SATs) in the September 5, 1977 issue.

Why are applications to ob/gyn residencies declining, albeit modestly? Surprisingly, lifestyle, professional liability concerns, and reimbursement were well ahead of male discrimination on the list of reasons given by these [...]

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 a 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 dean must look at the needs of the several consumers he serves as he assesses the strengths and weaknesses of a medical school department. The deans of the AAMC Southern Region medical schools perceive the major strengths of obstetrics and gynecology departments as patient care and resident programs; the major weakness, as insufficient faculty. Residency education has lagged behind progress in undergraduate learning. Numbers of graduate medical studients will soon need to be matched to the manpower needs of the region or state, not to the needs of the hospital. Departments can improve by relating their goals to those of the medical school and gathering comparative data to give support to their programs.

The major impact on the development of obstetrics-gynecology during the next 15 years will come from the substantially increased number of practicing physicians in the specialty and the less rapidly increasing patient population they will serve. Even at present record low fertility rates, the annual number of births in the United States will increase slowly to a level near 4 million by the early 1980's; children already born will contribute to a 16 per cent increase in the female population 15 to 44 years of age between now and 1990. Over the same time interval, the number of practicing specialists will increase dramatically, based on rising numbers of medical school graduates and more Ob-Gyn residents; there will be a 52 per cent increase in certified specialists per unit population over the next 15 years.

This final report from the cooperative manpower study of the University of Southern California and The American College of Obstetricians and Gynecologists describes the development of a female data file that outlines the care of women patients by all specialties. Obstetrician-gynecologists are compared to other specialists; they see 300,000 women per day in the United States and provide a wide range of care. Preventive care plays a larger role than in other major specialties, patient counseling and education are emphasized, and obstetric care is a major commitment. Nonetheless, acute and serious surgical and medical diagnoses are an important component of the practices of obstetrician-gynecologists.

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.

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.

The formal development of subspecialties within obstetrics and gynecology has focused attention on problems of physician supply and demand. The need for subspecialized practitioners appears to be 750 in maternal-fetal medicine and 350 each in reproductive endocrinology and gynecologic oncology. Taken together, this number represents about 10 per cent of presently certified specialists. As supply is now developing, the demand in gynecologic oncology should soon be saturated, but there will be a longer term demand in maternal-fetal medicine and in reproductive endocrinology. However, the expectation of 30 per cent of present residents that they will enter subspecialties is far in excess of available fellowships or ultimate need. Fellowships leading to subspecialty certification should be approved by the Residency Review Committee, and numbers should be limited to best estimate of need.

1. Evidence is accumulating that the ABO genes are not “neutral”, but are affected by natural selection.2. Such natural selection would be of obstetric importance.3. ABO incompatibilities cause a small percentage of cases of erythroblastosis fetalis.4. Group O mothers appear to have a lowered reproductivity as compared to mothers of other blood groups. The cause is uncertain, as is the exact degree of effect.5. Group O mothers may have a higher incidence of pre-eclampsia.6. Maternal isoimmunization by an ABO heterospecific fetus is a possible cause of some cases of pre-eclampsia.7. Further studies should throw more light on these interesting problems.

The inaccuracies of the modern obstetrical forceps and their possible relationships to perinatal mortality are outlined and discussed. A metric forceps designed by one of us, capable of measuring and recording the forces of compression and traction exerted during delivery, is presented. This modification is adaptable to almost any obstetrical forceps.

The free amino acid content of human placenta has not previously been reported, although such levels are known for many normal and malignant tissues. Free amino acids in the placenta increase during pregnancy although they are already quite high by 20 weeks. Compared to studies of uterus and endometrium, placental aspartic acid is high and glutamic acid is normal, while asparagineglutamine is uniformly low, suggesting a deficiency of asparagine and glutamine synthetase. In hydatidiform mole, aspartic and glutamic acid levels are low while asparagine and glutamine levels are comparable to those of normal placenta, suggesting that transamination is not a major metabolic activity of trophoblast. Placental arginine is high compared to levels in normal uterus. All other essential amino acids show little variation. Free amino acid levels are low in infarcted placenta and high in toxemic placenta. All tissue samples exhibited low levels of valine and proline, suggesting they are active, rather than degenerating.