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.