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

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.