Ethical challenges in the managed practice of obstetrics and gynecology

Obstetrics and gynecology has been transformed from a fee-for-service, unma naged system to a prepaid managed system. This change poses significant eth ical challenges, which we address. We show that obstetrician-gynecologists and medical institutions are moral co-fiduciaries of female and pregnant pa tients, that the obstetrician-gynecologist should be economically disciplin ed without capitulating to managed care, and that managed care organization s have an obligation to support the medical education and research from whi ch they benefit. (Obstet Gynecol 1999;93:304-7. (C) 1999 by The American Co llege of Obstetricians and Gynecologists.).