The role of gynecologists in providing primary care to elderly women

BACKGROUND Federal legislation has recently been proposed to designate obst etrician-gynecologists (OBGs) as primary care physicians. The institute of Medicine identifies care unrestricted by problem or organ system as an esse ntial characteristic of primary care. We examined the degree to which OBGs in the state of Washington offer this aspect of primary care to their elder ly patients by investigating the type and amount of nongynecologic care the y provide. METHODS Using 1994 Part B Medicare claims data for Washington residents, we identified visits made by women aged 65 years and older to OBGs (N=10,522) and 9 other types of specialists. Diagnoses were classified as in or out o f the domain of care traditionally provided by each specialty, Visit volume s, proportion of out of domain visits, and the frequency of diagnoses were reported, RESULTS Of the patient visits to obstetrician-gynecologists, 12.2% had nong ynecologic diagnoses. The median percentage of nongynecologic visits for in dividual OBGs was 6.7%. Patients who saw OBGs received 15.4% of their overa ll health care from an OBG; patients who saw family physicians received 42. 9% of their total health care from a family physician. CONCLUSIONS In 1994, a small amount of the care that Washington OBGs provid ed to their elderly patients was for nongynecologic conditions. Studies are needed to evaluate how the practices of OBGs have changed since the 1996 i mplementation of a primary care requirement in obstetrics-gynecology reside ncies, and if adopted, how legislation designating OBGs as primary care phy sicians affects the health care received by elderly women.