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 ser ving as primary care physicians and their perceived preparedness for t hat role from the view points of managed care plans and obstetrician-g ynecologists. Methods: A sample of obstetrician-gynecologists was aske d to describe their preferred physician roles in managed care plans. M anaged care medical directors were asked to define the obstetrician-gy necologist's role in their health plans. The mailed survey questions f ocused on 1) obstetrician-gynecologists' interest in serving as primar y 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-gynecol ogists expressed little or no interest in serving as primary care phys icians, 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 b e allowed direct access to obstetrician-gynecologists. Over half of th e managed care plans allowed women to refer themselves to obstetrician -gynecologists, and one-third allowed these physicians to serve as pri mary care gatekeepers. Most plans believed that extensive additional t raining is needed for obstetrician-gynecologists to serve as gatekeepe rs, whereas 70% of specialists believed that little or no additional t raining is needed. Conclusion: Obstetrician-gynecologists do not all a gree on their appropriate and preferred role as physicians in the mana ged care environment; 37% see themselves as primary care physicians, w hereas 37% would rather act as consultative specialists. Nearly all, h owever, support direct access to o obstetrician-gynecologists. Most (6 9.7%) believe that they are capable of serving as primary care gatekee pers with little or no additional training, but managed care plans bel ieve otherwise. (C) 1997 by The American College of Obstetricians and Gynecologists.