Making the Tough Calls: Unmet—and Overmet—Needs

As physicians who care for women, ob-gyns must recognize the unmet needs of some of our patients—and the over-met needs of others. Carefully evaluating the needs of each of our patients will help improve care and reduce costs.

Every woman deserves health care that is necessary and appropriate for her. She also deserves a health care system that doesn’t burden everyone with unnecessary costs. In the changing healthcare environment, optimizing resources is critical for the continued improvement of women’s health care.

Many women in the U.S. have health care needs that are unmet. The ob-gyn workforce is dramatically mal-distributed over geographic areas. According to a 2008 study published in the New England Journal of Medicine, four out of five new physicians begin practice in regions where the physician supply is already high.

As a profession, we must make sure we provide services in areas of greatest need. We must not leave behind communities with long-standing deficits in health and well-being. ACOG continues to advocate for these women through the activities of the department on Health Care for Underserved Women. We stand by the principal that all women deserve access to health care.

Physicians also play a major role in controlling health care costs. Recent improvements in research and technology have given physicians many additional diagnostic and treatment options, but not every new option is appropriate for every patient. It is critical for ob-gyns to connect value to cost to reduce inefficient care.

A great example is ACOG’s partnership with Choosing Wisely. The Choosing Wisely campaign was designed to promote conversation between doctors and patients to encourage only appropriate and necessary treatment. By following the guidelines from Choosing Wisely, physicians can make sure that they are not “over-meeting” the needs of patients.

As the only group of physicians whose primary role is to provide care for women, ob-gyns have a unique leadership role to play in making these tough calls. Our goal is to make sure every women in the U.S. gets the care she needs. No more, and no less.

ACOG’s Executive Board is Working for You

In my role as ACOG President, I have the opportunity to work with many talented and dedicated people who serve on the Executive Board. The Board consists of national officers, district chairs, members at large, subspecialty representatives, and a public member. Our purpose is to carry out the objectives of ACOG by conducting the general management of the organization.

The recent meeting on July 12-14 was particularly productive.

The Board accepted the soon-to-be-published report from Immediate Past President Dr. Jeanne Conry’s Women’s Wellness Task Force. The task force worked to update and define key components of the well-woman visit, including age-specific recommendations for screening studies and other preventive health measures. The report also supports the value of offering pelvic examination as a component of the well-woman visit. This thoughtful and scientifically-based report supports the important role that obstetricians and gynecologists play in health care throughout a woman’s lifetime.

The Board also approved a strategic action plan for promoting global women’s health. The Global Operations Advisory Group was initiated by past president Dr. Jim Martin and has made remarkable progress since 2009. This new strategic plan is designed to organize and strengthen resources for health care efforts in other countries. ACOG members interested in global health affairs will have better opportunities to serve and learn from these structured programs. ACOG is the premier organization for women’s health and the Board’s support for global operations is a source of pride for all ACOG Fellows.

Another important responsibility of the Board is to approve and reaffirm policies of the organization. In an effort to insure transparency of all ACOG policies, the Board voted to provide access to policies through the ACOG website. This will let the public as well as members know where ACOG stands on important issues.

The Board is busy in many other areas as well. We received reports from working groups assigned to address needs of our Fellows related to practice transformation associated with health reform, and to promote leadership of women’s health care teams. Additionally, the Council of District Chairs is exploring ways to expand direct communications with our membership.

It was an honor to preside over this meeting. The Executive Board and all of our leadership are working hard to meet the needs of our Fellows and the women we serve!

Help Prevent Group B Strep this Month

July is International Group B Strep Awareness Month. Group B Strep (GBS), found in 10–30% of pregnant women, is the leading cause of sepsis and meningitis in newborns, according to the US Centers for Disease Control and Prevention (CDC).

Ob-gyns have long been aware that preventing GBS is a key part of our commitment to protecting the health of newborns. Now we have the tools at our fingertips—literally—to be more effective.

Ingbsapp 2010, the CDC released new guidelines for GBS prevention. To help clinicians better implement them, the CDC worked with ACOG, the American Academy of Pediatrics, the American College of Nurse-Midwives, and the American Academy of Family Physicians to develop an app called “Prevent Group B Strep.”

The app debuted in September 2013. It is designed specifically for obstetricians and other health care professionals who provide obstetric or neonatal care. It creates customized guidelines based on your patient’s characteristics. “Prevent Group B Strep” is free and available for Apple and Android devices.

If you haven’t already, download the app and implement it in your practice in this month. You can also help to educate your patients about the importance of GBS prevention by sharing ACOG’s patient education FAQ: Group B Strep and Pregnancy.

Spread the word about Group B Strep this month. Your efforts can help save more babies.

ACOG as a World Partner in Women’s Health

I am proud of what ACOG is doing in so many areas of women’s health, but I have particular pride in our global health initiatives. On June 13-14, I participated with a very dedicated group of ACOG Fellows in the Global Operations Advisory Group meeting to develop a strategic plan for our global operations. For two rewarding days, we created plans to help extend ACOG’s contributions to our ob-gyn colleagues in other countries and the women in those countries who are so in need of improvements in health care.

Yes, we do have our own problems within the United States, but our problems pale in comparison with those of many countries. As we work to strengthen women’s health care in our own country, we also have the opportunity to share those strengths. If we are truly leaders in women’s health care, we must consider the plight of women across the world and share our knowledge and expertise for the betterment of women everywhere.

ACOG is respected internationally for our educational materials and our leadership in all aspects of women’s health. A significant number of our Fellows already are dedicating time and effort to directly working with existing resources in other countries to improve obstetrical and gynecologic care. We also have many young physicians who are willing to offer their skills to help underserved populations at home and abroad. In exchange, ACOG Fellows are learning valuable lessons about basic issues in women’s health care that hold true across international boundaries.

As an organization, ACOG has the ability to convene individual ACOG Fellows and our affiliate organizations who want to do global work, and to collaborate with academic institutions in the United States with global health programs. Simply stated, our vision is to engage members and global partners to mobilize resources for support of best practices in women’s health care worldwide through education, information-sharing, training, quality improvement, advocacy, and delivery of care.

As the world has gotten smaller, our vision has grown larger. All of us can be proud of the participation by ACOG in global affairs.

ACOG Fellow Dr. Robert M. Wah Becomes Leader of AMA

Robert Wah and John Jennings

Dr. Wah and Dr. Jennings posed for a picture just before Dr. Wah’s inauguration ceremony.

I recently returned from Chicago, where I attended the 2014 American Medical Association Annual Meeting from June 6-11. It was a busy meeting! ACOG and the AMA have a long history of productive collaboration. This year, with the inauguration of ACOG Fellow Dr. Robert M. Wah as AMA President, our mutual relationship can only grow stronger.

On Friday, ACOG leadership met with representatives from the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Physicians. The meeting allowed us to work together to review the policies and resolutions to be presented at the AMA House of Delegates.

Later on Friday, ACOG leadership participated in a Section Council Handbook Review meeting to provide feedback on the proposed policies and resolutions to be considered by the House of Delegates.

One important function of the ACOG AMA Section Council is to interview the candidates for AMA office. These interviews provide an opportunity to assess the AMA candidates’ stance on ACOG issues such as legislative interference and access to women’s health care options.

Tuesday evening was very special for all ACOG Fellows in attendance. I was honored to be on stage as Dr. Wah was inaugurated as the 169th President of the AMA. Dr. Wah has served on the ACOG Executive Board, Health Care Commission, and other committees. In fact, he got his start in leadership at ACOG as the chair of the Junior Fellow Congress Advisory Council! Dr. Wah is also the first Asian American to be president of AMA.

In his inaugural address, Dr. Wah discussed how tradition can serve as the foundation for innovation. He joined me in calling for physicians to adapt to the changes and opportunities in the evolving health care market. Watch Dr. Wah’s speech.

I am looking forward to a year of great collaboration with Dr. Wah and the AMA.

Why Ob-Gyns Must Lead in Medicine, Business, and Politics

The Danish physicist Niels Bohr said that “Prediction is very difficult, especially about the future.” While it’s true we can’t predict the future, it is clear that the health care marketplace in the US is changing rapidly. To ensure that health care becomes what women deserve, individual ob-gyns must step into new leadership positions.

The changes in health care are increasingly calling on ob-gyns to become “doctor business persons.” Some analysts predict that in the future, up to 85% of physicians will be employed by integrated health systems or very large multispecialty groups. As this occurs, it will become more important than ever for ob-gyns to develop skills in communication, negotiation, finances, team building, conflict resolution, and strategic thought.

In addition, ob-gyns now also need to be “doctor politicians.” Recently, there has been an increase in legislation that attempts to infringe on the patient-physician relationship. These laws are often based on political agendas, not scientific evidence. Physicians need to be able to determine the best treatment for their patients without interference from politicians. It is critical that individual ob-gyns work with ACOG and other medical organizations to fight these types of laws. For more, read ACOG’s Statement of Policy: Legislative Interference With Patient Care, Medical Decisions, and the Patient-Physician Relationship.

Finally, ob-gyns must be leaders because we are best suited to tackle the issues that are increasing the cost and affecting the quality of health care for women. If ob-gyns do not step up to leadership, our practices will be run by administrators, businessmen and lawyers. They will be people who have never counseled a patient, delivered a baby, or witnessed the distress of an unplanned pregnancy.

Women’s health care is expanding beyond the exam room. So, too, must our roles. By becoming leaders in new areas, we can be sure to provide quality care to our patients now and into the future.

Our Patients Deserve Our Patience

Recent reports of rising cesarean delivery rates in the United States are a significant concern, both to the public and to those of us who are practicing obstetrics. Cesarean delivery rates vary dramatically across geographic areas of the country but also from one neighboring hospital to the next.

Certainly the variations in cesarean delivery rates are multi-factorial. It is easy to understand if a tertiary care hospital receiving high-risk pregnancies from a broad referral area would have an elevated cesarean delivery rate. However, it is disturbing to see that some hospitals with a high percentage of low-risk deliveries have higher cesarean delivery rates than the tertiary care hospitals in their referral area.

ACOG and the Society for Maternal-Fetal Medicine released a consensus statement in March on Safe Prevention of the Primary Cesarean Delivery. The statement addresses multiple modifiable considerations to reduce the cesarean delivery rate. I suggest that every obstetrician carefully read this document, paying particular attention to the discussion of labor dystocia and labor arrest as the most common cause of primary cesarean delivery.

Simply stated, current evidence according to the Consortium on Safe Labor indicates the diagnosis of labor arrest should not strongly be considered until the cervix has reached 6 centimeters dilated in both primiparous and multiparous women. This is in contrast to the standards proposed by the Friedman curve that have been operational in most labor and delivery units.

Waiting, observing, having another cup of coffee, and even pacing the floor until the cervix reaches 6 cm dilated can make the difference between a vaginal delivery and a cesarean delivery. Normal labor can be a relatively slow process, but our patients do deserve our patience.