Come gather ’round people…
…If your time to you’s worth savin’
Then you better start swimmin’ or you’ll sink like a stone
For the times they are a-changin’ ~Bob Dylan
I began my ACOG Presidency this past Wednesday by reciting some of Bob Dylan’s famous verse from the 1960’s. It rings true today, especially in medicine and our specialty as obstetrician-gynecologists.
As the times change I thank our now past-president, Dr. John Jennings, for his leadership and friendship during this past year. With the counsel of his past president, Dr. Jeanne Conry, John tackled some of the very difficult issues facing our practices and our workforce. I will continue his fine work and advance it on behalf of our patients, our specialty and our organization, ACOG.
Serving as ACOG President is indeed an honor. It is also a significant responsibility involving accountability to the 58,000 members who pay dues to our organization. We are the premier organization advocating for obstetrics and gynecology and women’s health care. As ACOG members, we are above all things dedicated to striving for and preserving our reputation of excellence, our credibility and our integrity in the pursuit of the best in women’s health care delivery.
This has been an interesting and exciting year for me to say the very least. The meetings, the travel, the interactions with other medical societies, and advocacy efforts were all expected. Yes, there have been challenges, conflicts, resolutions, and clearly, many positive accomplishments. However, I did not expect that almost every waking hour would include some activity related to ACOG.
Medicaid is an integral part of our health care system and a crucial source of coverage for many of our patients. More than one out of every ten adult women in the US (13%) are insured by Medicaid. However, the promise of timely access to care through the program is limited by low reimbursement rates across most of the country.
On average, Medicaid pays a doctor only 59% of what s/he would earn for treating a patient with Medicare for the same primary care services. In some states, payments lower than the cost of care force doctors to limit the number of Medicaid patients that they can see, or not accept Medicaid patients at all.
For some women, alcohol is an occasional indulgence – a glass of wine with dinner, a cocktail at a special event. For other women, drinking is a much more frequent and dangerous activity. Thirteen percent of women in the US consume more than seven drinks per week, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). And according to the Centers for Disease Control and Prevention (CDC), about 1 in 8 women and 1 in 5 high school girls report binge drinking.
Once again, Angelina Jolie Pitt is shining a bright spotlight on women’s health.
On March 24, Ms. Jolie Pitt wrote an op-ed piece for the New York Times in which she announced her decision to have a risk-reducing laparoscopic bilateral salpingo-oophorectomy (removal of her ovaries and fallopian tubes.) This is following her decision to undergo a preventive double mastectomy in 2013, after learning through genetic testing she carried a BRCA1 gene mutation.
Maternal deaths related to childbirth in the United States have been rising in the past decade. According to a 2014 report published in The Lancet, the maternal mortality rate in the U.S. is now more than double the rate in Saudi Arabia and Canada, and more than triple the rate in the United Kingdom.
To address this trend, ACOG and the Society for Maternal-Fetal Medicine (SMFM) recently issued Levels of Maternal Care, the first consensus document establishing levels of care for perinatal and postnatal women. It is the second document in the joint ACOG and SMFM Obstetric Care Consensus series.
This January, National Birth Defects Prevention Month, let’s dedicate ourselves to educating our patients about the importance of preconception planning – and lifelong health.
According to the CDC, birth defects affect 1 in 33 babies in the US every year, and 18 babies die each day as a result of a birth defect. Some are caused by genetic factors such as Down syndrome or sickle cell anemia. Others are caused by certain chemicals or drugs, including alcohol and tobacco. Unfortunately, however, the cause of many birth defects is not yet known.
Workforce issues in women’s healthcare continue to be a primary concern for ACOG.
A recent survey of 20,088 physicians conducted by the Physicians Foundation, a non-profit research organization, found that increasing workloads, regulatory requirements, and other changes in the healthcare system are prompting physicians to make career changes. It found that 81% of physicians described themselves as either overextended or at full capacity. Although these findings are not specific to our specialty of obstetrics and gynecology, it can be assumed that many ACOG Fellows have similar opinions.
In recent years, we’ve made great strides in encouraging vaccination in pregnant women. During the 2009 H1N1 pandemic, influenza vaccination rates in pregnant women increased from 15% to around 47%. Since then, rates have been sustained around 50%, increasing to 53% in the 2013-14 flu season. However, there are still patients who choose not to be vaccinated, possibly due to misinformation about vaccines.
December 1 is World AIDS Day, an opportunity to bring awareness to the fight against HIV and AIDS. This year, the focus of the UN AIDS campaign is “closing the gap,” which means providing prevention, treatment, care, and support services to all people.
Women, particularly young women and pregnant women, are often more at risk for and more affected by HIV. Most cases of HIV infection in women are diagnosed in the reproductive years. According to UN AIDS, in 2013, almost 60% of all new HIV infections among people aged 15–24 occurred among adolescent girls and young women.