The Expanding Role of OB/GYNs in Primary Care
Edition: April 2003 - Vol 11 Number 04
Author: By Mark Thill
There’s a growing opportunity in the medical market for doctors and sales reps. That opportunity is women’s health.
OB/GYNs are making inroads into what has traditionally been the turf of internists and family practitioners, says Sheila Dunn, president of Quality America, Asheville, N.C.
“There’s a continuing trend for OB/GYN physicians to be the primary care providers for women of all ages,” says Dunn. “If they don’t do that, they’re really missing the big market opportunities that exist.”
OB/GYNs should be taking over diabetes care, which itself is a huge segment of the internal medicine market, says Dunn. “They need to be getting involved more in routine screening for all types of chronic illnesses, such as hypertension, osteoporosis and heart disease.”
Statistics are difficult to come by. In other words, it’s difficult – if not impossible – to tell how many “non-traditional” OB/GYN procedures are being performed by OB/GYNs. But anecdotal evidence seems compelling.
Trust Is a Big Factor
The growing role of OB/GYNs in the overall care of female patients was reflected several years ago in the (largely successful) attempt by women to convince managed care organizations to allow them to see their OB/GYNs without first receiving the go-ahead from their primary care physicians.
One reason for the rising importance of OB/GYNs seems to be that unlike some other specialties, they enjoy long-standing relationships with their patients, just as internists, family practitioners and pediatricians. The Virginia Women’s Center in Richmond offers just one example.
“We are a combination of high-touch and high-tech,” says Peter Zedler, M.D., partner, Virginia Women’s Center. The Center, formed by a merger of practices in 1996, now employs 20 physicians, four nurse-midwives and six nurse practitioners. It has relationships with two hospital systems in the area: Bon Secours Richmond Hospital System and HCA.
“We want to be the best in technical skills, and we have the facilities available to help us do that,” says Dr. Zedler. Indeed, the Center provides care in the area of high-risk obstetrics and offers a full range of services, including ultrasound and bone densitometry.
“But an important part of what we do is high-touch,” adds Dr. Zedler. “You have to have a relatively high number of staff who are interactive with patients, so that those patients feel they can get answers to their questions. That’s what builds the practice. It’s a patient-driven market. We have a group of patients who are well-informed, fairly affluent and have some choice in their healthcare providers. They’re looking for someone to give them extra service and knowledge.
“Patients in this specialty are very loyal,” adds Dr. Zedler. “They come to see us on an annual basis. And women are the drivers of the healthcare market, so we have an opportunity to influence the people who are making the decisions.
“Hospitals have tried to do this, but patients are loyal to their doctor, not their hospital – at least in this field, and perhaps pediatrics.”
Vendors are seeing the shift as well.
“We very much see the OB/GYN as a primary care physician,” says Bill Elliott, executive vice president of Quidel Corp. in San Diego. In fact, Quidel encourages distributor reps to sell the company’s line of rapid tests (such as strep and flu) to the OB/GYN, as well as its women-specific products, such as pregnancy and ovulation tests, vaginalis tests and the new QUS-2 ultrasonometer to aid in the diagnosis of osteoporosis.
“We want [OB/GYNs] to see us as their solution for rapid diagnostics,” says Elliott.
Clearly, reps themselves are seeing the opportunity.
Brian Hansen, vice president of sales for Physician Sales & Service, points out that his company’s reps are seeing more waived tests moving into the OB/GYN’s office.
“I can personally think of three large OB/GYN accounts in San Diego that were getting into ‘mainstream medicine’ big time,” adds Hansen. One had a cryo gun to remove warts from patients’ hands. “They were becoming more and more progressive along these lines,” he says.
Broad View of Medicine
Distributors selling into the women’s market have to be prepared to take a broad view of medicine, because that’s exactly what their customers are doing.
“We look forward to getting into nutritional counseling and exercise counseling,” says Dr. Zedler at the Virginia Women’s Center. “Our patients are getting older and they want to be active for as long as they can.”
For the past seven years, the federal government has spearheaded an integrated approach to women’s health. Taking the lead is the Office on Women’s Health of the Department of Health and Human Services. Established in 1991, the Office on Women’s Health works to redress inequities in research, healthcare services and education, which have historically placed the health of women at risk, according to HHS.
In 1996, HHS established six National Centers of Excellence in Women’s Health, to serve as models for improving the healthcare of American women. These centers (since expanded to 13) are located at academic institutions. They’re charged with integrating healthcare services, research programs, public education and healthcare professional training, and with forging links with healthcare services in the community.
The 13 Centers of Excellence in Women’s Health in U.S. academic centers are:
• Boston University Medical Center, Boston
• Harvard Medical School, Boston
• Indiana University School of Medicine, Indianapolis
• Magee-Women’s Hospital, Pittsburgh
• Drexel University, Philadelphia
• Tulane Xavier Universities of Louisiana, New Orleans
• University of California, Los Angeles.
• University of California, San Francisco.
• University of Illinois at Chicago
• University of Michigan Health System, Ann Arbor
• University of Puerto Rico, San Juan
• University of Washington, Seattle
• University of Wisconsin, Madison
Women served by the Centers of Excellence are to have much of their healthcare needs met in one place through access to comprehensive services and resources. In addition, the centers develop multidisciplinary research agendas across medical specialties; focus medical education on gender differences in the causes, treatment and prevention of disease; and disseminate information to the public and to healthcare providers. The centers are also charged with developing leadership strategies to foster recruitment, retention and promotion of women in academic medicine.
Four years later, the HHS Office on Women’s Health created the first model community-based health centers for women. The National Community Centers of Excellence in Women’s Health (CCOEs) are charged with coordinating all aspects of a woman’s health throughout her life span, including active management of the socioeconomic and cultural influences that often stand in the way of quality healthcare for under-served women.
The CCOE program is also intended to provide recognition and funding for community-based programs that unite promising approaches in women’s health across six components: health services delivery (particularly preventive services), training for lay workers and professional health providers, community-based research, public education and/or outreach, leadership development for women and technical assistance to other communities that want to replicate the program.
Last year, the Office on Women’s Health experimented with bringing together the efforts of the academic-institution-based Centers of Excellence with the community-based National Community Centers of Excellence in Women’s Health. Seven projects were funded to see how well providers could combine their efforts to provide integrated healthcare to women in their communities. Examples include:
• The Mariposa Community Health Center (Arizona) CCOE, UCLA CoE, UCSF CoE, and University of Washington CoE, which combined forces to develop educational tools on menopause for use by lay health educators during home visits or in small groups.
• The Pilot City Women’s Center (Minnesota) CCOE, Magee-Women’s Hospital CoE, and University of Wisconsin CoE, which joined to reduce violence against women and girls in North Minneapolis by promoting healthy relationships through education, training and advocacy.
• The Northeast Missouri Health Council CCOE and Boston University CoE, whose programs are designed to reduce cardiovascular risk through exercise.
• The Women’s Health Center (New Mexico) CCOE and University of Illinois at Chicago CoE, which developed a project to enhance patient-provider communication regarding use of dietary supplements and/or herbal medicine in mid-life and older women.
• The Northeastern Vermont Area Health Education Center CCOE, University of Indiana CoE, and MCP Hahnemann CoE, which developed outreach and education programson domestic violence for use in rural settings.
The Office on Women’s Health is in the process of developing a methodology for evaluating these joint projects.