Thread by @meenalmisalMD

Some thoughts about this recent research letter.
Authors' argument: proportion of OBGYN residency grads working as generalists to US population is ⬇️ & this is a problem

I agree ⬇️ density of OBGYNs in underserved areas is a problem. BUT 1/

journals.lww.com/greenjournal/A…

#medtwitter

Authors don't ask WHY. Why are more grads pursuing fellowship / not working as generalists?

Traditional OBGYN practice is less sustainable now. Def from a physician work/life/$ balance standpoint but also - it's hard to provide truly high quality care as a generalist bc 2/

OBGYN is just such a broad field. Many trainees don't want to be a Jill of all trades but master of none. (me, that was me) Authors point out that more fellowship-trained surgeons = available for surgical volume & generalist practice may ➡️ more OB heavy

That's a good thing! 3/

High volume surgeons have better outcomes. Every pt deserves a #MIGS approach if appropriate. (ok done w/ that soapbox for now)

The authors propose 5 strategies:
1. Place a cap on fellowship programs & positions
But who will decide what # should be & HOW will it be decided? 4/

Strategies 2&3 seem wise. Definitely interested in any OB specialist takes on these. @cclareMDMPH
Strategy 4: let's definitely experiment with telehealth in underserved areas. Anyone have any experience with true OBGYN telehealth? Seems like a good fit for MFM consultation 5/

As a field we need to pay attention to changes in the national "practice" & how that impacts both us & pts (looking at EM yikes). This letter had some good ideas - but not all change is bad!

Interested in your thoughts @ChrisDeSteph @louise_p_king @VeronicaLerner @obstatsinc