Changing trends in gynaecological surgical workload

A reduction has been recorded in National Health Service gynaecological bed occupancy in Winchester and Wessex. At least part of this change may be explained by an increase in private hospital practice. NHS managers should plan for similar changes elsewhere in the United Kingdom.

Is there a surplus of obstetrician-gynecologists?

An excess of physicians ranging from 21,000 to 70,000 has been predicted for 1990, including a "surplus" of 10,450 obstetrician-gynecologists. Published supply figures have been overestimated. In 1990, the supply of and the demand for obstetrician-gynecologists should be essentially in balance. The classic law of supply and demand is beginning to operate in medical care.

Collaborative practice in obstetrics/gynecology: implications for cost, quality, and productivity

Rising costs, concern over quality of care, and low worker productivity are some of the factors suggesting a need for revision in the organization of the health care delivery system. Reorganization of the nurse-physician working relationship through the establishment of collaborative practice can serve as the mechanism for improving cost, quality, and productivity outcomes. This analysis evaluates collaborative practice within the disciplines of obstetrics and gynecology.

Rates of surgery in the United States: the decade of the 1970s

Rates of surgery for gynecology, general surgery, otorhinolaryngology, and urology have either decreased or reached a plateau since 1974. Increasing rates are demonstrated for orthopedics, ophthalmology, cardiothoracic surgery, and neurosurgery. These changes are analyzed. Such data can help health care planners to more accurately predict the future of surgical health care delivery.

Women-oriented health care: New Hampshire Feminist Health Center

There are today some 200 women's health centers in the United States providing information and, in many cases, direct health and family planning services to women in a manner responsive to their needs and preferences, and that involves them in the design and provision of services. This approach to delivering services was specifically recommended by the International Conference of Family Planning in the 1980's held in Indonesia in April 1981. in addressing the challenges facing family planning programs in the decade ahead, the conference noted that in many parts of the world, women often have little control over decisions related to their own fertility. Furthermore, low levels of acceptance and use of family planning, which are characteristic of many programs, often reflect a failure to design and provide services in a manner that is responsive to the needs and perceptions of the users. The conference called for measures to improve the status of women, and recommended that women be involved in all aspects of program design, management, policymaking, and provision of services. In this special report, Judith Bruce describes how women-oriented services are designed and provided at one of the women's health centers, The New hampshire Feminist Health Center.

Gynecologic oncology: changing perspectives

As knowledge grows and our experience is tabulated and analyzed, there must occur modifications in our management of disease and in the principles and policies that direct our decisions. In gynecologic oncology, some degree of change in perspective has taken place in almost every aspect, in prevention, screening, detection, diagnostics, and therapeutics, as well as in the attention devoted to the sociologic, emotional, and political implications of cancer in women. The specialty is now 50 years old and was established and fostered by physicians who thought in surgical terms and who were willing and competent to extend their technical arena as far and as fast as continuous improvements in anesthesia and other support measures permitted. The textbooks and journal publications of that era clearly mirror this emphasis. A new generation of gynecologic oncologists has assumed leadership. Their training is broad, and their knowledge and competence extends far beyond technical surgery. This is well illustrated by the program of this conference. And comparison of this program with that of the last session five years ago clearly demonstrates how far we have come from a time of preoccupation with morphology and technique.

An overview of hospital gynecologic practice

Table 1 presents an overview of current gynecologic practice in hospitals as illustrated by three New England states. We believe the balance of diagnoses and operations displayed are reasonably typical of practice elsewhere in the United States. However, since operative rates are lower in New England than in other parts of the country, the proportions of women undergoing hysterectomy or a sterilization procedure will be somewhat higher elsewhere. The general issue of variation in rates of diagnoses and operations is presented; professional uncertainty is a fact which may account for the variation. Further controlled studies are urgently needed to decrease this element of uncertainty and to distinguish too much diagnosis and treatment from too little. Ultimately, nothing less will meet the standards of the best care for patients or satisfy health insurance or government programs that premiums or taxes are supporting an appropriate level of health care.