Objectives and principles in the training of the obstetrician-gynecologist

Establishing specialty jurisdictions in medicine: the case of American obstetrics and gynaecology

The profession of medicine has evolved into an extremely specialised occupation. Yet, recent research has neglected the intra-occupational processes influencing medical specialisation. This article aims to correct this oversight. It develops an historical account of intra-occupational factors influencing the decision to establish gynaecologic oncology as American ob/gyn's surgical subspecialty in 1972. Working within the framework initially developed by Everett C. Hughes and his students, the article examines this development as the outcome of a three-party relationship among gynaecologic oncologists, American ob/gyns, and gynaecologic pelvic surgeons. Aggressive movement by the gynaecologic pelvic surgeons challenging the established élite's identity definition for the ob/gyn specialty helped spur official recognition of gynaecologic oncology, a less threatening subspecialty. The article draws theoretical implications from the case regarding the role of a threatening other in influencing the specialisation process.

The making of the "women's physician" in American obstetrics and gynecology: re-forging an occupational identity and a division of labor

After struggling as a surgical specialty, obstetrics and gynecology initiated its "women physician" program in the 1970s. This program officially defined the mostly male obstetricians and gynecologists at that time as women's primary care physicians. Using archival data, this article explains this development as a response to the specialty's dishonored position within the medical division of labor. Whatever else it was intended to be, the women's physician program, in its most developed form, aimed to galvanize the various interests within obstetrics and gynecology behind a strategy to restructure the medical division of labor serving women so that obstetricians and gynecologists controlled both the upstream positions responsible for their own case referrals and the downstream positions to which they referred their difficult cases. The article illustrates the importance of integrating insights from both macro-institutional and intra-occupational explanatory frameworks in accounting for significant developments in medicine.