Under Obamacare, Will Internists or Ob-gyns Be Women’s Go-To Docs?

Half of all American women have skipped health visits, follow-ups or treatments because they couldn’t afford to pay, according to a 2011 report by the Commonwealth Fund. Women have also been paying higher health insurance premiums, with 92 percent of U.S. health plans practicing gender rating, according to a 2010 report from the National Women’s Law Center. The report added that 56 percent of plans charge non-smoking women more for coverage than male smokers.

All that should change as President Barack Obama’s reelection lowers the uncertainty about the Affordable Care Act and the new law continues its gradual implementation. The predictable effect will be a major expansion of women’s preventive health care. More in doubt, however, is which doctors will provide that care.

Currently, many healthy women with adequate health coverage have two primary care doctors, in contrast to men, who generally have one. Women see a primary care doctor and an obstetrician-gynecologist, a specialist who often requires a referral under current systems.

But that could change since the new health law defines certain services as primary or preventive care but leaves open the matter of who provides that care. It could be a general practitioner or internist or another primary-care provider. Or it could be the physician who does a woman’s annual Pap smear, while she’s in the office for a regular visit.

Beginning this year, all new plans have been required to cover preventive services — including cervical cancer screenings, mammograms and contraceptives, among many other services –without co-pays, coinsurance or cost sharing. Existing plans will phase that in over time. Medicaid expansion in most states and the mandate to buy health insurance will further expand coverage of women’s preventive care.

Many states already allow women direct (non-referral) access to specialists such as ob-gyns. The new law mandates this, so an increasing number of insured women means an increasing number of visits. Many ob-gyns already provide preventive services that are not specific to women, such as complete physical exams, blood pressure readings and blood cholesterol tests, says Dr. Albert Strunk, a deputy executive vice president for the American Congress of Obstetricians and Gynecologists, called ACOG.

Strunk argues that ob-gyns–who are in short supply in many parts of the country–should be included in the new law’s program for increasing Medicaid primary care reimbursement rates, another facet of the law designed to address primary care needs for both sexes.

Since ob-gyns see women as their regular practice, they will be more in tune with potential problems, such as fibroids, cancer or anything else out of the ordinary. If the health care provider is not an ob-gyn, it is essential that the person “have ongoing training and experience; not someone who just did some rotations,” Clark says. She applauds the Affordable Care Act for doing away with higher co-pays for ob-gyns because “gynecologists should not be treated as rare specialists.”

But Dr. Jeffrey Cain, chairman of the American Academy of Family Physicians, cautions against thinking that women can do away with their general practitioner. Cain, based in Denver, says women benefit from the family physician’s “broader perspective” and coordination of care. Studies have shown that when people have a “first contact” provider, no matter what type, their overall costs decline and their health improves, Cain said.

Cain expects ob-gyns to take an increasingly close place beside family doctors and other general practitioners as the system moves toward what he and others call “team-based care.”

Ms. readers, would you rather go to your primary care physician or your ob-gyn for preventive services? Answer in the comments box.

Excerpted from Women’s eNews. Find the original story here.

Photo courtesy of Alex E. Proimos via Creative Commons 2.0.

Comments

  1. I like going to both a PCP for “general care” and a CRNP who specializes in women’s health. I work at (and get my gyne care at) a birth center with midwives and a CRNP, and it operates under the midwifery model of care. I prefer this model because it’s more personalized, collaborative and empowering. So, to answer the question I’d like to continue to get preventative services from both my PCP and my CRNP/midwife. They both have unique strengths and abilities in what they can do for me. It would be a major barrier to healthcare to make women choose one or the other.

    • A woman’s choice for a PCP will likely vary with age. I have found ob-gyns as knowledgeable and caring as any GP or internist, and I would like to be able to choose.

  2. Barbara M Melrose says:

    At my stage of life (80+) I would clearly rather have an internist provide my general medical care. Perhaps this is not an “either-or” situation, and women should have a choice based on their ages and their individual health conditions.

  3. Evelyn McMullen says:

    The OB(eventually retired from that)-GYN Dr I worked for did not want to be dealing with sore throats, aches & pains, things not related to GYN. He would always tell patients to see their “regular” Dr for those things. I would imagine other GYN Drs might feel the same way, after all their specialty is womens’ issues.

  4. I am a family doctor and provide gynecological and prenatal care to my patients. I can also answer their questions about sore shoulders and sinus infections. After their babies are born, I see many of them for post-partum care an their babies for well-child care and for rashes and infections. I love seeing moms and babies together and think some of the issues that arise with both (eg, breastfeeding) are best addressed by a provider who cares for both. I of course refer when necessary. Many of my patients express appreciation that they can see me for many of their questions and concerns. I think that a family physician or family nurse practitioner is an ideal women’s health provider. I don’t think a women’s health/primary care dichotomy is always valid.

  5. I’d rather go to my neurologist because they know how my epilepsy drugs interact with my body systems. THe primary care/gyn are good for basic services–but they don’t have extensive experience with epilepsy or hydrocephalus.

  6. I also fully believe that the family doctor is the best choice for providing general health care for women and I like that I can go to one doctor, build a relationship and understand that this ONE person is looking out for me and will refer me to a specialist if need be. I think the health care system has forced us to go away from this model and now we’re all ‘shopping’ (for lack of a better word) for the doctor that can fix the specific issue we have at that very moment. But as always, this model works for me and may not for the next person.

  7. Marilyn Dafeta says:

    I am a 3rd yr Medical student(Graduate Entry Medical Programme) in the University of Ghana Medical School and I just want to say that whether you prefer your Ob-gyn or Family Doctor as your primary care Physician if you are a woman, the fact remains that there are aspects of Women’s Health that are better managed by an Ob-gyn doctor than an internist or Family care physician and a woman’s choice to prefer her Ob-gyn as her primary care physician would depend on many factors; is she in the reproductive age group?, is she pregnant?, does she have Medical disease in pregnancy? Is she in at risk for developing cancer affecting any part of the reproductive system?, does she have a urogenital prolapse secondary to laxity or weakening of pelvic support?.These questions and many more would influence her decision.I also think that not only does primary care need the ob-gyn doctors to be part of its system particularly because of their importance in women’s health but also because ob-gyn docs have to work closely with the internists and Family care physicians as a team to give comprehensive medical care to women.In short, the patient should be allowed to see the doctor who can help with her problems so it is not an ‘either this or that’ situation. The power of referral still remains strong but I still believe that Ob-gyn docs being part of the primary care system does women a great service and is not a disservice as many seem to think.

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