The percentage of women who see an obstetrician-gynecologist (ob-gyn) has declined steadily since 2000, a study has found.
“Furthermore, the overall percentage of those having seen a general physician did not increase over time, suggesting that the decline in having seen an ob-gyn was not merely a substitution of physician types,” Alan E. Simon, MD, and Sayeedha F.G. Uddin, MD, MP, from the Office on Women’s Health, Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC, write. “Of note, these patterns persisted after controlling for several sociodemographic and health status variables and, for the most part, when only those with a usual source of preventive care were examined. This would suggest that the observed trend cannot be accounted for by changes in population characteristics or access to care over time.”
The researchers report their findings in an article published online September 7 in Obstetrics & Gynecology.
The researchers analyzed data from the 2000 to 2015 National Health Interview Surveys to determine the percentage of women in the United States who have seen an ob-gyn, as well as the percentage of US women who have seen a general physician (including general practitioners, family medicine physicians, and internists) or both during the previous 12 months.
After adjustment for sociodemographic and health factors, the percentage of women who visited a general physician during the preceding year did not change significantly from 2000 to 2015; the percentage ranged from 70.1% in 2007 to 74.2% in 2003 (P > .05 for trend).
Similarly, the adjusted percentage of women who visited an ob-gyn during the preceding 12 months remained steady from 2000 to 2003 and from 2007 to 2011 (P > .05). However, it fell in the intervening periods, from 45.0% to 41.2% during 2003 to 2007 and from 41.8% to 38.4% during 2011 to 2015 (P < .001 for trends).
“The reason for the decline in the percentage of women who saw an ob-gyn cannot be directly identified from these data. One possibility is that increased use of longer acting contraceptive methods during this period has led to decreased visits to see an ob-gyn,” the researchers explain. “Another possibility is that there may have been an increase in the use of nurse practitioners and physicians’ assistants to see women for visits that may formerly have been conducted by ob-gyns.”
The adjusted percentage of US women who visited both an ob-gyn and a general physician was 32.4% in 2000, peaked at 35.2% in 2003, and then fell to 29.8% in 2015 (P < .001 for trend).
The percentage of women who visited neither an ob-gyn nor a general physician in the previous 12 months was 17.2% in 2000 and 16.0% in 2003, and then rose to 20.4% in 2015.
Unclear Whether or Not Preventive Services Fell
“Perhaps one of the most disturbing statistics in the study was the increasing trend of women seeing neither an ob-gyn nor a general physician. The results show that fewer women are accessing preventive services, regardless of health care provider type,” Haywood L. Brown, MD, from the Department of Obstetrics and Gynecology at Duke University Medical Center, Durham, North Carolina, writes in an accompanying editorial. Dr Brown is also the current president of the American College of Obstetricians and Gynecologists.
However, he says these results should be interpreted cautiously. The study looked at the percentages of women who saw specific types of healthcare providers, not the number of actual visits made, so it is unclear whether the number of visits decreased. In addition, the researchers did not study the reasons for healthcare visits, and therefore it is not possible to know whether preventive services actually decreased.
Most important, as the researchers did not gather clinical data, it is not clear “whether, and how, this trend affected outcomes, either related to the provision of preventive services or more specific gynecologic care,” Dr Brown writes.
Women May Feel Annual Visit Is Unnecessary
“With the decrease in the frequency of cervical cancer screening, changes in the indications for the performance of a pelvic examination, increasing use of long-acting reversible contraceptive methods, and potentially less frequent breast cancer screening, there are certainly concerns that women will feel that an annual visit to an ob-gyn may not be necessary,” he explains.
“However, the provision of age-appropriate preventive services is critical to women’s health maintenance, and the annual visit provides a venue to address these preventive services.”
Dr Brown urges clinicians to work together to educate women about the need for preventive services and to ensure that women have access to preventive services and care for specific women’s health issues.
“We are ob-gyns. We provide primary care and preventive services. We provide obstetric and gynecologic care. We are women’s health care providers, and we must continue to educate women about the importance of these issues and ensure women receive the high-quality care they deserve,” Dr Brown writes.
The authors and editorialist have disclosed no relevant financial relationships.
Obstet Gynecol. Published online September 7, 2017.
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