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RICHARD BINETTI, M.D.
Attending Obstetrician/Gynecologist, Saint Barnabas Medical
Center
Office practice in West Caldwell
 What
has become of our specialty? What has happened to the art
of obstetrics? Why are so many experienced obstetricians retiring
early? Why are so few medical students choosing ob/gyn as
a specialty? Why has our society allowed the one-two punch
of HMO dominance and excessive, unregulated medical malpractice
premiums overshadow our primary goal of providing good medical
care? Will women across the country have easy access to care
by professional, well-trained, board-certified ob/gyns? In
the future, will these women accept care from less qualified
health-care providers?
Unfortunately, over the past few years, these queries have
become major concerns among members of our dedicated specialty.
So much time has been expended, at both the state and national
levels, in attempts to clarify these issues and to offer common
sense solutions. The concept of “common sense” does
not seem to exist at certain levels of our society, most notably
in our courtrooms and in the Political Action Committee (PAC)
-controlled, special interest group-influenced chambers of
our legislative bodies. And, without it, are any fair solutions
really attainable?
Our goal of providing the best possible care for our patients
has always been our main objective. In obstetrics, this means
close prenatal surveillance and the subsequent delivery of
a healthy baby. And, although childbirth is a natural process
with inherent imperfections, we are expected to provide nothing
less than perfect results. No matter how competent and proper
the care and management may be, our excessively litigious
society has been conditioned to reflexly take legal action
if the results are not perfect.
All medical specialties already practice with an abundance
of defensive thinking and testing. In obstetrics, does that
mean that all patients should be delivered by cesarian section?
After all, there would no longer be any
lawsuits related to any fetal or maternal complications of
vaginal births. Such occurrences as fetal nerve injury from
shoulder dystocia, abnormal fetal heart tracings or fetal
distress during labor, placental abruption during labor, maternal
or fetal heart tracings or fetal distress during labor, or
excessive vaginal tears from difficult natural or operative
vaginal deliveries would no longer exist.
As ludicrous as this may sound, there would be fewer adverse
outcomes, fewer lawsuits and a substantial reduction in malpractice
premiums. As a result, fewer ob/gyns would be forced to retire;
fewer medical students would be discouraged from entering
the specialty; and women’s access to care would not
be in jeopardy.
Let’s get back to common sense thinking. Such drastic
measures don’t seem appropriate, at least not yet. However,
a crisis does exist in our country and we should not be complacent.
The results from the American College of Obstetrics and Gynecology’s
(ACOG) latest professional liability survey, covering 1999-2003,
confirm the previously listed concerns. The survey shows that “more
and more ob/gyns have stopped doing what they spent years
in training to do.”
There is a national campaign for medical liability reform,
but such measures usually become deadlocked in the Senate.
At our state level, the New Jersey Senate recently approved
a long debated bill (Bill A50) to raise money for a temporary
fund to help pay for malpractice insurance. More importantly,
it finally gives the state insurance commissioner new powers
to adjust unwarranted increases in malpractice premiums. Shouldn’t
the commissioner have been a watchdog all along?
This bill must go back to the state assembly for more amendment
approvals (the meeting was held in May). Many believe this
bill will not do very much to prevent early retirement of
ob/gyns or to decrease premiums. Nevertheless, we are trying
to communicate with our legislators. Legislators have to understand
that our young, brilliant college students will not choose
medicine as a career if they see what the future holds for
them. After years of training, sacrifice and expensive school
loans (the average student has $150,000 of debt), they would
enter practice in a system that allows excessive malpractice
premiums or makes it impossible to obtain insurance in some
specialties, if the physician has two active lawsuits.
We must regain our spirit. As frustrating as it may be, we
must try to focus on the positives. We became ob/gyns because
it is truly a rewarding specialty. We feel great satisfaction
when we care for a patient for nine months and then deliver
a beautiful, healthy baby. That is a tremendous feeling and
a great contribution to society. We should continue to remind
ourselves why we selected the field of ob/gyn as our life’s
work. We develop lifelong relationships with our patients.
We perform various surgical procedures, some of which are
even lifesaving. We make such a difference.
I like to think of the glass as always half full. And so,
I would like to believe that in the near future, common sense
will prevail and a more healthy environment will return for
us and our patients.
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