Obstetrician Gynecologists are frequently responsible for management of the primary care needs of their patients. A survey performed in 2005 found an estimated 37% of, non-pregnant patients, relies on gynecologists for routine primary care. The same study found that almost a quarter of gynecologists reported they needed additional primary care training across a broad set of medical topics (Acad Med. 2007; 82:602–607). The impetus for training in primary care skills is increasing. In response to language in the Affordable Care Act, the Institute of Medicine developed a report on clinical preventative services necessary for women (Clinical Preventative Services for Women: Closing the Gaps IOM. 2011; also Current Opinion in Obstetrics and Gynecology 2011, 23:471–480). The US Department of Health and Human services has adopted these IOM recommendations and, as a result, health plans are required to include these services. While initiatives such as the American Congress of Obstetricians and Gynecologists’ Well-Woman Task Force and recent cross-specialty ACOG educational collaborations have begun to address supplemental educational needs, additional resources covering key primary care topics are necessary. This issue of Obstetrics and Gynecology Clinics is an ideal means for accomplishing this important goal.
On July 1, 2003, work-hour reforms were enacted nationally for the roughly 129,000 resident physicians in the United States. The reforms limit weekly work hours (a maximum of eighty per week) and in-hospital call (no more than once every three nights), mandate days free of clinical and educational obligations (one day in seven), and regulate other aspects of resident work life. Why Surgeons Struggle with Work-Hour Reforms focuses on general surgeons, a historically long-hour specialty, who fiercely opposed the reforms and are among the least compliant. Why do surgeons struggle with the reforms? Why do they continue to work long hours and view the act of doing so as reasonable if not quintessentially professional? Although the analysis is situated in the growing scientific literature on the consequences of fatigue, the authors do not adjudicate between the claims of surgeons and reform advocates about the effects of long work hours on patient or provider safety. Rather, the aim is to explore and explain how aspects of the occupational culture of surgeons and the social organization of surgical training and practice interlock to impede the reforms.
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