A recent editorial article in the American literature has called for the separation of obstetrics from gynaecology. This sentiment has been raised increasingly around the western world as a consequence of a decrease in the overall number of operations performed and an increase in the number of surgeons.
The situation has arisen as a result of multiple factors. Technological advances such as the development of the Mirena IUCD and improved imaging have meant a dramatic reduction in the number of procedures performed. Hysterectomy rates in the UK have more than halved with similar changes in both Australia and America. The number of laparoscopies and overall procedures has also been falling. Procedures once exceedingly common such as laparoscopic sterilisation are now virtually never performed. At the same time there has been a significant increase in the number of trainees and ultimately surgeons. The American literature looking at the period from 1979 to 2006 revealed a 46% decrease in the number of operations with a 54% increase in the number of surgeons and an 81% decrease in the number of operations per fellow. Similar statistics are available for Australia.
One measure is the number of hysterectomies per gynaecologist. In the United States from 1980 to 2007 this number has fallen from 28 to 9.8. I reviewed the Australian literature recently and the Medicare data as of 4 years ago revealed the average number of hysterectomies per fellow and trainee was less than 8. Another way of looking at this would be to consider another operation. If the average number of caesarians per fellow was only 8 it would be laughable and clearly dangerously inadequate. It is quite clear that in the current climate the average gynaecologist does not perform sufficient surgical procedures to safely maintain skills and it is completely untenable that they should be training upcoming surgeons.
I agree with the Americans. It is time that obstetrics and gynaecology split.