Abstract
John C Jennings is 2014–2015 President of the American College and Congress of Obstetricians and Gynecologists. He is currently Professor of Obstetrics and Gynecology at Texas Tech University Health Sciences Center and has previously served as Regional Dean of the School of Medicine at TTUHSC Permian Basin. He is a passionate medical educator and during his academic career he has served as division chief, residency program director and department chair. He has authored numerous peer-reviewed and other publications and has been the recipient of multiple teaching awards. Prior to entering academic medicine, he was a busy practicing obstetrician/gynecologist in San Angelo, TX, USA.
For the first 12 years of my career in obstetrics and gynecology, I was a very busy private practitioner. The best teachers I had during my residency training were those persons with extensive experience in practice and I decided I wanted to share my experience with medical students and residents. I left private practice to enter academic medicine and have since served as a residency program director, division chief of gynecology, department chair and most recently dean of a medical school campus. My passion for obstetrics and gynecology and women's healthcare overall has been the impetus to work with the American College of Obstetricians and Gynecologists (ACOG) and to eventually serve as President of our organization.
ACOG promotes excellence in the practice of obstetrics and gynecology and advocates for the continuing betterment of all aspects of women's health care. ACOG has a wide variety of educational programs and publications for both practitioners and patients. The information ACOG provides to our membership through practice bulletins and committee opinions is authoritative and regularly updated. In addition, we provide readily available information materials for patients by both printed materials and electronic sources. Of most importance, ACOG is a leading advocate for women's healthcare in our country and around the world.
Our resources for healthcare are limited and the rising costs of healthcare in the USA are simply unsustainable. Our system has been characterized by both overutilization and overconsumption of health services. Efficient, value-based delivery of women's healthcare requires collaboration and integration among various health disciplines. This means we must provide the right care, by the right person, at the right time, in the right place and at the right cost. A collaborative, team-based, multidisciplinary approach that is well coordinated is arguably the best source of this high quality care. A team that works together needs to train together and in that respect we must also promote interprofessional education for women's healthcare team members. The multifaceted aspects of women's healthcare are ideal for the development and demonstration of this delivery model.
This past year ACOG invited representatives from multiple health disciplines to meet in our Washington, DC office with the challenge of collating and developing guideline information for collaborative, integrated models of healthcare delivery that fit various geographic and population densities in our country. The group was instructed to first consider the most efficient models for care delivery as opposed to starting with a payment reimbursement method and then trying to develop a model from that standpoint. By working throughout the year, the commonality of purpose and the enthusiasm of the participants have resulted in an innovative document that will be published in early 2016.
These are exciting times for scientific and technologic advances in our specialty. Immunotherapy is a promising treatment for a variety of cancers and can have particular utility in gynecologic malignancies. The introduction of cell-free DNA testing along with sophisticated computational analytics of genetic interactions are changing the landscape of prenatal diagnosis. Minimally invasive surgical techniques, including robotics, offer improved outcomes for many gynecologic surgical procedures.
It would be extremely difficult for me to try to designate specific areas for technologic improvement since there is so much already in development. However, I believe any technologic advance must be accompanied by initial evidence of clear benefit above risk and then confirmation by longitudinal outcome studies. We must learn to be consistent in how we evaluate new technologies prior to their widespread usage. These same principles apply to the introduction and ongoing evaluation process of all technologic innovations.
ACOG works closely with other medical specialty societies in our country. We have long-standing, cooperative relationships with the American Academy of Pediatrics, the American College of Physicians and the American Academy of Family Practice because our organizations have so much common interest in women's health. We also have a particularly close working relationship with the American College of Nurse Midwives. Our ACOG Collaborative Practice Task Force has involved representatives from additional disciplines’ organizations including advanced nurse practitioners, physicians’ assistants, pharmacists and public advocacy. We also work closely with the American Medical Association and surgical specialties on many issues.
ACOG's international influence is exceptional. We have ACOG Sections in North American, Central American and South American countries. ACOG also regularly interacts with the Royal College of Obstetricians and Gynecologists, the Society of Gynecology and Obstetrics of Canada, International Federation of Gynaecology and Obstetrics and with other comparable obstetrics and gynecology societies across the world in addressing international issues in women's health. For many years, ACOG has participated in an educational exchange program with the Japanese Society of Obstetrics and Gynecology. Our ACOG Global Operations Advisory Group has been charged to assist in the identification of deficiencies around the world in women's healthcare and work with other organizations to help in collating resources to fill these needs.
We are living through the most dynamic time in American medicine. I worry very little about the progress of scientific evidence in the practice of obstetrics and gynecology. I am certain we will continue to see rapid advances in our ability to prevent, diagnose and treat disease. However, I do worry about how we are going to be able to deliver the high quality of care that should be available to our patients.
Our country's healthcare is in a state of conversion from a traditional fee for service system to a value, quality, based system of healthcare. Information technology is changing the way professionals communicate with each other and with our patients. This transition demands many adjustments but we all must recognize that our country's healthcare resources must be used in a much more efficient manner.
We have a significant geographic maldistribution of obstetricians and gynecologists in the USA with an abundance of practitioners in many urban areas. To the contrary, in some broad geographic areas in our country there is very limited access to an Ob/Gyn physician.
The population of women in the USA is continually increasing but the numbers of retiring Ob/Gyns are now approximately equal to the number of new graduates of our training programs. It is apparent that we must learn to be smarter in how we provide care with the understanding that the absolute numbers of obstetricians and gynecologists will not significantly increase in the near future.
In my opinion, to be able to deliver high-quality care specific to an individual patient's needs, we must work within regionalized, integrative systems based upon a collaborative team practice model. This approach allows for personalized primary care but also gives access to specialized resources when needed. Ob/Gyns can expand access to quality women's healthcare by working in high functioning, multidisciplinary teams where team members are empowered to practice to the extent of their education and experience.
I do not have a crystal ball, but I do have opinions about the future based upon what is happening now. A high percentage of obstetricians and gynecologists are already going from traditional private practice to employed positions in larger groups, hospital systems and universities.
The number of Ob/Gyn subspecialists has become proportionately larger with 27% of graduates from our residency programs in 2015 entering fellowship training in one of our subspecialties. We will see an increasing role for obstetricians/laborists who work shifts in labor and delivery units across the country.
Technological advances will continue to affect gynecologic surgical practice. Some conditions we currently manage surgically will likely be managed nonsurgically in the future. Gynecologic surgical practice will continue to adapt new techniques, revise old techniques and discard others.
In both inpatient and outpatient settings, Ob/Gyns will expand patient access through team-based care. The information exchange through electronic health records will dramatically improve. We will be better able and required to measure specific parameters that reflect the safety, quality and value of care rendered to patients.
I also think we will see significant changes in the educational process of obstetricians and gynecologists. These changes will have a positive effect on our overall practice and will clarify our continuing role in women's healthcare.
Health issues are inevitably related to socioeconomic and environmental conditions. In the USA, we are seeing epidemic obesity in women along with associated comorbidities such as hypertension and diabetes that are potentially modifiable by lifestyle changes.
Domestic abuse and violence against women have been inadequately addressed and are, at least in part, indicative of a lack of cultural respect for the dignity, autonomy and rights of women. ACOG's advocacy in this area remains unrelenting.
Obstetrics and gynecology must address the multifactorial causes of our country's disproportionate increase in maternal morbidity and mortality. There is ample opportunity for improvement with this problem.
In my opinion, as a society, we have an overexposure, overutilization and overconsumption of legal, illegal, prescription and nonprescription drugs. Factors that change how our genes work (epigenetic factors) have been related to ingested substances and other environmental exposures that are documented to have effects on reproductive health and our general health. This is a modifiable area where medical, pharmaceutical and environmental scientific research can have high impact.
Finally, there is a need for a healthcare paradigm shift to a greater emphasis on wellness and prevention. I have repeatedly said that women are the ‘medical directors’ of their families. Obstetricians and gynecologists are the only exclusive specialists for women. With that in mind, we have an opportunity to convey to the women we serve, and indirectly to their families, an understanding of the importance of a healthy lifestyle and preventive health measures available to them.
Disclaimer
The opinions expressed in this interview are those of the interviewee and do not necessarily reflect the views of Future Medicine Ltd.
Footnotes
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.