Thorp, John M., Jr. (2013). BJOG Editor's Choice: The Plague of Niches. BJOG: An International Journal of Obstetrics & Gynaecology, 120(11)
Subspecialisation has had numerous benefits to women's health including enhanced care to women with rare and serious conditions, improved training of clinicians, and multiple research platforms focused on niches of ignorance within the broad construct of women's lives and wellbeing. Our department at the University of North Carolina has embraced this approach ‘whole hog’, to use an NC colloquialism, and the result is seven subspecialty fellowships in maternal and fetal medicine (MFM), gynaecological oncology, reproductive endocrinology and infertility, family planning, urogynaecology, pelvic pain and reproductive epidemiology. We take great pride in these divisions, or silos, but they can confuse, frustrate and even harm patients. Consider the 37-year-old woman I recently saw who in the past 18 months had seen a reproductive endocrinologist for mild subfertility, a midwife for prenatal care and delivery, an MFM specialist for her ‘advanced maternal age’, a gynaecological oncologist for a low-grade finding on cervical cytology, a family planning consultant to get an immediate insertion of an intrauterine device postpartum, and a urogynaecologist as she had a third-degree laceration with flatus incontinence (Figure ). Her pocketbook was depleted from her parking costs alone and I would argue that none of her ‘conditions’ were life-threatening. Readers from outside the USA can readily deduce why our healthcare system is so expensive and frustrating.
BJOG: An International Journal of Obstetrics & Gynaecology
Thorp, John M., Jr.