Jan 7, 2014--10 members of the Family Medicine Obstetrics coalition(private practice) met with the OB chair and 2 UT FP's to remove the following mandatory consultations for family medicine OB at the St Francis Tenet hospital on Park Avenue in Memphis. This is a university teaching hospital.
First of all the need for proctored vaginal deliveries was dropped from 20 to five. Cesarean section proctoring remains at 6.
Labor disorders not responding to active management--dropped
Vaginal delivery of malpresentations-shoulder, face--dropped
Pregestational morbid obesity[BMI greater than 40]-dropped
Preterm oligohydramnios and polyhydramnios--dropped
Three or more previous cesarean sections was changed to more than 4
Grand multip-- dropped
Third trimester bleeding of undetermined etiology--dropped
Low forceps without cesarean section privileges-dropped
We remain unified in our goal to have vaginal and cesarean delivery privileges granted by the department of family medicine. We have twenty years of experience, and the track record is proven with adequate proof of quality on the basis of 50-100 sections and 40-50 vaginal deliveries.
This a repeat of what I sent yesterday
Subject: privileges history and MED document
Reflecting on 35 years of work in this area, the rate limiting step has been discriminatory privileging which effectively prohibited the delivery of babies by family medicine.
1975--Most of the profession was Hippocratic-- one for all and all for one. If family physicians had a difficult delivery someone on the staff with surgical privileges would be there to help. NO questions asked. UTenn offered three month surgical fellowships for rural FP's wanting Cesarean privileges, but it was not necessary.
1985--Cesarean sections rate starts increasing due to concerns about "quality". FP residencies with aspirations for OB training start to hear, " We will give your residents rotations, but we will not train any family physician to do a Cesarean" . Lack of Cesarean backup is frequently cited as the reason for prohibiting ALL delivery privileges.
1995--The Rochester-Tacoma-Spokane-Memphis et al OB fellowship years create a politically acceptable model for Cesarean training, but there is little uniformity about the curriculum for emergencies, higher risk, and point of care ultrasound. ALSO and the UT Ultrasound CME series begin to address these issues.
2005--OB practice by family medicine continues its decline led by residency program directors who campaign for elimination of required OB. Fourth year fellowship and P4 programs increase to n=30 ish.
Board of Family Medicine Obstetrics[BC FM OB] forms curriculum standards for certification. This includes ALSO, higher risk topics., and some ultrasound.
2008-2012 STFM Phoenix coalition produces 4 publications culminating with 3 tier standards for Family Medicine Obstetrics. Very broad strokes but few specifics. ABPS[sponsor of BC FM OB] recognized by federal government as a valid entity for medical credentialing.
2014--The Memphis FM OB coalition 1994-2014 completes the 10th revision of hospital privileges documents for 3 university affiliated urban hospitals as a model of collaboration based on the AAFP-ACOG agreement for specialty neutral credentialing. Each of these revisions has gradually diminished unnecessary barriers which do not improve care. Ironically the chronology and content of these restrictions is almost identical to the high risk OB curriculum described by ALSO, STFM Phoenix, and the BC FM OB certification process.
Documents available by request, but, in the long run, our success will be judged by the ability of our graduates to run the gauntlet of hospital privileging.See attached 2013 revision at the MED in Memphis.
Index -- OB privilege