QUESTION:
I am currently looking at various OB fellowships and am inquiring about c-section numbers. Approximately how many c-sections would one perform by the end of their fellowship?
REPLY:
The question is, how many Cesarean training experiences will meet the credentialing standards where you are likely to practice. Many hospitals have one or two other important criteria. Approximately 5-10 % of hospitals will not allow credentialing regardless of the number of Cesareans. Generally, our fellowship tries to work with each candidate to determine the hurdles they are likely to face.
The only studies published indicate that most physicians with reasonable aptitude and a commitment to learning can independently operated after 40 Cesareans, but some do it after 20-25. One of our major urban teaching hospitals requires the number of 10 Cesareans documented. Interesting political story there.
My fellowships gave up on the credentialing arms race about fifteen years ago because we needed to balance the fellowship with other skills such as managing the office while you have someone in labor, coding and billing, using off the shelf software to develop and follow risk on a weekly basis (without having the residency secretary do it for you), and on maintaining your primary identity as a family physician who sees the children they deliver. This is almost impossible to do when you are owned by the Department of OB-Gyn.
The outcome we track is the ability to obtain hospital privileges for Cesarean section. Among completers over 95% have obtained the privileges. Locations range from rural to Washington DC/Memphis. see ARFEM fellowship section at www.psot.com
Wm MacMillan Rodney MD
Adjunct Professor of Family Medicine
Adjunct Professor Surgery/Emergency Medicine
Meharry/Vanderbilt School of Medicine
Medicos para la Familia
Memphis and Nashville, Tn.
www.psot.com
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