Is it okay for women to rely on their OB/GYN for primary care?

For most of my life, I've relied on an obstetrician/gynecologist as my primary-care doctor. I figured that if I was going in for contraception and a Pap test, why not see a doctor who specialized in such things? It wasn't until I was shopping for new physician (after my OB/GYN reacted with hostility over my decision to opt out of mammography) that I considered selecting a family doctor instead.

There's nothing inherently wrong with going to an obstetrician/gynecologist for routine preventive visits - these doctors are trained to provide such services - but a recent study suggests that women who choose an OB/GYN as their primary physician may miss out on more-comprehensive care.

Donna Cohen, a family physician and associate director of the family practice residency at Lancaster General Health in Pennsylvania, and her colleague Andrew Coco analyzed information from two large data sets containing information on patient visits.

The researchers evaluated 7,882 records of doctor visits for preventive gynecologic visits that occurred between 1999 and 2008. About 81 percent of these visits were made to an obstetrician/gynecologist; the rest involved a primary-care doctor.

The analysis revealed that primary-care physicians were nearly 2 1/2 times as likely as OB/GYNs to address such problems as mental health issues, metabolic conditions and circulatory, respiratory, digestive and skin diseases during a preventive gynecologic visit.

The results didn't surprise Cohen. "In this country, there's an idea that you'll get a better value from a specialist," she says, but family physicians are trained to provide comprehensive care spanning multiple realms.

An OB/GYN is primed to focus on your reproductive system and may be less attuned to other aspects of your health, says Robert Wergin, president of the American Academy of Family Physicians. Going to a gynecologist for your regular checkup is sort of like going to a tire shop to get your car checked out, he says. Primary-care doctors, on the other hand, are trained to assess your health in an all-inclusive way.

Family doctors learn to deliver services ranging from routine heart disease and diabetes care to Pap tests and even obstetrics, Cohen says. "I was just up all night delivering babies," she points out.

Many women don't know that a family physician can provide birth control, Pap tests and other women's health care, Cohen says. "Sometimes they're pleasantly surprised - they say, 'I didn't know you could do that for me,' " she says. "They think they're supposed to go to another doctor for that."

Cohen's study found that the vast majority of women see an OB/GYN for their annual visit, and Barbara Levy, vice president of health policy at the American College of Obstetricians and Gynecologists (ACOG), says that's OK. OB/GYNs are trained to deliver more than just Pap tests, she says.

One study found that nearly half of obstetrician-gynecologists considered themselves primary-care providers.

"We do provide a large spectrum of services," Levy says. "We know a patient's background, her children, her worldview."

ACOG has issued guidelines for what it calls well-woman visits, and these include not just Pap tests but also cholesterol screenings and immunizations.

Yes, Cohen's study found that women were more likely to receive non-gynecologic diagnoses during a preventive care visit at a family physician than at the OB/GYN's office, but that doesn't mean that the specialists are overlooking these health problems, Levy says. The study wasn't designed to detect differences between women who see an OB/GYN for care and those who see a family doctor. True comparisons of the quality of care between the two types of doctors would require looking at the same women getting care in two different places.

"We may be looking at two different populations," Levy says. "Women who have a lot of medical issues generally don't see me for their primary care, and those who do are generally healthy."

It's also possible that primary-care physicians in Cohen's study diagnosed conditions that gynecologists referred to other doctors, Levy says. If that's the case, Wergin says, making a family doctor your primary physician could save you time and money by sparing you extra referrals and visits, which, depending on your insurance, could require additional out-of-pocket expenses.

"If you come in to me and you have something simple like a rash, that's part of what I do - I don't refer you to dermatologist," he says. "When you cut your finger washing dishes, we can sew you up, and it's $150 instead of $1,500 in the emergency room."

Every doctor develops an individual repertoire of services, and the best way to ensure quality care is to form a long-term relationship with a physician whose skills, training and bedside manner are a good fit to your needs, Levy says. "Choosing a doctor often comes down to personality," she says. "If you find someone you feel comfortable with, it doesn't really matter what their title is - that's the person you want as your doctor."