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November 23rd, 2013

OB/GYN Board Says Their Docs May Only Treat Women

Here’s a surprising move:  The American Board of Obstetrics and Gynecology has decreed that gynecologists may only treat women. From the New York Times coverage:

In September, the American Board of Obstetrics and Gynecology insisted that its members treat only women, with few exceptions, and identified the procedure [high-resolution anoscopy] in which Dr. Stier has expertise as one that gynecologists are not allowed to perform on men. Doctors cannot ignore such directives from a specialty board, because most need certification to keep their jobs.

Many ID/HIV specialists will immediately see this move as strange, and potentially quite disruptive. At one of my practice sites, we refer all our HIV-positive patients who have anal dysplasia — men, mostly, but also women – to gynecologists who are skilled in high-resolution anoscopy, a procedure similar to colposcopy. Plus, on a national level, there’s an important ongoing clinical study that is evaluating whether this screening strategy prevents anal cancer; at least some of the co-investigators are gynecologists.

(FYI, we’ve been wondering about the efficacy of this in screening for anal cancer prevention for years.)

It’s also a strange move because, frankly, no such other restriction exists for any specialty — it’s tough even to envision such a thing, unless there’s a dermatologist somewhere out there who will only treat patients whose last names start with the letters Z, I, and T.

With the caveat that as an ID specialist, I’m far from the center of this debate, this action by the OB/GYN Board seems extreme. It’s doubtful that the relatively small number of gynecologists who perform this procedure on men will distract them sufficiently to negatively impact the health of women.

Perhaps it’s a “waiting room” phenomenon? My local expert says that women have grown comfortable seeing only other women at gynecology practices, and might find it strange to share the waiting room space with men. And we men do have a tendency to yuck things up — “boy slime,” is how my wife described the effect of sharing bathrooms with guys during college.

But she offers this logical solution: Let the gynecologists who are currently providing this clinical service and participating in research continue doing so. A statement from the board that such treatment is discouraged (but not forbidden) will certainly decrease the number of new gynecologists taking male referrals.

14 Responses to “OB/GYN Board Says Their Docs May Only Treat Women”

  1. 1humanwoman says:

    This is an important issue that goes beyond treatment of anal cancer. Women are not a subspecies of human beings. A doctor trained to treat humans should be competent to treat all humans. There is nothing sex-specific about the anus. More here: http://humanwithuterus.wordpress.com/2013/11/23/the-unprivileged-body-can-gynecologists-treat-humans-or-just-women/

  2. Ron Gelb says:

    Now that she has stopped treating these male patients, the doctor in question is in violation of her hospital’s patient rights policy, which prohibits gender discrimination (see their website, bmc.org).

    Should she be disciplined for this violation?

  3. Loretta S says:

    I am puzzled and distressed by this move by ABOG. Why are they drawing this line in the sand? The article in the Times pointed out the shortage of doctors trained and skilled in anoscopy. But the ABOG wants to make the set of doctors who can perform the procedure even smaller. I have to wonder what they would say if a patient is transgender. Did the board go so far as to say which specific body parts the patient has to have in order to be considered a woman and therefore OK to treat? It feels ridiculous to even say that, but that is the kind of crazy debates the board’s edict might open up.

  4. Dr Murugan Sankaranantham says:

    Dear Paul,
    It is not possible to treat one partner in HIV and STD. It could not be a complete one.There are many problems. One partner had been treated and other has high viral load, Sero-discordant female has a sero-reactive male partner, family counselling, child birth, Prevention of MTCT, are becoming problems. In many country female has no right to decide about sex, safe sex, child birth etc.
    So treating females alone is a misconception. Instead they could refer their patients to a HIV specialist.
    Dr S.murugan

  5. Sous says:

    I don’t understand, what is driving this, why?
    That’s it, ID docs should be trained in anoscopy.

  6. Paul Sax says:

    ID docs should be trained in anoscopy.

    Sous,
    The issue here is high-resolution anoscopy, which requires special equipment and training — something that many gynecologists already have. While some ID doctors have been trained to do this, it is a very small number.
    Paul

  7. Dear paul, this situation ist well known for me as a pediatric gastroenterologist, resticted only for patients below 18 Y´s old.
    So i´ve fighted for the possibility to treat my patients with crohn´s so long, they wonna. now i´ve a special licence to treat adult ibd patients , when they start as a child in my praxis.
    crazy, becouse a pediatric ge is trained in children and adults, a physican ge is only trained in adult patients.
    if in medicine someone is able to do a special thing, a restiction is a result of middle age..
    so it goes and the world dont stop to turn …

  8. Dr. DelPino says:

    I am very disturbed by this new mandate. OB/GYN residents typically rotate through internal medicine, so I suppose that if they are not allowed to treat men as attending physicians then they would not be required to take care of male patients on these rotations? I doubt that is the case. A physician trained to take care of human beings should be able to take care of a human being regardless of gender if it falls within their scope of practice. Men and women are not different species! How is it possible that mid level providers with far less training, education and experience may treat and prescribe to both males and females, but a licensed MD cannot?!

  9. In Belgium 13% of HIV infected individuals report care refusal from medicine practitioners and andrology is simply not a speciality.So sex specialists are gynecologist or urologist.
    This amazing official decision in the US is sad and ashamed, let us hope that it is reversible but it is always difficult to put the clock back

  10. David Margulies says:

    The information in this blog is outdated. In the future we hope that you will contact ABOG directly prior to publishing information about the organization.

    Ob-Gyn Board Reverses Position on Treating Male Patients

    Robert Lowes

    November 27, 2013

    Obstetrician-gynecologists can continue to treat male patients for sexually transmitted infections after all, the American Board of Obstetrics and Gynecology (ABOG) announced yesterday in a policy reversal.

    In September, ABOG announced that to remain board-certified, obstetrician-gynecologists must not care for male patients except in several narrow circumstances, such as evaluation of fertility, family planning, and emergency care. Treating the male partner of a female patient with a sexually transmitted disease was another exception in the board’s definition of a certified obstetrician-gynecologist, but it would not have applied to obstetrician-gynecologists who treat this condition in gay men, for example.

    One obstetrician-gynecologist at risk of losing her board certification was Elizabeth Stier, MD, an associate professor at Boston University School of Medicine in Massachusetts. Most of her patients are women, but she evaluates and treats men and women alike for diseases of the anus associated with the human papillomavirus (HPV), which causes anal as well as cervical cancer.

    One of her main clinical tools is high-resolution anoscopy. She participates in 2 government-funded trials for anal cancer prevention that involve men with HIV, and she cares for both men and women with HIV in another trial — government funded to the tune of $5.6 million — also aimed at preventing anal cancer.

    Dr. Stier told Medscape Medical News that after she inquired with ABOG about the policy announced in September, she received a letter from one of its officers stating that “if I didn’t stop seeing men, I would lose my certification.” Dr. Stier began canceling appointments with dozens of her male patients.

    A New York Times article last week about the ABOG policy and Dr. Stier’s plight may have nudged the certification board to bend a little. Yesterday ABOG released a revised version of its obstetrician-gynecologist definition that allows these clinicians to evaluate and manage sexually transmitted infections.

    Three ABOG officers also sent Dr. Stier a letter — released to Medscape Medical News — stating that the board does not intend to prohibit one of its diplomats with anoscopy expertise to participate in government-funded research “that may include studies of both genders.”

    The ABOG officers acknowledged in their letter that some certified obstetrician-gynecologists provide routine care to male patients. “We do not wish to disturb the doctor–patient relationship,” they state. However, they advised such physicians to “transition” these male patients to other specialists “over a reasonable period of time.” The reason? Obstetrician-gynecologists who treat men have less time to treat women.

    “There are currently too few doctors to provide care for pregnant women, too few to manage female cancer, and too few to provide necessary preventive women’s healthcare,” wrote ABOG Executive Director Larry Gilstrap III, MD; Kenneth Noller, MD, the group’s director of examinations; and George Wendel, Jr., MD, its director of certification maintenance.

    As a result of the revised policy, Dr. Stier remains in good standing with ABOG, and she can continue her work in the clinical trials. “I’m very happy,” she said.

    She added that she received an email from ABOG explaining that the directive to eventually transfer male patients to other physicians applies to obstetrician-gynecologists functioning as primary care providers. It does not apply to those treating men just for sexually transmitted infections, Dr. Stier said.

    David Margulies, a spokesperson for ABOG, told Medscape Medical News that the board is mostly concerned about obstetrician-gynecologists branching out into cosmetic procedures for both men and women, testosterone therapy for men, and other sidelines that divert them from women’s health.

    “Men have hundreds of thousands of qualified physicians to treat them,” Margulies said.

  11. Paul Sax says:

    The information in this blog is outdated.

    Thanks for the comment — for the record, it was not outdated when it was posted! Here’s the coverage of the reversal, including praise for the Board’s decision:

    http://blogs.jwatch.org/hiv-id-observations/index.php/gynecologists-may-treat-men-after-all/2013/11/27/

    Paul

  12. Geoff Lambert says:

    In order to become an OB/GYN you must first be an MD, right?

    Does any doctor answer to OB/GYN board on how to be a doctor? Can this board take away their medical license? No because they are not constituted to regulate that.

    When can a doctor ethically refuse to provide necessary treatment to a patient? It’s almost never, isn’t it? (I hope)

    Does the OB/GYN board regulate that? NO.

    If a doctor finds his ethical responsibility is to treat a male (or a gay person, or a black person, or a Muslim) can the OB/GYN board prohibit them from doing so? I sure hope not.

    If the OB/GYN board requires a MD who is board certified as an OB/GYN to stop being an ethical MD in order to retain their certification, why can’t a car mechanic become an OB/GYN without first becoming an (ethical, I hope) MD?

    The board is clearly stepping way out of their purview and need to stop acting in such a blatantly unethical way or face losing their own MD certifications.

  13. Geoff Lambert says:

    I should moderate what I said myself. If the board does not reconsider what their own authorities are, perhaps a new certification board will be generated which will cover the broader spectrum of care and make the OB/GYN board obsolete.

    The undesirable alternative (in my view) would be that anal cancer and many pelvic disorders receive their own specialty. This would be tantamount to saying OB/GYNs don’t need to be skilled in those areas. Is that what anybody wants?

  14. Geoff Lambert says:

    I apologize for the several grammatical errors. I was a bit excited when I wrote those posts and did not edit myself as was appropriate.

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