Obstetrics and gynaecology

Obstetrics and gynaecology (or obstetrics and gynecology; often abbreviated to OB/GYN, OBG, O&G or Obs & Gynae) is the medical speciality dealing with fields of obstetrics and gynaecology through only one postgraduate training programme. This combined training prepares the practicing OB/GYN to be adept at the care of female reproductive organs's health and at the management of obstetric complications, even through surgery.

Training
The training required to practice medicine as an OB/GYN is extensive, although the exact duration of training varies by country. In the United Kingdom, training lasts seven years. In the United States, four years in residency are required for MDs and DOs. In Australia, the residency training period is six years, matched only by neurosurgery and maxillofacial surgery. In India, post graduate training in obstetrics and gynecology is in the form of a two-year diploma course (DGO) or a three-year (MD or MS). Some OB/GYN surgeons elect to do further subspecialty training in programs known as fellowships after completing their residency training, although the majority choose to enter private or academic practice as general OB/GYNs. Fellowship training can range from one to four years in duration, and usually have a research component involved with the clinical and operative training.

All gynecologists are trained obstetricians, although the reverse is not necessarily true. However, some OB/GYNs may choose to drop the obstetric component of their practice and focus solely on gynecology, especially as they get older. This decision is often based on the double burden of very late hours and, depending on the country, high rates of litigation.

This combined training prepares the practicing OB/GYN to be adept at the surgical management of the entire scope of clinical pathology involving female reproductive organs, and to provide care for both pregnant and non-pregnant patient. A bachelors degree is the minimum formal education required.

Subspecialties
Examples of subspecialty training available to physicians in the US are:


 * Maternal-fetal medicine – an obstetrical subspecialty, sometimes referred to as perinatology, that focuses on the medical and surgical management of high-risk pregnancies and surgery on the fetus with the goal of reducing morbidity and mortality.
 * Reproductive endocrinology and infertility – a subspecialty that focuses on the biological causes and interventional treatment of infertility
 * Gynaecological oncology – a gynaecologic subspecialty focusing on the medical and surgical treatment of women with cancers of the reproductive organs
 * Female pelvic medicine and reconstructive surgery – a gynaecologic subspecialty focusing on the diagnosis and surgical treatment of women with urinary incontinence and prolapse of the pelvic organs. Sometimes referred to by laypersons as "Female urology"
 * Advanced laparoscopic surgery
 * Family planning – a gynaecologic subspecialty offering training in contraception and pregnancy termination (abortion)
 * Paediatric and adolescent gynaecology
 * Menopausal and geriatric gynaecology

Of these, only the first four are truly recognized sub-specialties by the Accredited Council of Graduate Medical Education (ACGME) and the American Board of Obstetrics and Gynecology (ABOG). The other subspecialties are recognized as informal concentrations of practice. To be recognized as a board-certified subspecialist by the American Board of Obstetrics and Gynecology or the American Osteopathic Board of Obstetrics and Gynecology, a practitioner must have completed an ACGME or AOA-accredited residency and obtained a Certificate of Added Qualifications (CAQ) which requires an additional standardized examination.

Additionally, physicians of other specialties may become trained in Advanced Life Support in Obstetrics (ALSO), a short certification that equips them to better manage emergent OB/GYN situations.

Recent shortage in US
From 2000 through 2004, American medical students were increasingly choosing not to specialize in obstetrics. This led to a critical shortage of obstetricians in some states and often fewer health care options for women — although it did not lead to higher average salaries. However, beginning in 2004, increasing state legislation mandating tort reform combined with the ACGME's decision to limit resident work hours led to a gradual resurgence in the number of medical students choosing OB/GYN as a specialty. In the medical residency match for 2007, only six spots in OB/GYN training programmes remained vacant throughout the entire United States; a record low number, and one that puts OB/GYN on par in terms of competitiveness with some other surgical specialties.