Practitioners’ organizations are the ones that usually recommend the contents of the scope of practice. In particular, the scope of practice of certain practitioners in a hospital may also vary from those in another hospital in consideration of the scope of practice established in general. In the field of Obstetrics and Gynecology, the American Congress of Obstetricians and Gynecologists (ACOG) determines the scope of practice of obstetricians-gynecologists. On its Web site, ACOG (2005) defines the scope of practice of ob-gyn, thus:
a discipline dedicated to the broad, integrated medical and surgical care of women's health throughout their lifespan. The combined discipline of obstetrics and gynecology requires extensive study and understanding of reproductive physiology, including the physiologic, social, cultural, environmental, and genetic factors that influence disease in women. This study and understanding of the reproductive physiology of women give obstetricians and gynecologists a unique perspective in addressing gender-specific health care issues.
Preventive counseling and health education are essential and integral parts of the practice of obstetricians and gynecologists as they advance the individual and community-based health of women of all ages.
Based on the above, there are three primary duties of an oby-GYN, namely, medical and surgical care, preventive counseling, and health education for patients. In addition, ACOG explains that obstetricians and gynecologists may choose a scope of practice they want to pursue, which ranges from primary ambulatory health care to a focused area of specialization.
The scope of practice of obstetricians-gynecologists in hospitals varies according to their residency status. Understandably, those who hold senior status are endowed with heavier responsibilities than those who are in their junior or lower residency status. For example, in the Medical University of South Carolina (2011), a PGY-1, which holds the lowest-level status may hold normal delivery, postpartum tubal ligation, caesarian delivery, and external cephalic version under the supervision of higher-level residents such as a PGY-3 or a PGY-4, and a university faculty. In terms of documentation, the PGY-1 and PGY-2 are responsible for certain documentation requirements, which are not assigned to PGY-3 and PGY-4 such as preoperative evaluation, operative notes, and discharge summaries. Meanwhile, there are some procedures that PGY-1 cannot perform and are limited to upper-level residents, such as anterior/posterior colporrhaphy.
The scope of practice of a physician should be clear to the staff and personnel of a hospital. In this regard, hospital nurses and staff must know to learn about the scope of practice of attending physicians to facilitate documentation and ensure providing the best services to patients.
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