Gynecologists are becoming an important source of general preventive health services for their patients, sometimes to a greater extent than general medical physicians. This study, based on data from the 2000 National Health Interview Survey, examined associations between type of provider on the one hand and, on the other, Pap tests, screening for tobacco use, and counseling on exercise and diet. Participants were 7317 women, 18 to 64 years of age. Provision of these services along with clinical breast examination, mammography, and colon cancer screening were analyzed in 1551 women 50 to 64 years of age. Care was modeled by multivariable logistic regression analysis, and propensity score techniques were used to limit selection bias from the choice of a provider.
Fifteen percent of women were seen by general medical physicians, 62% by gynecologists, and 23% by both. Taking all services into account, women seeing only gynecologists reported having received preventive care at least as often as, or more often than those seeing only general medical physicians. Overall rates of gender-specific services such as the Pap test, clinical breast examination, and mammography ranged from 88% to 95%. Rates of gender-neutral services, in contrast, ranged from 23% to 53%. Women seeing only gynecologists were relatively likely to have Pap tests, to be screened for tobacco use, and to have clinical breast examination and mammography. Combined care by a gynecologist and general medical physician did not, in general, make preventive measures more prevalent. These findings were confirmed by analysis of propensity scores.
The results of this survey validate a role for gynecologists as providers of general preventive health care to women. Both gynecologists and general medical physicians, however, must remain aware of the continuing need to prevent conditions for which good screening tests are not yet available.