Why Can't Gynaecologists Treat Male Patients?

In September 2013, the American Board of Obstetricians and Gynaecologists announced that doctors could no longer call themselves gynaecologists if they treat male patients. Late last month, the board reversed a decision they should never have made in the first place.

When announcing the new policy in September, the American Board of Obstetricians and Gynaecologists said that it has always regarded the treatment of women as its 

sole mission. But recently, an increasing number of gynaecologists have branched into moneymaking sidelines. These include prescribing testosterone or male hormone therapy to men and doing liposuction and other cosmetic procedures on women as well as men. The board felt these sidelines were tarnishing the image of gynaecologists. So, it posted on its website an explicit definition of obstetrician-gynaecologist - one that placed limits on the time they could spend doing non-gynaecological procedures. The new definition also said that gynaecologists could not treat men and if they wanted to continue calling themselves gynaecologists.

Those of you looking for the original policy are out of luck because it has been deleted and replaced by the revised policy.

The reaction among gynaecologists was swift. Those who treat men as a regular part of their jobs were put suddenly at risk of losing their credentials and their income. But the move would not have hit gynaecologists in the pocketbook alone.  Some of them would have lost their hospital admitting and operating room privileges, which means they wouldn't have been able to perform surgery or be on call for gynaecological emergencies. 

Some of those affected may have been gynaecologists who see and treat the occasional male patient; for them, it would have been fairly easy to stop seeing male patients altogether. However, it turns out that some gynaecologists see and treat men as a routine part of their practice. These gynaecologists treat men with HIV who are at high risk of anal cancer, which (like cervical cancer) is caused by human papillomavirus. One gynaecologist told the  New York Times that she treated over a hundred men last year. She was on the verge of telling them to look for a new doctor - not an easy task given the lack of experts in the field. Not only that, but her research into the cause and prevention of anal cancer had to be put on hold.

Experts in anal cancer started a letter-writing campaign - asking the board to reconsider its position. Then, patient advocacy groups became vocal critics of the board's policy 

- saying they feared that the prohibition would interfere with scientific research. They also said the policy would make it harder for male patients to find doctors to screen them for anal cancer and to treat it. 

The board came to realize that a government-funded study on anal cancer was at risk of being cancelled. Board members also came to realize that the gynaecologists had been seeing and treating some of their male patients for years and that all the policy was doing was to put the doctor-patient relationship in jeopardy. On late last month, the board issued a  revised definition of an obstetrician-gynaecologist.

The move and the climbdown sure left me wondering just how much of the whole thing was due to gender politics. Back in the day, when most OBGYNs were men, I doubt anyone would have cared that some gynaecologists treated men. To me, it can't be a coincidence that this has become an issue now - when three quarters of all OBGYN residents are women and when the field is about to be dominated by them. Male gynaecologists are becoming an endangered species, and more and more women say they prefer a female gynaecologist. To me, prohibiting mainly female OBGYNs from treating male patients is payback.

I doubt we'll see a anything like that in Canada anytime soon. There is nothing on the websites of the Society of Obstetricians and Gynecologists of Canada or the Royal College of Physicians and Surgeons of Canada that such a move has even been considered. Let's just say it was a non-starter in the US and would almost certainly meet the same fate here in Canada. As to the idea of male gynaecologists becoming an endangered species, I would hope that gynaecologist is an equal opportunity speciality, and that it stays that way.

While obstetrics and gynaecology may be the only speciality developed for women only, it's not the only one that excludes certain kinds of patients. Paediatrics isn't gender specific but it is age specific. Patients age 16 or 17 outgrow their paediatrician (they call that  'aging-out') and have to see a physician who treats adults. This is not a problem for young adults who are in good health.  But it's quite the challenge for young patients with severe chronic childhood conditions like congenital heart disease, juvenile rheumatoid arthritis and those with severe developmental delay. Such patients often search frantically for a physician who treats adults with severe challenges.  I've seen many such patients who visit the ER because they have no other place to go.  

In my opinion, such patients would be far better served remaining with the paediatric specialist who cared for them during their childhood years. 

The idea that the system forces these long-held relationships to an end is just as absurd as ordering a gynaecologist not to treat male patients when she or he has the skill and competence to treat them.  It's time to get rid of arbitrary measures that do more harm than good.