PCP vs GYN

[mccallister84]

Is there any reason for me to see my gynecologist as opposed to just seeing my pcp? I just got an (generic) email from my PCP reminding me that they are there for physical and well women check ups during Covid. I’m due for a physical in July. I haven’t seen my gynecologist since my post partum check up with DD2, which will be two years this July. I LOVE her but she’s kind of far away and keeps limited hours so it was always a hassle getting over there (hence why I didn’t see her last year). We are done having babies and H had a vasectomy so no need for birth control. From that email I’m guessing my PCP could do a Pap smear. Is there anything I’m missing? Any reason to see the specialist here?

[isabel]

I stopped going to my GYN last year. I realized there was really no point in seeing her anymore now that I'm done having kids. I met with a PCP just to establish a relationships and she said she'll do a pap this year.

[kooshball]

My PCP always does my paps and all my women care. Never even seen a gyn.

[Patsy Baloney]

I’d save yourself the hassle and just do PCP! If you ever need a specialists care, you can see your gyn again.

[wanderingback]

Yes a pcp is all you need.
They can refer you to gyn just like any other specialist for any care that would benefit from a specialist.
And a pcp can do birth control too (I know you don’t need it, but just thought I’d throw it out there for anyone reading).

[mommin]

I haven't seen my gyn in 6+ years. My pcp does my pap smear and the results are always normal. I like that I can get my pap done with regular check up stuff and save myself an extra appointment. If there was an irregularity I would definitely go back to my gyn but that hasn't been an issue to date.

[fernweh]

Within the last couple years I have started seeing my PCP for my pap. She even did my IUD insertion. I don’t plan to have kids so honestly I’ll likely not go back to my gyn. I left early because the office moved three times and then downsized so there was only 1 dr with very limited hours that just didn’t work for me anymore. I was too lazy to find a new a new one.

[SusanBAnthony]

I see a FP doc who delivers babies and does all my well woman care. I love her. I can't imagine if need a gun unless I had complications of some kind.

[dexteroni]

I saw only my PCP for many years, and she did pretty much the same stuff as my GYN did. I was more than happy to only have one annual per year instead of two. When I entered perimenopause and had a couple abnormal paps, my PCP recommended starting to see a GYN again, so I did. So basically as long as everything is uneventful, it's fine to see your PCP.

[rubytue]

My old PCP did paps, but my current one sends my to gyn.

[foundmylazybum]

I prefer a gyn. Its true a PCP can handle the basics but i appreciate that a gyn can respond with a quickness to specific issues and I like going to a specialist for that.

[starburst604]

I don’t think so, unless there are gyn issues that need attention. My PCP does my pap when needed along with my general examination. I did see a gyn when I had a concern specific to that, but otherwise only go to my PCP.

It seems a lot of women see a gyn in place of a PCP, which is maybe fine but I feel like my PCP covers a much wider spectrum of my care than just my lady parts.

[Susie]

Before kids, I only saw a PCP who did my paps and prescribed my BCPs.  It made my life simpler, and I didn't feel like I had any need for an ob/gyn.

Now that I am done having kids, I plan to stick with my ob/gyn.  I have family histories of ovarian and breast cancer and prefer monitoring by/advice from a specialist.  

I need to keep the PCP in addition because even when I was pregnant if I had a concern that wasn't immediately in the ob/gyn lane, they were like, IDK call your PCP.  I know a lot of posters seem to say they only see an ob/gyn, but that definitely doesn't work with the doctors I've seen.

[DotAndBuzz]

Now that I’m done with babies, I also just use my PCP for my annual. I had been going to a gyn, but I got a new PCP when my old one retired a couple years ago, as she said that while I’m still welcome to go to the gyn, she can also do the basics so I don’t have to make another appointment. So that’s what I do now. Not sure why it never occurred to me before, but my only plan for a gyn now is if something comes up that requires more specialized care/treatment.

Edit - I don’t have a known elevated risk of breast, ovarian, cervical, etc cancer. If I did, I may consider sticking with a gyn for my appointments.

[beerlover]

I don't know if this is #regional, but I don't know anyone that uses their PCP for paps. Everyone I know has a separate OB/GYN. I actually have a PCP appointment tomorrow so I'm going to ask about this.

[wambam]

Jul 1, 2020 7:47:28 GMT -5 beerlover said:

I don't know if this is #regional, but I don't know anyone that uses their PCP for paps. Everyone I know has a separate OB/GYN. I actually have a PCP appointment tomorrow so I'm going to ask about this.

Same. It never even occurred to me to have my PCP do my pap. I’m sure she can, I just never thought about it. I really like my gym though.

[beerlover]

Jul 1, 2020 7:52:40 GMT -5 wambam said:

Jul 1, 2020 7:47:28 GMT -5 beerlover said:

I don't know if this is #regional, but I don't know anyone that uses their PCP for paps. Everyone I know has a separate OB/GYN. I actually have a PCP appointment tomorrow so I'm going to ask about this.

Same. It never even occurred to me to have my PCP do my pap. I’m sure she can, I just never thought about it. I really like my gym though.

Mine's just OK, but I'm hesitant to switch - I think because my mom has had different gyn issues over the years (pre-cancerous type stuff that was caught early and she's fine now) that she's had to have various procedures for. If your PCP discovered anything abnormal in a pap, I'm guessing you'd have to go to an ob/gyn anyway, so I feel like I might as well just keep mine.

Side note, are they still recommending paps every 3 years?  I swear to God they give me one every single time, but maybe that's because I've had to switch providers a few times over the years due to closures or doctors quitting etc.

[wanderingback]

Jul 1, 2020 8:12:09 GMT -5 beerlover said:

Jul 1, 2020 7:52:40 GMT -5 wambam said:

Same. It never even occurred to me to have my PCP do my pap. I’m sure she can, I just never thought about it. I really like my gym though.

Mine's just OK, but I'm hesitant to switch - I think because my mom has had different gyn issues over the years (pre-cancerous type stuff that was caught early and she's fine now) that she's had to have various procedures for. If your PCP discovered anything abnormal in a pap, I'm guessing you'd have to go to an ob/gyn anyway, so I feel like I might as well just keep mine.

Side note, are they still recommending paps every 3 years?  I swear to God they give me one every single time, but maybe that's because I've had to switch providers a few times over the years due to closures or doctors quitting etc.

Depends on the abnormal found and the pcp/training. Some abnormals you can do a repeat pap smear within a certain time frame and don't need to do anything else and most pcps were trained to follow the recommendations. Where I work we also do colposcopy. We refer out if patient needs LEEP, cone, etc.

Current guidelines for cervical cancer screening: 
Age 21-30 cytology only every 3 years 

Age 30 - 65 cytology plus high risk hpv every 5 years OR high risk hpv only every 5 years OR cytology only every 3 years

Some gyn offices are still recommending "well-woman" exam every year which has been found to be medically unnecessary and definitely don't need a pap smear every year unless it's a special circumstance. Pap smear every year has been found to be more harm than benefit, hence the newest guidelines. 

[somersault72]

Jul 1, 2020 8:21:26 GMT -5 wanderingback said:

Jul 1, 2020 8:12:09 GMT -5 beerlover said:

Mine's just OK, but I'm hesitant to switch - I think because my mom has had different gyn issues over the years (pre-cancerous type stuff that was caught early and she's fine now) that she's had to have various procedures for. If your PCP discovered anything abnormal in a pap, I'm guessing you'd have to go to an ob/gyn anyway, so I feel like I might as well just keep mine.

Side note, are they still recommending paps every 3 years?  I swear to God they give me one every single time, but maybe that's because I've had to switch providers a few times over the years due to closures or doctors quitting etc.

Depends on the abnormal found and the pcp/training. Some abnormals you can do a repeat pap smear within a certain time frame and don't need to do anything else and most pcps were trained to follow the recommendations. Where I work we also do colposcopy. We refer out if patient needs LEEP, cone, etc.

Current guidelines for cervical cancer screening: 
Age 21-30 cytology only every 3 years 

Age 30 - 65 cytology plus high risk hpv every 5 years OR high risk hpv only every 5 years OR cytology only every 3 years

Some gyn offices are still recommending "well-woman" exam every year which has been found to be medically unnecessary and definitely don't need a pap smear every year unless it's a special circumstance. Pap smear every year has been found to be more harm than benefit, hence the newest guidelines. 

What is the harm to yearly paps? I had not heard that.

And yes both the OB/Gyn office I work for and the one I go to recommend yearly well woman exams (my doctor still does a bimanual exam on me even if I don't get a pap).

[wanderingback]

Jul 1, 2020 8:43:57 GMT -5 somersault72 said:

Jul 1, 2020 8:21:26 GMT -5 wanderingback said:

Depends on the abnormal found and the pcp/training. Some abnormals you can do a repeat pap smear within a certain time frame and don't need to do anything else and most pcps were trained to follow the recommendations. Where I work we also do colposcopy. We refer out if patient needs LEEP, cone, etc.

Current guidelines for cervical cancer screening: 
Age 21-30 cytology only every 3 years 

Age 30 - 65 cytology plus high risk hpv every 5 years OR high risk hpv only every 5 years OR cytology only every 3 years

Some gyn offices are still recommending "well-woman" exam every year which has been found to be medically unnecessary and definitely don't need a pap smear every year unless it's a special circumstance. Pap smear every year has been found to be more harm than benefit, hence the newest guidelines. 

What is the harm to yearly paps? I had not heard that.

And yes both the OB/Gyn office I work for and the one I go to recommend yearly well woman exams (my doctor still does a bimanual exam on me even if I don't get a pap).

HPV the virus that can cause cervical cancer is typically cleared by the body/immune system if you are immunocompetent. Plus cervical cancer is very slow growing. What was happening before is people were having abnormal pap smears and getting sent straight for procedures, not only colposcopy but LEEP and cone procedures. Any procedure has risks such as infection and bleeding. In addition LEEP for example can cause the cervix to be stenotic, which can cause difficulty with fertility and pain with pap smears in general. So with all that said after they studied all the data they changed the recommendations to spread out cervical cancer screening to a less harmful model. 

And unless a patient has a complaint, for bimanual exams there isn't enough evidence to recommend them either. They have not been shown to reduce morbidity or mortality. I try to think with a "trauma-informed" lens and do things or touch people when it's only necessary, especially when it comes to sensitive exams. 

From ACOG, "Pelvic examinations should be performed when indicated by medical history or symptoms."

www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/the-utility-of-and-indications-for-routine-pelvic-examination

[wanderingback]

ETA: also health care dollars. I know no one likes to think about it, but we can't just test everyone for everything all the time. Resources are limited and if there are no benefits we need to be conscious of the cost for unnecessary yearly exams and extra procedures that don't provide benefits.

[wildrice]

Jun 26, 2020 23:04:29 GMT -5 wanderingback said:

Yes a pcp is all you need.
They can refer you to gyn just like any other specialist for any care that would benefit from a specialist.
And a pcp can do birth control too (I know you don’t need it, but just thought I’d throw it out there for anyone reading).

Maybe dumb question - if you see a gyn yearly for an exam, do you really need to do a separate physical with a PCP?

I love my gyn but I don't like my PCP and want to switch. The last few physicals I had were more or less just a conversation and very basic physical exam (things like checking to make sure my reflexes are normal, which I had no concerns about anyway). They have honestly felt like a waste of my time. I see a derm for an annual skin check and a gyn for an annual exam so maybe I'm covered? 

Would a GYN do bloodwork (to check for normal things like cholesterol, thyroid levels, etc) if i ask?

[wanderingback]

Jul 1, 2020 9:47:06 GMT -5 wildrice said:

Jun 26, 2020 23:04:29 GMT -5 wanderingback said:

Yes a pcp is all you need.
They can refer you to gyn just like any other specialist for any care that would benefit from a specialist.
And a pcp can do birth control too (I know you don’t need it, but just thought I’d throw it out there for anyone reading).

Maybe dumb question - if you see a gyn yearly for an exam, do you really need to do a separate physical with a PCP?

I love my gyn but I don't like my PCP and want to switch. The last few physicals I had were more or less just a conversation and very basic physical exam (things like checking to make sure my reflexes are normal, which I had no concerns about anyway). They have honestly felt like a waste of my time. I see a derm for an annual skin check and a gyn for an annual exam so maybe I'm covered? 

Would a GYN do bloodwork (to check for normal things like cholesterol, thyroid levels, etc) if i ask?

You would have to ask a gyn what they'll do. 
I highly doubt it though. They aren't trained for that. In general they don't know how to manage or counsel on abnormals in general.  This is just my experience based on patients coming back to me saying my gyn won't do xyz.
Obviously I'm biased, but I'd go to the person where you can get the full spectrum of care. Our office does prenatal care, deliveries, peds, complex contraception, geriatrics, etc, so it's nice to have one home.
Like I said above I don't think anyone needs yearly "well-woman" exam, definitely not a pelvic exam.

In general for healthy people age 20-40ish that have access to healthcare going to 1 doctor every few years is likely fine. Most people don't need blood work every year, but I do think periodic blood pressure check is also good. I've definitely picked up a lot of high-is blood pressure in younger people. Same with mildly elevated blood sugar and cholesterol. At age 30 might not actively do much about it such as medication, but like to have conversation with patient about it. Also, mental health concerns are something I see A LOT, so it's nice to be connected with someone who can at least screen and get things started if needed.

But obviously most important is to go to someone that you're comfortable with. It definitely sucks if you can't find a doctor you're comfortable with. If you like your gyn and they are ok with managing those things then great! I'm sure if they didn't feel comfortable they'd refer out, just like pcp will refer out for what they're not comfortable with. 

[beerlover]

wanderingback, I was hoping you would weigh in on this. Thank you, that's really good information. I would rather not undergo these exams every year if I don't have to (I don't know if I am really sensitive or what but I HATE them and find them very uncomfortable), so I'm definitely going to inquire about it when I go in September if they are telling me I need a pap again.

[wildrice]

Jul 1, 2020 10:22:35 GMT -5 wanderingback said:

Jul 1, 2020 9:47:06 GMT -5 wildrice said:

Maybe dumb question - if you see a gyn yearly for an exam, do you really need to do a separate physical with a PCP?

I love my gyn but I don't like my PCP and want to switch. The last few physicals I had were more or less just a conversation and very basic physical exam (things like checking to make sure my reflexes are normal, which I had no concerns about anyway). They have honestly felt like a waste of my time. I see a derm for an annual skin check and a gyn for an annual exam so maybe I'm covered? 

Would a GYN do bloodwork (to check for normal things like cholesterol, thyroid levels, etc) if i ask?

You would have to ask a gyn what they'll do. 
I highly doubt it though. They aren't trained for that. In general they don't know how to manage or counsel on abnormals in general.  This is just my experience based on patients coming back to me saying my gyn won't do xyz.
Obviously I'm biased, but I'd go to the person where you can get the full spectrum of care. Our office does prenatal care, deliveries, peds, complex contraception, geriatrics, etc, so it's nice to have one home.
Like I said above I don't think anyone needs yearly "well-woman" exam, definitely not a pelvic exam.

In general for healthy people age 20-40ish that have access to healthcare going to 1 doctor every few years is likely fine. Most people don't need blood work every year, but I do think periodic blood pressure check is also good. I've definitely picked up a lot of high-is blood pressure in younger people. Same with mildly elevated blood sugar and cholesterol. At age 30 might not actively do much about it such as medication, but like to have conversation with patient about it. Also, mental health concerns are something I see A LOT, so it's nice to be connected with someone who can at least screen and get things started if needed.

But obviously most important is to go to someone that you're comfortable with. It definitely sucks if you can't find a doctor you're comfortable with. If you like your gyn and they are ok with managing those things then great! I'm sure if they didn't feel comfortable they'd refer out, just like pcp will refer out for what they're not comfortable with. 

Thanks! This is helpful. I should probably just find another PCP. I've only seen 2 since I've lived here (and one was just because my actual PCP was out of the office that day) so I probably just need to shop around more. I just really like my GYN and the office is within walking distance of my work office, so it is too bad they aren't a PCP instead of a specialist!

And good to know about an annual physical, maybe I shouldn't do one every single year anyway. It has seemed fairly pointless the last few years, since I don't have any active diagnoses and they haven't been all that comprehensive anyway. I have a family history of skin cancer and breast cancer so I do think the gyn and derm visits are the most critical for me personally. 

[litskispeciality]

Honestly if I wasn't worried about another fibroid or peri-menopause I'd skip the GYN this year. Paps are now what 5 years or longer? The apts often feel like a waste of time, a quick peek "yup everything looks good", and not believing how often I change pads. Not worth the time or co-pay (if you have one). Way back I had a PCP do paps and prescribe BCP's. Just a thought if you don't have issues or concerns.

[picksthemusic]

Unless you need something gyn-related, it's highly likely your PCP can take care of you. Your PCP will know if it's out of their scope and refer you if you happen to need a specialist for whatever reason.

I will say, PCPs are trying to get people in for well visits right now to generate revenue since they usually pay well through insurance and are a higher fee than one-off visits.

Hope that helps!

[lolalolalola]

The only time I’ve seen a gynecologist was when I had a high risk pregnancy. We don’t see them here unless it’s needed. (Specialists of any kind aren’t used for ‘regular ‘ appointments in a socialized medical system).