Obstetrics and Gynecology (often abbreviated to OB/GYN or O&G) form a single medical speciality and have a combined postgraduate training program. This is quite arduous: in Australia, for example, it is among the longest, six years, matched only by neurosurgery. In the United States, OB/GYN specialists require four years of medical school followed by four years in residency. Some generalists can work as obstetricians, mainly in rural areas. All gynecologists, therefore, are trained obstetricians, and vice versa. However, some doctors drop their obstetric practice, especially as they get older. This is often due to the double burden of very late hours and, depending on the country, high rates of litigation.
In the last few years, medical malpractice suits and skyrocketing insurance premiums have forced many American obstetricians and gynaecologists to leave or limit their practice. Medical students are increasingly choosing not to specialize in obstetrics (see Bower 2003). This all adds up to fewer obstetricians in some states and fewer health care options for women, though it has led to higher average salaries, as an article by Medical Economics points out.