He likens his role to that of a show producer.
“You have to have a vision, and the overarching vision is, ‘What do you want your show to look like?’” says Dr. Lawrence D. Devoe, who retired June 30 as Brooks Professor and chair of the Department of Obstetrics and Gynecology.
When he became interim chair in 1995, Dr. Devoe’s vision was to offer the obstetrical and gynecological services women need and want. Today’s reality is well on its way to being just that.
“We really have everything covered,” says Dr. Devoe, reeling off advances that have made his department an “overnight sensation that only took 10 years.”
For instance, the Section of Urogynecology/Pelvic Surgery, led by Dr. Sean L. Francis, “is taking off,” Dr. Devoe says. “It’s the newest area in our field that has been recognized as its own discipline.” Its focus areas include female urologic dysfunction (largely incontinence, which will affect an estimated 20 million women by 2010) and prolapse, or weakening of the pelvic floor.
The Section of Reproductive Endocrinology, Infertility and Genetics, led by Dr. Lawrence C. Layman, “is in the top echelon nationally in terms of pregnancy success. It’s an extraordinarily good program.”
He lauded the collaborative efforts of his department’s gynecologic oncology program with the community’s medical oncology group. “They have really extended the sphere of cancer care,” Dr. Devoe says of Drs. Michael S. Macfee’s and Sharad A. Ghamande’s innovative relationship with Augusta Oncology Associates.
He recently recruited Dr. Andrew W. Helfgott as chief of the Section of Maternal-Fetal Medicine, a post that Dr. Devoe assumed in 1984 and maintained throughout most of his chairmanship.
The Section of General Obstetrics and Gynecology is the largest section. Its highly successful program, Nurse Midwives of Augusta, is the only midwifery program in the region.
A complementary medicine section was a final piece of Dr. Devoe’s plan. Drs. Jane Blackwell and Michelle Manting-Brewer, experts in acupuncture and holistic medicine, have filled that niche. “The demand for complementary medicine services is one of the most rapidly growing demand areas in medicine, targeting areas including chronic pelvic pain, migraine syndrome, painful menstruation and even infertility,” says Dr. Devoe.
“There is a theme in both depth and breadth of services,” he says. That theme has been played out during 10-plus hard years for the field of ob-gyn, with litigation and lifestyle issues severely diminishing the number of interested young doctors.
In the early 1990s, ob-gyn was one of the most popular residency choices for U.S. medical graduates. “Programs were competitive, hard to get into; about 90 percent of the positions filled through the annual match [of senior medical students with residency programs],” he says. Then, malpractice premiums skyrocketed, reimbursement rates plummeted and future doctors began looking at other options; some practitioners even got out, particularly of the delivery process. Today, about 70 percent of residency programs are filled by U.S. medical school graduates. “You can see where this is going; not all the folks who train here are going to stay in the United States,” he says. “If the current trend continues, we will reach a critical point about 2010.
“The biggest problem in general obstetrics is that the expectation of perfection is 100 percent,” says Dr. Devoe, a specialist in high-risk pregnancies who still loves the delivery room despite concerns that have sent others packing. “What a wonderful experience. You go into a room with two people and you leave the room and there is a family. You are the first person typically to touch the baby. It’s a privilege and a gift to be able to do that.”
He personally advises several medical students each year, telling them their choice of specialty is akin to choosing a marriage partner.
“A lot of this medicine business is about inspiration,” says Dr. Devoe, whose original dream was to be a surgeon like his grandfather. The dream took a new direction at the University of Chicago Pritzker School of Medicine, when he worked as a medical student in the laboratory of Dr. Uwe Freese, an obstetrician studying factors that influence embryo implantation. Dr. Devoe went on to complete an ob-gyn residency and maternal-fetal medicine fellowship at the University of Chicago’s Lying-In Hospitals and Clinics.
Dr. Devoe, along with Dr. Iqbal Khan, former student education coordinator and now assistant dean of MCG’s Southwest Georgia Clinical Campus in Albany, helped reshape MCG’s ob-gyn program to try to keep the dream alive for medical students and residents.
Moves have included the painful one of reducing the longtime affiliation with Augusta’s University Hospital to meet the 80-hour weekly work limit of the Accreditation Council for Graduate Medical Education.
A happier move was sending medical students to alumni practitioners statewide—Dalton, Eastman, Valdosta, Rome, Carrollton, LaGrange, Waynesboro and Albany—for their ob-gyn rotations. “The students love it,” Dr. Devoe says. “They basically live with them for six weeks. It’s really like adopting a child.”
The strong clinical and education initiatives are fueled by vibrant research activity. “We have research faculty in virtually every one of the major research venues on campus,” he says, referencing substantial National Institutes of Health funding and studies in cancer, cardiovascular disease, diabetes, infection/ inflammation and neurological disease.
With his “overnight sensation” on task, Dr. Devoe decided to complete his vision by making this academic year his last as chair.
“These are hard jobs and I have only one gear,” says Dr. Devoe. “The best time to do this is when you have good people, the department is in good shape, the programs are clicking and you have an attractive scenario for somebody good to come to. I also, philosophically, never wanted to do the same year twice.”
Dr. Ana Alvarez Murphy, founding director of the Division of Reproductive Medicine and Infertility at Emory University School of Medicine and MCG’s new ob-gyn chair, “brings a lot of good things to the table, a nice balance of research and clinical interests and high degree of motivation,” Dr. Devoe says. (See Blazing New Trails)
The good news is he went no farther than the labor and delivery suite of MCG Medical Centers where he continues the privilege of helping couples become families.
Toni Baker