General Services
The Department of Obstetrics and Gynecology at The LBJ Tropical Medical Center (henceforth “LBJ”) provides inpatient services in Labor and Delivery, Maternity, Gynecology, and as needed in the Intensive Care Unit. We also provide outpatient services in the Obstetrics and Gynecology Clinic, Family Planning, and at times in the Prenatal Clinics in our outlying villages. Our Labor and Delivery Unit is comprised of an eight-bed unit with two birthing beds and a separate delivery room, and typically manages around 70 births per month. Laboring patients are admitted to the Labor and Delivery Unit, where they receive care until post-partum transfer to the Maternity Unit. In addition to laboring patients, the Labor and Delivery Unit cares for patients with pregnancies complicated by pre-eclampsia, diabetes, pre-term labor, and other common morbidities. Our Maternity Unit is a 30-bed unit, where stable patients with pre-term labor and post-partum patients are managed. Our Intensive Care Unit (ICU) is a shared 7 bed unit with patients from Internal Medicine, Surgery, Pediatrics, and other inpatient services as needed as well. Common diagnoses requiring ICU management include pre-eclampsia, diabetes mellitus, acute renal failure, sepsis, and occasional post-operative complications.
The Obstetrics and Gynecology Outpatient Clinic provides services primarily in pre-natal care, gynecology, and post-partum care. Typical high-risk prenatal care in American Samoa includes pregnancies complicated by hypertension, gestational diabetes, rheumatic heart disease, thyroid dysfunction, and hyperemesis gravidarum. Common gynecologic diagnoses include abnormal uterine bleeding, uterine cancer, and morbidities associated with the high prevalence of obesity. Family planning counseling is provided at the Family Planning Clinic. The Family Planning Clinic offers prenatal counseling for women considering tubal ligations and post-partum family planning services, such as condoms, Depo Provera, oral contraceptive pills, hormonal implants, and intrauterine devices. The Department on Health Community Health Centers located in Amouli, Leone, and Tafuna are staffed by nurse practitioners. Staff provide low-risk prenatal care up to 36 weeks of gestation and some contraceptive methods.
Sub-Specialty Services
Obstetric and gynecologic subspecialty care is available to our patients through a number of different avenues. The OBGYN physicians are able to consult with OBGYN physicians and Maternal Fetal Medicine specialists at the University of Hawaii and specialists in Auckland, New Zealand via a telemedicine network. Additionally, LBJ funds an Off-Island Referral Program, which provides access to discounted airfare(s) for patients requiring care that is unavailable here in American Samoa to travel to a higher level of care outside of the Territory, generally in Hawai’i, New Zealand, or the mainland U.S.A. Common subspecialty care that is sought off-island includes urogynecology, gynecologic oncology, and a higher level of care for complicated obstetric cases.
Physician Job Description
On-call physicians: These physicians follow all patients, whether obstetric or gynecologic, who are admitted during their on-call shifts. Physicians are responsible for performing all types of interventional deliveries as necessary, including cesarean sections, forceps deliveries, and vacuum-assisted deliveries, as well as managing complications like eclampsia, retained placenta, placental abruption, and placenta previa. Post-partum hysterectomy may be required for post-partum hemorrhage. During the on-call shift, the physician on duty does not have outpatient clinic responsibilities unless there are emergency cases. The on-call physician admits patients from the Emergency Department and provides consultative services to the Emergency Department and other specialties, as requested. The second on-call physician provides back-up for the first on-call by assisting with emergent cesarean sections and laparotomies. Call coverage runs from 8am to 8am the following day and averages 1:4 or 1:5, depending on the current staffing, with a goal of 1:6.
Clinic physicians: These physicians work primarily in the OBGYN Clinic from 8am to 4pm. They are responsible for starting the clinics every day. They are to assist the on-call physicians by seeing walk-in patients and admitting patients for the on-call physician if the on-call physician is busy. It is the on-call physician’s responsibility to follow patients admitted to the OBGYN Ward on their behalf.
Weekly Schedule
On Mondays, physicians meet at 7:30am for sit-down rounds to discuss complicated cases being managed in either the inpatient or the outpatient setting. The remainder of the morning is scheduled for surgeries, primarily elective cesarean sections and gynecologic cases. While physicians are operating, clinic nurses are registering new prenatal cases. Monday afternoons are then spent with initial prenatal physical exams for those patients who were registered in the morning. During Tuesday morning and afternoon clinics, physicians see low-risk prenatal follow-up appointments. Every Wednesday morning from 7:30am to 8:30am, physicians are expected to participate in the medical staff Continuing Medical Education meeting, during which topics of general interest to the entire medical staff are presented from each department on a rotating basis. Afterwards, Wednesday morning and afternoon clinics are dedicated to gynecologic cases and post-partum care for both new and follow-up cases. Thursday clinics see high-risk prenatal cases. Friday clinics are spent with low-risk prenatal follow-up appointments. On the first Friday of every month, the department holds a unit meeting with Family Planning, Maternity, Labor and Delivery, and other practitioners from the outlying clinics. On the third Friday of every month, the department holds an in-service for physicians, midwives, and nurses, during which time protocols are reviewed and lecture material is presented. Occasionally, other meetings, such as Perinatal Morbidity and Mortality, are called on an ad-hoc basis.
Position Qualifications
- MD from an accredited medical school or MBBS from an accredited foreign school.
- Prefer a Master of Medicine in OB/GYN.
- Eligible for medical licensure in American Samoa.
- Internship, Residency and Fellowship preferred but not required.
- Five years of clinical experience preferred.
Physical Requirements:
- Must be able to lift up to 50 pounds on own; amounts over 50 pounds with assistance of mechanical devices or other personnel.
- Must be able to twist, bend, stoop, squat, crawl, kneel, push, pull.
- Must be able to climb stairs, use standing balance, walk on uneven ground.
- Must be able to use hands repetitively, use simple grasp, use firm grasp, use manual dexterity.
Pay: $75,000.00 - $80,000.00 per year
Experience:
- Ob/Gyn: 6 years (Required)
Work Location: In person
