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The future of obstetrics and gynecology
EDITORIAL
The Future of Obstetrics and Gynecology
John T. Queenan, MD Deputy Editor
The results of the 2003 National Resident Matching Program showed fewer US medical student seniors entering the field of obstetrics and gynecology than in the past. The number of postgraduate year 1 positions has remained remarkably stable over the last decade, at around 1150 positions. This year, only 68% of available obstetrics and gynecology residency positions were filled by US medical school seniors, compared with 86% a decade ago. The number of foreign medical graduates filling these positions is increasing. The trend of fewer US senior students choosing to specialize in obstetrics and gynecology has very serious implications, the most obvious of which is the potential for physician shortages. Second, the dwindling popularity of the specialty can influence medical students against considering obstetrics and gynecology as a viable career choice. These factors urgently deserve our attention because they seriously jeopardize future health care delivery for women. With many exciting scientific and technological advances in obstetrics and gynecology, one would think the specialty would be very attractive. Delivering new lives into the world brings enormous joy and happiness to physicians. However, some medical students consider our specialty unattractive for a variety of reasons. In truth, practicing obstetrics and gynecology entails long hours. Being on call requires nights and weekends away from home and family. In this era, young people seriously consider quality of life issues when making career choices. Additionally, the professional liability crisis in many states has made the financial aspect of obstetric practice seem bleak. Many medical students incur large debts, and within the specialty, the potential for paying off student loans seems dismal. Financial concerns are compounded by disastrous professional liability suits and how much harder one has to work to maintain a level standard of living. Currently, quality of life and professional liability issues are so serious and pervasive that many practicing obstetrician– gynecologists are growing dissatisfied. As they sit in the labor and delivery department in the wee hours of the morning, it is easy to predict what they are talking about. Medical students rotating through obstetrics hear their role models, the attending physicians, grumbling to one another about how bad conditions are. Residents are seen as tired and overworked. Instead of concentrating on the exciting aspects of the specialty such as birth, innovative surgery, assisted reproduction, or sonography, students witness an uninspiring “sad sack” mentality. With this scenario, isn’t it logical for them to cross obstetrics and gynecology off their lists of career choices? Is dissatisfaction in the field of obstetrics and gynecology real or anecdotal? In their article in this month’s issue,1 Kravitz et al present the result of a survey showing that 25% were dissatisfied with their career choice. These were predominantly younger physicians. Obstetrician– gynecologists were significantly less satisfied than primary care physicians. They also were dissatisfied with the opportunity for continuity of care. The sampling of physicians is already several years old, and I suggest that the dissatisfaction has increased since then. In recent years, the sweeping trend of women patients choosing female obstetrician– gynecologists has seriously affected the number of men entering the specialty. This trend began with the large number of women entering medical school in the 1980s. As they finished training and entered practice, established physicians rushed
VOL. 102, NO. 3, SEPTEMBER 2003 © 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier.
0029-7844/03/$30.00 doi:10.1016/S0029-7844(03)00743-9
441
to hire female physicians to provide options to their patients. Commonly, the appointment personnel in obstetrician– gynecologist offices promoted the fact that the office now had a female physician. As more women finished residencies, they enjoyed great demand, making it harder for men to get jobs in practice. Recently, male medical students have been told that the future for men in the specialty is limited. As men shy away from choosing obstetrics and gynecology, the pool of applicants is almost cut in half. Is this problem serious? We have already seen a marked drop in the number of US medical graduates choosing a career in obstetrics and gynecology. The rush to hire women is a result of the phenomenon of introducing them into the specialty. In time, the preferential recruiting of women to practices will decrease, and gender will be less important. In the meantime, however, there is a risk that public perception could be exaggerated to a point where it becomes the norm to go to a female obstetrician– gynecologist. This could irrevocably tip the balance, making it almost impossible to recruit men to the specialty. If only a few men choose the specialty, and some women shy away because of poor prospects, the quality of obstetrics and gynecology candidates could plummet. Is this problem worth fixing? I consider it crucial to the preservation of women’s health care in the United States. A major effort is needed to address the portrayal of our specialty to young physicians. We need to educate medical students that what they see in the medical school setting are not the only options. Our specialty has many
442
Queenan
Future of Obstetrics and Gynecology
practice opportunities for almost any lifestyle, and it has traditionally provided financial security.1 The war we are waging against the malpractice crisis is beginning to turn in our favor. In many parts of the United States the professional liability climate is already favorable due to liability reform. Certainly, we have a major challenge ahead of us. The prospects of our specialty must be kept bright for males and females. Everyone has a responsibility to portray the specialty favorably while we work at improving our lot. Young people should make decisions that are appropriate for their future medical careers and lifestyles. Some areas of the specialty, such as coverage and scheduling, are being changed to improve lifestyle and family time for practitioners. Finally, there are few areas in the medical arena where one can combine professional skill and exciting scientific advances with the joy of welcoming a new life into the world. The medical outcomes are usually good, and the rewards of this specialty are unique. We must mount a campaign to assure that future medical students will choose this specialty, thus affording physicians and patients alike a bright future.
REFERENCE 1. Kravitz RL, Leigh JP, Samuels SJ, Schembri M, Gilbert WM. Tracking career satisfaction and perceptions of quality among US obstetricians and gynecologists. Obstet Gynecol 2003;102:463–70.
OBSTETRICS & GYNECOLOGY
The Future of Obstetrics and Gynecology
John T. Queenan, MD Deputy Editor
The results of the 2003 National Resident Matching Program showed fewer US medical student seniors entering the field of obstetrics and gynecology than in the past. The number of postgraduate year 1 positions has remained remarkably stable over the last decade, at around 1150 positions. This year, only 68% of available obstetrics and gynecology residency positions were filled by US medical school seniors, compared with 86% a decade ago. The number of foreign medical graduates filling these positions is increasing. The trend of fewer US senior students choosing to specialize in obstetrics and gynecology has very serious implications, the most obvious of which is the potential for physician shortages. Second, the dwindling popularity of the specialty can influence medical students against considering obstetrics and gynecology as a viable career choice. These factors urgently deserve our attention because they seriously jeopardize future health care delivery for women. With many exciting scientific and technological advances in obstetrics and gynecology, one would think the specialty would be very attractive. Delivering new lives into the world brings enormous joy and happiness to physicians. However, some medical students consider our specialty unattractive for a variety of reasons. In truth, practicing obstetrics and gynecology entails long hours. Being on call requires nights and weekends away from home and family. In this era, young people seriously consider quality of life issues when making career choices. Additionally, the professional liability crisis in many states has made the financial aspect of obstetric practice seem bleak. Many medical students incur large debts, and within the specialty, the potential for paying off student loans seems dismal. Financial concerns are compounded by disastrous professional liability suits and how much harder one has to work to maintain a level standard of living. Currently, quality of life and professional liability issues are so serious and pervasive that many practicing obstetrician– gynecologists are growing dissatisfied. As they sit in the labor and delivery department in the wee hours of the morning, it is easy to predict what they are talking about. Medical students rotating through obstetrics hear their role models, the attending physicians, grumbling to one another about how bad conditions are. Residents are seen as tired and overworked. Instead of concentrating on the exciting aspects of the specialty such as birth, innovative surgery, assisted reproduction, or sonography, students witness an uninspiring “sad sack” mentality. With this scenario, isn’t it logical for them to cross obstetrics and gynecology off their lists of career choices? Is dissatisfaction in the field of obstetrics and gynecology real or anecdotal? In their article in this month’s issue,1 Kravitz et al present the result of a survey showing that 25% were dissatisfied with their career choice. These were predominantly younger physicians. Obstetrician– gynecologists were significantly less satisfied than primary care physicians. They also were dissatisfied with the opportunity for continuity of care. The sampling of physicians is already several years old, and I suggest that the dissatisfaction has increased since then. In recent years, the sweeping trend of women patients choosing female obstetrician– gynecologists has seriously affected the number of men entering the specialty. This trend began with the large number of women entering medical school in the 1980s. As they finished training and entered practice, established physicians rushed
VOL. 102, NO. 3, SEPTEMBER 2003 © 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier.
0029-7844/03/$30.00 doi:10.1016/S0029-7844(03)00743-9
441
to hire female physicians to provide options to their patients. Commonly, the appointment personnel in obstetrician– gynecologist offices promoted the fact that the office now had a female physician. As more women finished residencies, they enjoyed great demand, making it harder for men to get jobs in practice. Recently, male medical students have been told that the future for men in the specialty is limited. As men shy away from choosing obstetrics and gynecology, the pool of applicants is almost cut in half. Is this problem serious? We have already seen a marked drop in the number of US medical graduates choosing a career in obstetrics and gynecology. The rush to hire women is a result of the phenomenon of introducing them into the specialty. In time, the preferential recruiting of women to practices will decrease, and gender will be less important. In the meantime, however, there is a risk that public perception could be exaggerated to a point where it becomes the norm to go to a female obstetrician– gynecologist. This could irrevocably tip the balance, making it almost impossible to recruit men to the specialty. If only a few men choose the specialty, and some women shy away because of poor prospects, the quality of obstetrics and gynecology candidates could plummet. Is this problem worth fixing? I consider it crucial to the preservation of women’s health care in the United States. A major effort is needed to address the portrayal of our specialty to young physicians. We need to educate medical students that what they see in the medical school setting are not the only options. Our specialty has many
442
Queenan
Future of Obstetrics and Gynecology
practice opportunities for almost any lifestyle, and it has traditionally provided financial security.1 The war we are waging against the malpractice crisis is beginning to turn in our favor. In many parts of the United States the professional liability climate is already favorable due to liability reform. Certainly, we have a major challenge ahead of us. The prospects of our specialty must be kept bright for males and females. Everyone has a responsibility to portray the specialty favorably while we work at improving our lot. Young people should make decisions that are appropriate for their future medical careers and lifestyles. Some areas of the specialty, such as coverage and scheduling, are being changed to improve lifestyle and family time for practitioners. Finally, there are few areas in the medical arena where one can combine professional skill and exciting scientific advances with the joy of welcoming a new life into the world. The medical outcomes are usually good, and the rewards of this specialty are unique. We must mount a campaign to assure that future medical students will choose this specialty, thus affording physicians and patients alike a bright future.
REFERENCE 1. Kravitz RL, Leigh JP, Samuels SJ, Schembri M, Gilbert WM. Tracking career satisfaction and perceptions of quality among US obstetricians and gynecologists. Obstet Gynecol 2003;102:463–70.
OBSTETRICS & GYNECOLOGY