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Evolution of a reproductive endocrinologist: the Society for Reproductive Endocrinology and Infertility fellows retreat and preliminary results of manpower survey
INKLINGS Evolution of a reproductive endocrinologist: the Society for Reproductive Endocrinology and Infertility fellows retreat and preliminary results of manpower survey I had the privilege of attending the Society for Reproductive Endocrinology and Infertility (SREI) fellows retreat in Park City, Utah, in August. This meeting is the crown jewel and signature event of the SREI. This retreat started in 1998 in Aspen, Colorado, and has been held continually for 17 years. The retreat grew out of a longstanding annual fellows retreat for maternal-fetal medicine and neonatology fellows sponsored by the National Institutes of Health (NIH) and under the leadership of Duane Alexander. The retreats were held at the Given Institute in Aspen until it was sold by the University of Colorado. The SREI retreat has subsequently been held in Park City since 2004. The NIH retreat, now called the Annual NICHD [National Institute of Child Health and Human Development] Young Investigator Conference on MaternalFetal-Neonatal-Reproductive Medicine, is now in its 26th year. It is held at the Eaglewood resort (outside of Chicago) and is usually attended by 2nd-year reproductive endocrinology and infertility fellows. Although I did not attend as an SREI fellow, I have had the opportunity to attend the retreat as faculty when it was held in Aspen, as well as cocoordinate the retreat in 2011 and 2012. This year I was able to attend as president of the SREI. I would like to compliment the organizes for coordinating a terrific program. The fellows were energetic, enthusiastic, sponges for advice and knowledge, and, of course, appreciative. The SREI fellows retreat represents an outstanding and unique opportunity for our field. During 3 days in a retreat environment, 1st- and 3rd-year fellows in reproductive endocrinology and infertility are able to interact with successful clinicians, academicians, and businessmen who give advice on finding the right job, career advancement, conducting high-quality research, marketing yourself, life balance, and finances. For the past 2 years we have also been able to include fellows in andrology. Reflecting on this experience, I note that the enthusiasm and appreciation of the fellows has never wavered. However, the message and format has clearly evolved. There is an increase in attention regarding finding the right job, how to succeed in private practice, and the use of social media. Moreover, the age and sex of speakers has evolved away from male white-haired inhabitants of the ivory tower. This change has been by design to reflect perceived changes in the practice of reproductive medicine. Often we do not note change in real time, but see it only in large intervals. Moreover, change is subject to the eye of the beholder. No one can predict how our field will continue to change. However, the best prognosticators start from knowledge of the current state. To this end, I would like to share some preliminary data from a snapshot of how reproductive endocrinology and infertility is practiced today and who is practicing it. Each reader will have to compare today to their perception of the past. In late 2013 and early 2014, the SREI conducted a manpower survey to assess the demographics and practice 950
patterns of reproductive endocrinologists. The survey was sent out electronically to all members of SREI. The SREI is an exclusive club, because membership requires board certification from the American Board of Obstetrics and Gynecology in the subspecialty of reproductive endocrinology and infertility. The survey was answered by 336 individuals, about one-third of the SREI members. If the respondents represent a cross-section of a specialty, we are on average 53 years old (range 34–90). Please note that this survey was only open to those who have passed their boards, which explains the apparent older age. We are 61% male and 79% white. About 37% of us work in an academic setting and 57% in private practice. Only 6% have employment that does not fit those general categories. Approximately 10% work part-time. We have had on average 2.5 jobs since our fellowship. We work on average 53 hours per week. We are very focused in our practice of medicine. We work in large groups with an average of 5.5 M.D.s and approximately two M.D. extenders per practice. A large percentage of our practices do not have contact with fellows (68%), residents (30%), or medical students (35%). On average, our practices consist of 63% infertility, 10% endocrinology, 10% surgery, 10% research, and 5% gynecology. We practice very little primary or preventive medicine. On average, we conduct 12 major and 69 minor surgical cases per year (excluding in vitro fertilization [IVF]). Each practice conducts an average of 480 fresh IVF cycles per year, with each M.D. personally conducting about 125 retrievals per year. Of note, there is a large range for these numbers. Of particular interest it that we are a very contented subspecialty with very high job satisfaction. A total of 83% of respondents were positive or very positive about the current state of our profession. Similar percentages were positive or very positive about the future state of our profession. Morale was high or very high for 83% of respondents, and 75% noted a high or very high morale for others in the field. A total of 92% would choose reproductive endocrinology and infertility again if they had to do it all over, and 80% would recommend the field to others or their children. I suspect that these are much higher percentages compared with other medical specialties. The high morale was driven by satisfaction with (in order) patient interaction, intellectual stimulation, interaction with colleagues, work schedule, and compensation. Those that reported negatives aspects of our profession cited (in order) work schedule, compensation, and interaction with insurance. We are well compensated, with average compensation reported in this survey above that reported by the American Association of Medical Clinics for our field. However, the standard deviation of average compensation is larger than the mean, reflecting a huge variation and a skew toward a small percentage of respondents reporting very high compensation. This likely explains why most are satisfied in this area while others may be less so. When asked about training and the future of the field, respondents noted that we received a ‘‘surplus’’ of training in our fellowships in the areas of female infertility, ultrasound, and basic research. Respondents noted ‘‘insufficient’’ training VOL. 102 NO. 4 / OCTOBER 2014
Fertility and Sterility® in our fellowship in the areas of male infertility, embryo transfer, embryology, genetics, and clinical research. These answers likely reflect the evolution of practice outpacing training. Because these answers reflect how we are currently practicing, as a field we need to take note and perhaps alter the training of fellows (and practitioners) accordingly. It can also be interpreted from this survey that our field is about the correct size, and is not expanding briskly. Although 48% noted they expect their practice will increase in next 5 years, 43% stated that it would stay the same and 9% expected a decrease. A total of 45% stated that they expect someone in the practice to retire in next 5 years. However, a total of 36% felt that there was a surplus of graduating fellows in reproductive endocrinology and infertility, whereas 57% felt the number was adequate and 6% felt there was a shortage. Currently the results of this survey are under analysis with the plan to look at the data stratified by age, sex, and mode of practice. A full report will be presented elsewhere. My point in sharing the preliminary data now is to emphasize what a privilege and joy it is to practice reproductive medicine. One cannot appreciate or measure change unless we know where we are currently. While the practice of reproductive endocrinology and infertility evolves, we need to continue to support those entering the field. The SREI fellows retreat is a great start. The retreat is not the sole reason for such high satisfaction within our field. However, I do believe that the enthusiasm for a career in reproductive medicine starts with this SREI fellows retreat. Preparing the next generation with realistic expectations, arming them with tools to succeed, promoting camaraderie, and welcoming them to our small elite club provide an excellent start to a career. I do not know of any other profession that can gather a vast majority of those entering a field in one place and provide them guidance and advice. Many in
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other subspecialties are envious of this program. I commonly hear wonderful comments about the positive experiences and memories of the SREI fellows retreat from both recent attendees and former attendees. I am thankful that I was able to be involved in the retreat. I am truly grateful for the founders and supporters such as the leadership of the American Society for Reproductive Medicine and SREI as well as long-standing contributors and supporters, such as Paul Weathersbee. This retreat is optimized by gathering all fellows in one place, at the same time, and because of the stewardship of a professional organization such as SREI. The SREI strives to improve the retreat every year. It is a unique and valuable tradition that we must not undervalue. The SREI fellows retreat, with its focus on the next generation, is worth the investment, in every sense of the word. Kurt T. Barnhart, M.D., M.S.C.E. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania http://dx.doi.org/10.1016/j.fertnstert.2014.08.026 You can discuss this article with its authors and with other ASRM members at http://fertstertforum.com/barnhartk-srei-fellows-retreatmanpower-survey/ Use your smartphone to scan this QR code and connect to the discussion forum for this article now.* * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace.
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patterns of reproductive endocrinologists. The survey was sent out electronically to all members of SREI. The SREI is an exclusive club, because membership requires board certification from the American Board of Obstetrics and Gynecology in the subspecialty of reproductive endocrinology and infertility. The survey was answered by 336 individuals, about one-third of the SREI members. If the respondents represent a cross-section of a specialty, we are on average 53 years old (range 34–90). Please note that this survey was only open to those who have passed their boards, which explains the apparent older age. We are 61% male and 79% white. About 37% of us work in an academic setting and 57% in private practice. Only 6% have employment that does not fit those general categories. Approximately 10% work part-time. We have had on average 2.5 jobs since our fellowship. We work on average 53 hours per week. We are very focused in our practice of medicine. We work in large groups with an average of 5.5 M.D.s and approximately two M.D. extenders per practice. A large percentage of our practices do not have contact with fellows (68%), residents (30%), or medical students (35%). On average, our practices consist of 63% infertility, 10% endocrinology, 10% surgery, 10% research, and 5% gynecology. We practice very little primary or preventive medicine. On average, we conduct 12 major and 69 minor surgical cases per year (excluding in vitro fertilization [IVF]). Each practice conducts an average of 480 fresh IVF cycles per year, with each M.D. personally conducting about 125 retrievals per year. Of note, there is a large range for these numbers. Of particular interest it that we are a very contented subspecialty with very high job satisfaction. A total of 83% of respondents were positive or very positive about the current state of our profession. Similar percentages were positive or very positive about the future state of our profession. Morale was high or very high for 83% of respondents, and 75% noted a high or very high morale for others in the field. A total of 92% would choose reproductive endocrinology and infertility again if they had to do it all over, and 80% would recommend the field to others or their children. I suspect that these are much higher percentages compared with other medical specialties. The high morale was driven by satisfaction with (in order) patient interaction, intellectual stimulation, interaction with colleagues, work schedule, and compensation. Those that reported negatives aspects of our profession cited (in order) work schedule, compensation, and interaction with insurance. We are well compensated, with average compensation reported in this survey above that reported by the American Association of Medical Clinics for our field. However, the standard deviation of average compensation is larger than the mean, reflecting a huge variation and a skew toward a small percentage of respondents reporting very high compensation. This likely explains why most are satisfied in this area while others may be less so. When asked about training and the future of the field, respondents noted that we received a ‘‘surplus’’ of training in our fellowships in the areas of female infertility, ultrasound, and basic research. Respondents noted ‘‘insufficient’’ training VOL. 102 NO. 4 / OCTOBER 2014
Fertility and Sterility® in our fellowship in the areas of male infertility, embryo transfer, embryology, genetics, and clinical research. These answers likely reflect the evolution of practice outpacing training. Because these answers reflect how we are currently practicing, as a field we need to take note and perhaps alter the training of fellows (and practitioners) accordingly. It can also be interpreted from this survey that our field is about the correct size, and is not expanding briskly. Although 48% noted they expect their practice will increase in next 5 years, 43% stated that it would stay the same and 9% expected a decrease. A total of 45% stated that they expect someone in the practice to retire in next 5 years. However, a total of 36% felt that there was a surplus of graduating fellows in reproductive endocrinology and infertility, whereas 57% felt the number was adequate and 6% felt there was a shortage. Currently the results of this survey are under analysis with the plan to look at the data stratified by age, sex, and mode of practice. A full report will be presented elsewhere. My point in sharing the preliminary data now is to emphasize what a privilege and joy it is to practice reproductive medicine. One cannot appreciate or measure change unless we know where we are currently. While the practice of reproductive endocrinology and infertility evolves, we need to continue to support those entering the field. The SREI fellows retreat is a great start. The retreat is not the sole reason for such high satisfaction within our field. However, I do believe that the enthusiasm for a career in reproductive medicine starts with this SREI fellows retreat. Preparing the next generation with realistic expectations, arming them with tools to succeed, promoting camaraderie, and welcoming them to our small elite club provide an excellent start to a career. I do not know of any other profession that can gather a vast majority of those entering a field in one place and provide them guidance and advice. Many in
VOL. 102 NO. 4 / OCTOBER 2014
other subspecialties are envious of this program. I commonly hear wonderful comments about the positive experiences and memories of the SREI fellows retreat from both recent attendees and former attendees. I am thankful that I was able to be involved in the retreat. I am truly grateful for the founders and supporters such as the leadership of the American Society for Reproductive Medicine and SREI as well as long-standing contributors and supporters, such as Paul Weathersbee. This retreat is optimized by gathering all fellows in one place, at the same time, and because of the stewardship of a professional organization such as SREI. The SREI strives to improve the retreat every year. It is a unique and valuable tradition that we must not undervalue. The SREI fellows retreat, with its focus on the next generation, is worth the investment, in every sense of the word. Kurt T. Barnhart, M.D., M.S.C.E. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania http://dx.doi.org/10.1016/j.fertnstert.2014.08.026 You can discuss this article with its authors and with other ASRM members at http://fertstertforum.com/barnhartk-srei-fellows-retreatmanpower-survey/ Use your smartphone to scan this QR code and connect to the discussion forum for this article now.* * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace.
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