Do we have a “problem” NOT a crisis Maybe not even a problem But certainly a disturbing trend A symptom of the times and our specialty that we must address IT.
Market Analysis “SWOT” What is your product? What is your market share? What is your market? –Has it changed? What is the competition? What are your strengths and weaknesses? Obstacles? Threats?
We are Obstetricians and Gynecologists. We are Women’s Health Care providers. We are Surgeons. We are reproductive biologists. We are high risk pregnancy specialists and gynecologic oncologists. What is your product?
What is your market share? How has it changed? We are recruiting from only HALF the medical students ……
Women as % of total Medical School Graduates AAMC
The percent of total women grads choosing OB/GYN has been constant ~9% AAMC
Ob/GYN Residents Matched by Gender from Total US Grads MalesFemalesRatio M to F 19933.6% (345) 8.7% (513) 40%/60% 20032.1% (180) 8.7% (608) 23%/77% AAMC
Women prefer female Obstetrician/Gynecologist? 40% prefer female 10% prefer male 50% Want a “good” doctor Cockburn J. BJOG 1996;103:2-3 Chandler PJ Mil Med 2000; 165:938-940 Fennema K. J Fam Pract 1990;30:441-446
Myths and Misperceptions? Male graduates couldn’t find jobs? Male Ob/gyns paid less? TRUTHS? Deans telling male students not to apply Chairs telling male students not to apply
Women’s attitudes to the sex of medical students in a gyn clinic: cross sectional survey O’Flynn N. BMJ 2002;325:683-684. 33% of women refused to see a medical student 42% accepted any student 25% would not see a male student
The impact of Perceived gender bias on Obstet and Gynec skills acquisition by third-year medical students Emmons SL. Academic Medicine 2004;79:326-332 78% of men felt gender negative effect 67% of women felt gender positive effect Males felt they would NOT be able to achieve a good grade. REALITY: –Minimal difference is exams and deliveries –No difference in grades
Gender Bias Against Male Obstetrician- Gynecologists in Women’s Magazines Kincheloe LR. Obstet Gynecol 2004;104:1089 Females ob/gyns interviewed more than men in magazines Females 20 times more likely to have an identifying picture Negative comments about physicians – especially ob/gyn more like to use male pronouns (17% vs. 77%)
What is the competition? The “controllable lifestyle” specialties?
“Specialty Lifestyles” ControllableNoncontrollable AnesthesiologyObstet and Gynec DermatologyFamily Practice RadiologyInt. Med. NeurologyOrtho. Surgery OphthalmologyPediatrics PathologyGen. Surgery PsychiatryUrology ENT Schwartz RW. Acad Med 1990;65:207-210.
Influence of Controllable Lifestyle on Recent Trends in Specialty Choice of US Med Students Dorsey ER. JAMA 2003;290:1173-1177 ∆ 1996 to 2002 US Med Grads Lifestyle, work hours, yrs. Residency, potential income Log linear models Lifestyle = 37% Income = 9% Work hours = 2% Yrs of res. = 4%
What impacts career choice? Extracurricular clinical experiences Premed and undergrad experiences Yr 1 and 2 exposure Role models
When do they decide? 15% of students chose specialty before medical school 45% during the first TWO years But 20 to 40% of students change their mind during the third year 40% during the third year Markett RJ. J Fam Prac 1983;17:295 Zeldow PB. Med Educ 1992;26:327 Kassebaum DG. Acad Med 1995;70:938
Considering obstetrics and gynecology as a specialty: current attractors and detractors Metheny WP. Obstet Gynecol 1991;78:308-312 11 medical schools 50% response Attractors Detractor Female Insurance Healthy patients life-style Reproductive issues Surgical procedures Mentors
Statistically significant and nonsignificant factors in influencing one to choose OB/GYN Fogarty CA. AJOG 2003;189:652-654. Creighton University Grads 1991-2001
What influences medical students to pursue careers in obstetrics and gynecology? Schnuth R. AJOG 2003;189:639-643 ½ of 205 medical students at MI State 64% women, 35% men Females felt negative factors for entering ob/gyn: length of training, stress, time demands, insurance costs, time on call Males were most interested in opportunities to perform surgery and not concerned about pressure, length of training, insurance or time on call
What are our strengths? Mentors like YOU Dedication Quality education
MENTORS 79% of the students that choose a surgical specialty do so because of a mentor and faculty influence. Bland KI, Ach Surg 2002;137;259-267
2001 AAMC Senior Survey (GQ) VS. NRMP OB/GYN Match Question 10 : Do you consider the OB/GYN clerkship to be excellent? On a 4-point Likert Scale, what were the top programs, as defined by over half of the medical students marking 1. 11/125 US Medical Schools met this criteria
2001 AAMC Senior Survey (GQ) VS. NRMP OB/GYN Match Comparing the top 11 schools by the GQ to the number of students from each US Medical School choosing OB/GYN – 7/11 of the TOP GQ schools were in the top 15% of schools by recruitment numbers QUALITY TEACHING DOES IMPACT CAREER CHOICE!!
Weaknesses/Obstacles Bad mouthing Legal impact Bad press “Perception” of unhappiness?
“Bad Mouthing” 17% of males vs. 6% of females were discouraged from ob/gyn. Schnuth 2003 2/3 of OB/GYN chairs discourage male students to enter field. (APGO survey)
Surgeons, I have to say honestly, they shred each other to pieces. That was a big turn-off. I can stand sleep deprivation for 10 years, but I can’t stand five minutes with the way they get at each other; to be rude to each other, to be rude to the house officers who couldn’t fight back, and to be rude to the students who couldn’t say anything in defense. Mutha S. Acad Med 1997;72:635-640. OB/GYN was not far behind surgery in negative comments!!