Recruiting to the OB/GYN Team

Dee E. Fenner, M.D.2004 APGO President

JUST ONE MORE STUDENT!!!

APGO

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……

Ob-Gyn PGY1Positions filled

60

70

80

90

100

Perc

ent

1980 1998 1999 2000 2001 2002 2003 2004Year

Positions filled USG

10.75.1 9.2

24.9

36

43 45.3

05

101520253035404550

Women as % of total Medical School Graduates

AAMC

The percent of total women grads choosing OB/GYN has been constant ~9%

0

1000

2000

3000

4000

5000

6000

7000

1950 1970 1990 2003

women grads

womenchoosingobgyn

AAMC

Ob/GYN Residents Matched by Gender from

Total US GradsMales Females Ratio

M to F

1993 3.6%(345)

8.7%(513)

40%/60%

2003 2.1%(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 surveyO’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 studentsEmmons 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%)

GENDER DISCRIMINATION

What is the competition?

• The “controllable lifestyle” specialties?

“Specialty Lifestyles” Controllable Noncontrollable

Anesthesiology Obstet and GynecDermatology Family Practice

Radiology Int. Med.Neurology Ortho. Surgery

Ophthalmology PediatricsPathology Gen. SurgeryPsychiatry Urology

ENT

Schwartz RW. Acad Med 1990;65:207-210.

Influence of Controllable Lifestyle on Recent Trends in Specialty Choice of

US Med StudentsDorsey 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 detractorsMetheny WP. Obstet Gynecol 1991;78:308-312

• 11 medical schools• 50% responseAttractors DetractorFemale InsuranceHealthy patients life-styleReproductive issuesSurgical proceduresMentors

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!!

APGO• Recruitment “Playbook”• Medical student task force• Letters to the chairs• Working with ACOG and LCOG• CUCOG task force• “Benchmarking” top clerkships

HELPING YOU BE BETTER TEACHERS