Charles Weissman, MD
Medicine is a rather unique career due to many decisions physicians make during their educational journey. Besides the initial decision to pursue the medical profession, physicians choose a specialty and, often, also a sub-specialty. Consequently, their initial decision is made towards the end of their teenage years with subsequent decisions made during their twenties. Therefore, there is a continual progression from the carefree enthusiasm of beginning medical students to making life-altering personal and professional decisions. Specialty selection, which takes place mainly during clinical rotations, involves deep introspective assessment of intellectual ambitions, manual dexterity, personality and interests. It is during this contemplative phase that Sein et. al. identified factors that 5th-year medical students thought made obstetrics/gynecology an attractive and less attractive the specialty. Among the latter was work-life balance which has become a major specialty selection criterion among both men and women students world-wide, reflecting their interests in controllable lifestyles not mainly dominated by their professional career. It has thus become the fifth issue contemplated during the introspection during clinical rotations. This interest has led to three important trends: increased popularity of lifestyle specialties, such as dermatology, shorter work-shifts and part-time-residencies.
The students in Sein et. al.’s study point out the distinctiveness of Obstetrics/Gynecology with its broad practice spectrum; from surgery-intensive gynecological oncology to more medically-oriented reproductive endocrinology and from hospital- to clinic-based practice. Notably, students focused on the specialty’s acute obstetrics component, labeling it a high stakes specialty that exacts an emotional toll potentially leading to burnout. Although, not all Obstetrician/Gynecologists practice acute obstetrics, trainees needing exposure to the entire range of obstetrics-gynecology practice, including acute obstetric care, often endure grueling residencies characterized by long hours, pressure and frustration. Yet, this is a passing phase that must be weathered. However, it appears to deter some students and needs to be addressed in order to attract more students to a specialty facing an impending workforce shortage. Our studies using marketing research methods revealed that when considering a specialty, students displayed more interest in working conditions after, than during residency (Weissman C: Isr J Health Policy Res. 2012;1:13). Therefore, the ”vendors” (department chairs, residency program directors) must consider such observations when marketing their ”product” (Obstetrics/Gynecology) to their ”customer” (students). They should also consider the basic marketing tenants that the ”customer knows best” (Weissman C: BMC Med Educ. 2023; 23:268) and when considering expensive long-lasting products consumers compare their selection criteria with a product’s features. The more the product meets their criteria the greater likelihood of a purchase. Therefore, studies like Sein’s are key to determining consumers’ (students’) criteria and should help ”vendors” tailor their ”product” and marketing approach. Equipped with this objective knowledge, plus listening to students’ suggestions, should aid the Obstetrics/Gynecology leadership in reducing the negative aspects of pursuing a career in the specialty. This might require substantial changes in both residency and post-residency working conditions, especially to meet the life:work balance expectations of the current generation of students, while maintaining the rigor of residency training.