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.