Recruiting to the OB/GYN Team

1. Recruiting to the OB/GYN Team Dee E. Fenner, M.D. 2004 APGO President

2. APGO JUST ONE MORE STUDENT!!!

3. 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.

4. 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?

5. What is your product? We areObstetricians 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.

6. What is your market share?How has it changed? • We are recruiting from only HALF the medical students……

7. Ob-Gyn PGY1Positions filled

8. Women as % of total Medical School Graduates AAMC

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

10. Ob/GYN Residents Matched by Gender from Total US Grads AAMC

11. 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

12. 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

13. 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

14. 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

15. Gender Bias Against Male Obstetrician-Gynecologists in Women’s MagazinesKincheloe 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%)

16. GENDER DISCRIMINATION

17. What is the competition? • The “controllable lifestyle” specialties?

18. “Specialty Lifestyles” Schwartz RW. Acad Med 1990;65:207-210.

20. 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%

21. What impacts career choice? • Extracurricular clinical experiences • Premed and undergrad experiences • Yr 1 and 2 exposure • Role models

22. 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

23. Considering obstetrics and gynecology as a specialty: current attractors and detractorsMetheny 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

24. Statistically significant and nonsignificant factors in influencing one to choose OB/GYN Creighton University Grads 1991-2001 Fogarty CA. AJOG 2003;189:652-654.

25. 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

26. What are our strengths? • Mentors like YOU • Dedication • Quality education

27. 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

28. 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

29. 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!!

30. Weaknesses/Obstacles • Bad mouthing • Legal impact • Bad press • “Perception” of unhappiness?

31. “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)

32. 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!!

34. 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