Ob-gyns revere their specialty
This is the sixth in a series of articles profiling medical specialties. The first article focused on anesthesiology, the second on physical medicine and rehabilitation, the third on osteopathic manipulative medicine, the fourth on dermatology, and the fifth on emergency medicine.
When Hamid Sanjaghsaz, DO, began medical school, he had every intention of becoming an emergency physician. But he soon realized that treating critically ill and seriously injured patients day after day was not for him. “When I did my obstetrics and gynecology rotation, I found the experience so joyful,” says Dr. Sanjaghsaz, the program director of the AOA-approved obstetrics-gynecology residency at Garden City (Mich.) Hospital. “The majority of the time, you are dealing with young and healthy patients.
“You take care of someone for nine months, deliver her baby, and in that family’s eyes, you are forever a hero. It’s very rewarding. Sometimes we do get tragic cases, but they are few and far between.”
The president of the American College of Osteopathic Obstetricians and Gynecologists (ACOOG), David A. Forstein, DO, made a similar self-discovery as a med student. “I realized that I didn’t want to deal with chronic life-threatening illnesses,” he says. “I wanted to be in a part of medicine that was more uplifting. I’m glad there are people who want to take care of me when I’m really sick, but that wasn’t what spoke to my heart.
“Delivering babies is the coolest thing in the world. It’s fun most of the time. It’s a great experience for the family, for the doctors, for the nurses. Who wouldn’t want to do that?”
For Chicago obstetrician-gynecologist Teresa A. Hubka, DO, the biggest draws were the variety and the ability to develop long-term relationships with patients. “You’re working in medicine, you’re working in surgery, and you’re working with all ages,” she says, noting that she treats the babies she delivers postpartum with cranial manipulation and develops strong relationships with her patients’ families.
On a random day in September, Dr. Hubka’s schedule included surgery at an outpatient surgical center in the morning, followed by a medical staff meeting, a cesarian section, a procedure in a hospital operating room, and then four outpatient surgical procedures back at her office. “There is never a dull moment,” she says.
Attractive to many medical students, obstetrics-gynecology has become an increasingly competitive specialty, with residency program directors reporting dozens of applicants for each slot. “When we started our obstetrics and gynecology residency in 2006, we had four applicants for one or two slots,” says Craig S. Glines, DO, the director of the AOA-approved program at Oakwood Southshore Medical Center in Trenton, Mich. “Last year, I had 85 applicants for one opening.”
The pay is part of the appeal, says Dr. Glines, who notes that the average starting salary for an obstetrician-gynecologist is around $225,000 to $250,000 a year, in the mid-range for medical specialties. Those who practice in rural underserved areas can start at more than $300,000 a year.
Today, roughly half of osteopathic medical graduates specializing in obstetrics-gynecology train in the 29 AOA-approved residencies, while half train in residencies accredited by the Accreditation Council for Graduate Medical Education, of which there are 243. Both the AOA and ACGME programs take four years and do not require a prior internship.
Obstetrician-gynecologists may also take part in fellowship training in maternal and fetal medicine, reproductive endocrinology, gynecologic oncology, and female pelvic medicine and reconstructive surgery. The AOA has approved programs in these four subspecialties.
Among older obstetrician-gynecologists, men outnumber women. But the discipline has become overwhelmingly female in the past decade. Roughly 75% to 80% of obstetrics-gynecology residents across the country are women, says Dr. Forstein, the director of the obstetrics-gynecology residency program at the University of South Carolina School of Medicine in Greenville. However, he has seen a “slight uptick” in the number of male candidates in the past two years.
The program director for the AOA-approved obstetrics-gynecology residency at Resurrection Medical Center in Chicago, Dr. Hubka has noticed a recent increase in male candidates as well. Last year, for her program’s four open positions, only 30 out of 280 applicants were male. This year, the proportion of men has been much higher but still far from 50%, she says.
As more women entered medical school, many gravitated toward women’s health, and female patients began seeking out gynecologists of their own sex. “The schedules of female obstetricians and gynecologists right out of residency would become filled right away, sometimes even before they started, while it took men in the specialty a while to build their practices,” Dr. Forstein notes. “This created a salary differential in which women coming out of residency were making more money than men.” Today, now that many obstetrics-gynecology group practices include women, supply has caught up with demand and the salary differential has gone away, he says.
Obstetrics-gynecology is a field fraught with ethical concerns about practices ranging from pregnancy termination to contraception to administration of the human papillomavirus vaccine. Students who feel strongly about such issues should carefully research the policies of individual residency programs.
In 1995, the ACGME adopted a policy that its obstetrics-gynecology residency programs must provide access to training on inducing abortions. Access, however, could be defined as simply allowing residents to serve elective rotations at institutions providing abortion training. Medical Students for Choice lists such training programs on its website.
The ACGME states that those institutions objecting to abortions on religious or moral grounds do not need to provide hands-on abortion training but must ensure that residents receive education and experience in managing the complications of abortion.
Striving to remain neutral on this charged issue, ACOOG does not have a policy mandating access to training in pregnancy termination, says Dr. Hubka, the society’s immediate past president. And no AOA-approved obstetrics-gynecology residency currently provides this training.
“If a woman’s labor takes longer than anticipated, then your next event may be delayed. That’s the way it has to be. You can’t get upset or worried about it.”
But ACOOG does require that residents learn about family planning and about the techniques, risks, benefits, side effects and complications of pregnancy termination, Dr. Forstein notes. “Every resident is going to get experience doing dilation and evacuations of the uterus for women who have miscarriages, so you can learn the technique without performing an abortion,” he says. In addition, residents in AOA-approved programs that do not have faith-based objections may be able to serve elective rotations with abortion providers.
All osteopathic medical students serve a core rotation in obstetrics-gynecology in their third year, as well as receive classroom instruction in the specialty in their second year. So students do not have to go out of their way to gain exposure to the discipline. And professors and preceptors can clearly see who is excited about it and who isn’t.
Saul Jeck, DO, the chairman of obstetrics-gynecology at the Philadelphia College of Osteopathic Medicine (PCOM), coordinates a series of approximately 50 required lectures for second-year students, bringing in numerous outside speakers who practice locally. “Students who are interested usually ask to rotate with me in my practice,” he says.
Because an obstetrics-gynecology rotation is required, Dr. Jeck and PCOM’s other preceptors observe a variety of student attitudes and abilities. “You can tell which students are rotating only because they have to, because it’s part of the curriculum,” Dr. Jeck says. “On the other hand, those who are excited love going to the hospital and being in the delivery room. It’s magical.”