**6.2 How do students in other countries select an OB/GYN residency?**

A Canadian study found residency selection results that were similar to the US students, i.e., having OB/GYN as their first choice when entering medical school, being female, and desiring a narrow scope of practice were strong determinants for an individual to enter OB/GYN. Like US students, being exposed to a good clerkship experience and excellent mentors were very important influences for deciding to practice OB/GYN (Scott et al., 2010). It is important to note, that good mentors in other specialties can draw students away from OB/GYN (Bédard et al., 2006).

In non-North American countries, the reasons to enter OB/GYN vary. In Switzerland, being female, having an in initial desire to enter OB/GYN, being driven to succeed and being "people oriented" were positive attractors (Buddeberg-Fischer et al., 2006). In Germany, 10% of students are interested in OB/GYN because of its positive image, the ability to have a

Who Selects Obstetrics and Gynecology as a Career and Why, and What Traits Do They Possess? 15

of female students entering OB/GYN. Brazil, Israel and Kenya have the highest percentage of males entering OB/GYN (16 - 7.3%). Iraq, Turkey and Norway have the lowest numbers

Table 1 also shows the percentage of students entering into FM, IM, PED and SURG varies by country. More medical students enter one of the above specialties vs. OB/GYN for all countries examined. The IM specialty was most frequently selected in four countries; Brazil, Iraq, Israel and Switzerland. Surgery was most popular in the UK and Kenya, while PED

Country OB/GYN FM IM PED SURG

Brazil (1) 16 16 18 23 14 30 15 6 Iraq (2) 1.5 19.1 20.6 8.8 16.2 8.8 25 0 Israel (3) 9.9 1.7 6.2 4.9 14.6 3.7 11.3 5.4 4.2 0.3 Kenya (4) 7.3 4.4 3.4 1.6 7.8 4.4 12.6 10.4 27.3 7.5 Norway (5) 1.1 3.2 48.1 46.4 10.2 9.1 2.0 3.6 9.8 8.1 Switzerland (6) 1.7 9.6 7.9 9.3 23.7 24.6 4.6 6.3 22.8 4.6 Turkey (7) 1.4 3.1 3.5 0.3 2.0 2.4 6.7 10.2 3.6 0.6 UK (8) 5 10 8 15 28 10 M = Male; F = Female; (1) Castro Figueiredo et al., 1997; (2) al-Mendalawi, 2010; (3) Reis et al. 2001; (4) Mwachaka & Mbugua, 2010; (5) Gjerberg, 2002; (6) Buddeberg-Fischer et al., 2006; (7) Dicki et al., 2008;

M F M F M F M F M F

of males entering OB/GYN (1.5 - 1.1%).

(8) Lambert & Goldacre, 2002

with advancement.

was more popular in Turkey, and FM in Norway.

Table 1. Percentages of students or residents entering into a specialty.

provide advice on how to enhance the OB/GYN experience.

**7. Why do residents and practicing OB/GYNs leave the profession?** 

Job satisfaction plays a large role in any occupation. It is then no surprise that physicians satisfied with their jobs will be more productive, get along better with their colleagues, and have a better mental attitude about job challenges and life in general. This section will explore job satisfaction among OB/GYN residents, faculty and those in private practice, and

Before job satisfaction is considered, generational differences on how people think and behave need to be taken into account, since each generation has an opinion on how the other generations behave. Drawing heavily from the publication by Phelan (2010), the "Silent Generation" (born between 1925 to 1942) is characterized as having heavily bureaucratic workplaces with clearly defined leaders, rules, policies and procedures. These individuals postponed gratification, are loyal to their jobs, detail-oriented, and respectful of the hierarchy. The "Baby Boomer Generation" (1943-1961) believes that vigorous competition is necessary to advance your career. They equate "work ethic" with their own "worth" to society and therefore, are driven and work long hours. The Baby Boomers miss many of their children's "firsts" and feel if they "pay their dues" they will eventually be rewarded

"Generation X" (1962-1981) usually grew up in homes where both parents worked, or from single-parent homes. They are self-reliant, independent, resourceful and accepting of change.

they

private practice and the variety of illnesses encountered (Kiolbassa et al., 2011). In the UK, having positive, active learning experiences in an OB/GYN clerkship was very important. Conversely, having a poor clerkship experience was a strong deterrent. Exposure to positive role models and having a good mix of medicine and surgery during the rotation were positive factors. Early career advice helped to keep students interested in OB/GYN (Tay et al., 2009). In Jordan, being female, the intellectual content of the specialty, and feeling confident in the specialty, were determining factors to enter OB/GYN (Khader et al., 2008). In Nigeria, material rewards, societal appreciation, and a quick response of patients to treatment, were motivating factors. Like other countries, positive, native, faculty rolemodels also inspired students to enter OB/GYN (Ohaeri et al., 1994).

#### **6.3 Stability within residency programs**

From 1997 to 2001, there was a 3.6% attrition rate for American OB/GYN residents, with female OB/GYNs 2.5 to 5 times more likely than males to leave because of family issues related to their spouses. Females who did leave an OB/GYN residency program were only half as likely to change to a different specialty (Moschos & Beyer, 2004). Most physicians left the OB/GYN residency during or right after their first postgraduate year (PGY) of training (63%), with 29% leaving in PGY2, and only 5% and 3% leaving in PGY 3 and 4, respectively. Gilpin (2005) had similar results with a resident attrition rate of 4.5% in 2003. Most residents left an OB/GYN program in PGY1 (49%), with 34% leaving in PGY2, 13% in PGY3, and 4% in PGY4. Of those who left, 60% went into another OB/GYN residency program, while equal numbers of the remainder selected controllable or non-controllable lifestyle residencies.

More recently, McAllister et al. (2008) looked at US data from 2001 to 2006. Of the 1,066 residents entering an OB/GYN program, 21.6% did not finish for various reasons. Of those who didn't finish, 58.3% switched to a different OB/GYN program, 32.9% left for another specialty, and 8.7% completely withdrew from graduate medical education. Over 90% of the females remained in OB/GYN, while only 41% of males stayed in an OB/GYN program. Residents that switched to a different specialty most often selected FM (18%), anesthesiology (15%), emergency medicine (9%), or PED (6%). Those who did not complete their residency training at their initial site were most often older, Asian, an underrepresented minority, or an osteopathic or international medical school graduate.

Overall, the trend to change OB/GYN residency programs or to leave OB/GYN altogether appears to be increasing. ACGME statistics show that from 1997 to 2005, the rate of departure has increased from 3.8% to 5.1% (cf. refs. McAlister et al., 2008). However, the likelihood of changing from the non-controllable lifestyle of an OB/GYN to a controllable lifestyle varies according to each study (Gilpin, 2005; McAlister et al., 2008; Moschos & Beyer, 2004).

#### **6.4 What are specialty preferences in non-US countries**

Table 1 shows there are considerable differences between choices in primary care and SURG in various countries. In all countries, except for Israel and Kenya, the percentage of females entering OB/GYN is larger than the male demographic. Iraq, Brazil and the UK have the greatest percentage of female OB/GYNs (19.1 - 9.6%). Norway, Turkey and Israel have <4%

private practice and the variety of illnesses encountered (Kiolbassa et al., 2011). In the UK, having positive, active learning experiences in an OB/GYN clerkship was very important. Conversely, having a poor clerkship experience was a strong deterrent. Exposure to positive role models and having a good mix of medicine and surgery during the rotation were positive factors. Early career advice helped to keep students interested in OB/GYN (Tay et al., 2009). In Jordan, being female, the intellectual content of the specialty, and feeling confident in the specialty, were determining factors to enter OB/GYN (Khader et al., 2008). In Nigeria, material rewards, societal appreciation, and a quick response of patients to treatment, were motivating factors. Like other countries, positive, native, faculty role-

From 1997 to 2001, there was a 3.6% attrition rate for American OB/GYN residents, with female OB/GYNs 2.5 to 5 times more likely than males to leave because of family issues related to their spouses. Females who did leave an OB/GYN residency program were only half as likely to change to a different specialty (Moschos & Beyer, 2004). Most physicians left the OB/GYN residency during or right after their first postgraduate year (PGY) of training (63%), with 29% leaving in PGY2, and only 5% and 3% leaving in PGY 3 and 4, respectively. Gilpin (2005) had similar results with a resident attrition rate of 4.5% in 2003. Most residents left an OB/GYN program in PGY1 (49%), with 34% leaving in PGY2, 13% in PGY3, and 4% in PGY4. Of those who left, 60% went into another OB/GYN residency program, while equal numbers of the remainder selected controllable or non-controllable lifestyle

More recently, McAllister et al. (2008) looked at US data from 2001 to 2006. Of the 1,066 residents entering an OB/GYN program, 21.6% did not finish for various reasons. Of those who didn't finish, 58.3% switched to a different OB/GYN program, 32.9% left for another specialty, and 8.7% completely withdrew from graduate medical education. Over 90% of the females remained in OB/GYN, while only 41% of males stayed in an OB/GYN program. Residents that switched to a different specialty most often selected FM (18%), anesthesiology (15%), emergency medicine (9%), or PED (6%). Those who did not complete their residency training at their initial site were most often older, Asian, an underrepresented minority, or

Overall, the trend to change OB/GYN residency programs or to leave OB/GYN altogether appears to be increasing. ACGME statistics show that from 1997 to 2005, the rate of departure has increased from 3.8% to 5.1% (cf. refs. McAlister et al., 2008). However, the likelihood of changing from the non-controllable lifestyle of an OB/GYN to a controllable lifestyle varies according to each study (Gilpin, 2005; McAlister et al., 2008; Moschos &

Table 1 shows there are considerable differences between choices in primary care and SURG in various countries. In all countries, except for Israel and Kenya, the percentage of females entering OB/GYN is larger than the male demographic. Iraq, Brazil and the UK have the greatest percentage of female OB/GYNs (19.1 - 9.6%). Norway, Turkey and Israel have <4%

models also inspired students to enter OB/GYN (Ohaeri et al., 1994).

**6.3 Stability within residency programs** 

an osteopathic or international medical school graduate.

**6.4 What are specialty preferences in non-US countries** 

residencies.

Beyer, 2004).

of female students entering OB/GYN. Brazil, Israel and Kenya have the highest percentage of males entering OB/GYN (16 - 7.3%). Iraq, Turkey and Norway have the lowest numbers of males entering OB/GYN (1.5 - 1.1%).

Table 1 also shows the percentage of students entering into FM, IM, PED and SURG varies by country. More medical students enter one of the above specialties vs. OB/GYN for all countries examined. The IM specialty was most frequently selected in four countries; Brazil, Iraq, Israel and Switzerland. Surgery was most popular in the UK and Kenya, while PED was more popular in Turkey, and FM in Norway.


M = Male; F = Female; (1) Castro Figueiredo et al., 1997; (2) al-Mendalawi, 2010; (3) Reis et al. 2001; (4) Mwachaka & Mbugua, 2010; (5) Gjerberg, 2002; (6) Buddeberg-Fischer et al., 2006; (7) Dicki et al., 2008; (8) Lambert & Goldacre, 2002

Table 1. Percentages of students or residents entering into a specialty.
