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

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 with advancement.

"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.

Who Selects Obstetrics and Gynecology as a Career and Why, and What Traits Do They Possess? 17

Perry and colleagues (2003) found that not only does the amount of sleep dramatically decrease after starting an OB/GYN residency, other lifestyle changes also occur which erode OB/GYN health. Residents are ill more often once they start an OB/GYN residency. The amount of time devoted to eating a proper diet and getting exercise drops. Time for religious activities and family interactions also decrease, with the latter causing residents to miss a greater number of "significant" events with the children and/or family. All of these detrimental factors contribute to burnout and emotional exhaustion. Fifty-nine and 61% of OB/GYNs report conflicts with colleagues and patients, respectively. This makes an OB/GYN more than twice as likely to suffer from emotional exhaustion (Yoon et al., 2010). The traditional thought that working a long number of continuous hours has perceived benefits is not valid. In order to avoid burnout and emotional exhaustion, residents desire having some control over the number of hours worked. Allowing residents more personal time will help increase the current 48% of OB/GYNs that are currently satisfied with their life/work balance. Emphasizing the sense of personal accomplishment among the residents also helps to enhance career satisfaction (Keeton et al., 2007). A new type of practitioner, "The Laborist", can help alleviate the OB/GYN workload and reduce burnout and emotional exhaustion. The laborist is defined as a physician who is solely devoted to obstetric care and, therefore, releases the OB/GYN from being constantly on call when a patient is in labor. This allows the OB/GYN to perform other clinical and office duties without being interrupted until time for delivery. Weinstein (2003) explains the detailed

roles of the laborist, and increasing numbers of hospitals are considering their use.

Those OB/GYNs that enter academic medicine do so because of their desire to carry out research and the intellectual stimulation that teaching in academia offers. Those that have completed an MD-PhD program are very likely to enter an OB/GYN department vs. entering private or group practice (cf. refs. in Straus et al., 2006). Furthermore, an academic setting is needed for the environment that provides opportunities for collaborative research, and the accommodation of equipment and animal care needs (if any) the research requires. As residents progress through an OB/GYN program, interest in pursuing an academic career drops with each successive year of training (Cain et al., 2001; Straus et al., 2006). The reality of lower financial rewards and the burdensome bureaucracy associated with academia are, by far, the two primary reasons OB/GYN residents fail to enter academia. Another reason is residents feel they could not effectively balance the time needed to perform research and publish, do committee work, as well as address clinical duties. Cain and colleagues (2001) clearly pointed out the vital importance of good and consistent mentorship in trying to dispel student and resident misconceptions about academia.

Making effective teaching a priority in the clerkship or residency program is a must. Actually doing so, vs. giving education "lip service", shows students that an OB/GYN department is not under the sway of the "hidden curriculum" that abrogates teaching to a distant second place after the pursuit of clinical and research dollars (Hafferty, 1998). For

**7.1 Why, or why not, practice academic medicine?** 

However, being realistic in addressing these issues is important.

**8. Enhancing recruitment into OB/GYN residencies** 

successive

They expect a balanced lifestyle, and are currently redefining the parameters of a "work week". These individuals saw the advent of personal computers and email. "Generation Y" (1982-2000) people are comfortable with technological advances and expect them to occur at ever increasing rates. *Importantly, GenYers are in a "continuous state of partial attention" due to growing up with cell phones, tweeting, texting, surfing the web and instant communication.* Accordingly, GenYers have difficulty filtering what they "say" because of the increasing amount of electronic vs. face-to-face communication, and this makes expressing empathy difficult (cf. section 5). The lack of verbal communication skills will contribute to their inability to form a trusting physician/patient bond. Furthermore, the speed of obtaining information is more important than dealing with the details, and where the information fits into the "big picture". Since data are only a web-search away, they do not feel the need to memorize large amounts of information. They see no need for knowing the history of a given subject.

For the medical profession, the infusion of Generation X and Y students and residents means they place a greater priority on lifestyle than the previous generations, and seek to have a more balanced work and home life. Thus, physicians born before Generation X and Y perceive these medical students and residents are not as dedicated to their work. Conversely, GenXers and GenYers see the Silent Generation and Baby Boomers working long hours, having too many demands on their time and having a limited or poor work-life balance. In order to maintain job satisfaction for all generations of OB/GYNs, each generation has to understand the other, and make attitudinal adjustments. It is vitally important to realize that although GenXers and GenYers do not desire to work as many hours as previous generations, they are still very dedicated to learning and being proficient. These individuals seek practice settings which provide them with professional satisfaction as well as personal growth. The GenXers and GenYers who seek flexibility in their work should not be considered as lazy or less committed (Phelan, 2010).

When examining all specialties, it is unfortunate that OB/GYN physicians are some of the least satisfied. Leigh and colleagues (2002) and Kravitz et al. (2003) found that only 34% of OB/GYNs were satisfied with their job, while 24% were dissatisfied. These data place OB/GYN physicians at next to last (30/31) for job satisfaction among all specialties. There are two main reasons for this disappointing statistic. Burnout and emotional exhaustion play the major roles which influence the remainder of the reasons for leaving an OB/GYN residency or career. Becker et al. (2006), reported 90% of OB/GYNs had moderate burnout, and 34% were clinically depressed. If a physician was dissatisfied in their profession, they were twice as likely to be depressed and suffer from emotional exhaustion. In addition, 96% of OB/GYN residents feared malpractice, which led 35% of them to pursue a fellowship for additional training. It's logical that depression, emotional exhaustion, and fear of malpractice are highly connected with job dissatisfaction.

Although not unique to OB/GYN, lack of sleep, especially while on call, also leads to burnout and job dissatisfaction. Only 10.8% of residents say they get more than four hours of sleep while on call, while 21.2% get less than one hour (Defoe et al., 2001). Many interns (77.6%) say they were fatigued when on call, while all residents reported negative medical experiences while sleep deprived. Sixty percent of residents feared a compromise of patient care because of a sleep-induced deterioration of clinical expertise. Additionally, a pernicious depersonalization of the patient may occur with sleep deprivation as professional traits are compromised by fatigue.

Perry and colleagues (2003) found that not only does the amount of sleep dramatically decrease after starting an OB/GYN residency, other lifestyle changes also occur which erode OB/GYN health. Residents are ill more often once they start an OB/GYN residency. The amount of time devoted to eating a proper diet and getting exercise drops. Time for religious activities and family interactions also decrease, with the latter causing residents to miss a greater number of "significant" events with the children and/or family. All of these detrimental factors contribute to burnout and emotional exhaustion. Fifty-nine and 61% of OB/GYNs report conflicts with colleagues and patients, respectively. This makes an OB/GYN more than twice as likely to suffer from emotional exhaustion (Yoon et al., 2010).

The traditional thought that working a long number of continuous hours has perceived benefits is not valid. In order to avoid burnout and emotional exhaustion, residents desire having some control over the number of hours worked. Allowing residents more personal time will help increase the current 48% of OB/GYNs that are currently satisfied with their life/work balance. Emphasizing the sense of personal accomplishment among the residents also helps to enhance career satisfaction (Keeton et al., 2007). A new type of practitioner, "The Laborist", can help alleviate the OB/GYN workload and reduce burnout and emotional exhaustion. The laborist is defined as a physician who is solely devoted to obstetric care and, therefore, releases the OB/GYN from being constantly on call when a patient is in labor. This allows the OB/GYN to perform other clinical and office duties without being interrupted until time for delivery. Weinstein (2003) explains the detailed roles of the laborist, and increasing numbers of hospitals are considering their use.
