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

16 From Preconception to Postpartum

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.

should not be considered as lazy or less committed (Phelan, 2010).

malpractice are highly connected with job dissatisfaction.

compromised by fatigue.

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

large

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

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 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. However, being realistic in addressing these issues is important.
