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  1. #1
    azskeptic's Avatar
    azskeptic is offline Moderator 666 points
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    Obstetrics is failing to draw new doctors

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    http://www.baltimoresun.com/news/hea...alth-headlines

    Obstetrics is failing to draw new doctors
    Trend: Malpractice insurance costs, gender issues and lifestyle are some of the concerns.

    By Jonathan Bor
    Sun Staff
    Originally published July 11, 2004
    With only a year left in her training as an obstetrician-gynecologist, Dr. Shahrzade Tabibi has no regrets about entering a field that some veterans say is being ravaged by the cost of malpractice insurance.

    "It might sound corny, but being the first person in the world to hold a little new baby is pretty incredible and a privilege I hope I deserve," said Tabibi, a fourth-year resident at the University of Maryland Medical Center.

    At 28, Tabibi is also a realist. With premiums for doctors who deliver babies surpassing $100,000 a year in many areas, Tabibi predicted that simple economics will force her to abandon obstetrics within a decade. Then she'll concentrate on gynecology - a choice many older physicians are making.

    But Tabibi, a Massachusetts resident who attended the UM medical school, is at least giving obstetrics a chance. Across the country, leaders of a specialty that once had great romantic appeal are alarmed because young doctors are increasingly reluctant to do the same.

    Since 1996, graduates of U.S. medical schools who enter training programs in obstetrics and gynecology have dropped 23 percent - from 968 to 743.

    Although they insist it hasn't happened yet, many veterans worry about an ultimate decline in the quality of doctors competing for training slots in obstetrics.

    "Nationally, we certainly are concerned about quality," said Dr. Jessica Bienstock, who runs the OB/GYN training program at Johns Hopkins Hospital. "If we're seeing fewer people going into the specialty, then we do need to start worrying about the quality of people who do go into the field."

    The trend shows up in the numbers at the University of Maryland and the Johns Hopkins School of Medicine, each of which once sent up to a half-dozen graduates into obstetrics residencies every year.

    At Hopkins, three students in a graduating class of 115 chose OB/GYN residencies last spring, and only one did so a year earlier. At Maryland, one student out of a class of 150 entered an obstetrics-gynecology program this year. None did last year.

    "People don't want to be in the delivery room - that's where the malpractice is," said Dr. Jack Gladstein, associate dean of students at the University of Maryland School of Medicine. "Any time a baby comes out bad, the gynecologist gets sued."

    Gladstein isn't sure how much importance to place in the past two years, because he has seen the numbers fluctuate between one and six in earlier classes.

    But this year, just two-thirds of new residencies in obstetrics and gynecology nationwide were filled by graduates of U.S. medical schools - down from 86 percent eight years earlier. The slippage has forced hospitals to look toward graduates of foreign medical institutions.

    Malpractice insurance is just one reason for the decline in interest, experts say. Lifestyle and gender roles also are in the equation.

    Balancing work and family life seems to play a larger part than ever before in the careers medical students choose. Students who are concerned about family, leisure time and other pleasures are less eager to put up with the demands of a residency that requires sleepless nights on labor and delivery wards.

    "You can schedule your office visits and gynecological surgery, but you can't schedule when the baby's coming out most of the time," Gladstein said.

    Dr. Mina Scott, a second-year resident in family medicine at the University of Maryland, said she considered an OB/GYN program but ruled it out, chiefly because the demands on her time would make it difficult to raise a family.

    "I love delivering - it's a magical time in a woman's life," said Scott. "Part of me would have been great at it. The other part would have been unhappy with the lack of family time - which is really important."

    Another issue: Over the past decade, male students have increasingly viewed the specialty as virtually off-limits to their gender. This coincides with rising consciousness about women's health issues. More female doctors have gone into the field, and many patients prefer them.

    But most discussions about changes in obstetrics begin with economics. The Mutual Liability Insurance Society of Maryland, which insures 80 percent of the state's doctors, plans to increase premiums for obstetrician-gynecologists to $160,130 next year, up from $115,919 this year.

    In this regard, the specialty leads all others. Neurosurgeons pay the next highest premiums - $87,860 this year and $121,464 next year.

    On the other side, OB/GYN specialists are well-compensated by any measure - in the East, they averaged $204,000 in compensation after expenses in 2002, says the Medical Group Management Association. But they also leave medical schools with average debts of $120,000.

    Dr. Marc Lowen, director of Sinai Hospital's residency program in obstetrics and gynecology, said he doesn't discuss economics or malpractice with young doctors.

    "I think that if they've made decisions to go into women's health care they think it's very rewarding," he said.

    Lowen agreed that rising premiums are driving away talented students. They know that fees from the first 25 to 30 babies they deliver every year could go toward insurance. "It's a huge overhead if you're doing 100 deliveries a year," he said.

    Lowen said he's also worried that students who might choose OB/GYN are being scared away by teachers who tell stories about how bad their own lives are.

    "They hear disgruntled 45- to 50-year-old OB/GYNs who moan about the specialty - the long hours, the low reimbursements," said Lowen. "And the threat of malpractice scares the daylights out of the young people."

    Trying to address issue

    Nationally, the American College of Obstetricians and Gynecologists is trying to address the problem on many fronts. One panel is working with medical schools to identify "career mentors" who would promote the specialty, start clubs for prospective OB/GYNs and conduct discussions with residents and local practitioners.

    Dr. Douglas Laube, head of the OB/GYN residency at the University of Wisconsin and chairman of the national panel, said medical school rotations should expose students to the more positive aspects of the profession. Students, for instance, should spend more time in community practices and less on gynecological cancer services, where he says they spend a disproportionate amount of time.

    Students should also understand that the malpractice problem is not uniform across the nation, he said. As onerous as premiums can be for specialists in about 15 states - notably Pennsylvania, Ohio, Nevada and Mississippi - there are many other states where premiums are much lower. In Wisconsin, which has instituted tough tort reforms, premiums average $45,000 to $50,000, he said.

    Appealing to male students is also a priority. "Men have felt they were unwelcome in the past seven to eight years," Laube said.

    Some doctors hope the field will regain popularity in several years, as graduating students realize they're suddenly in demand. They might also hear about the emotional rewards from young doctors who made the choice before them.

    Making a choice

    Four years ago, Tabibi wrestled with a choice between obstetrics-gynecology or surgery. She chose the former when she realized that it would not only give her time in the operating room, but also allow her to serve women as they experience the joys and problems of different stages in their lives.

    "I just like connecting with women, reaching out to women and helping them understand how to take care of themselves," Tabibi said.

    Dr. Jennifer Coles, who is training in OB/GYN at Sinai, said lifestyle issues loom large for her because, at 35 and married, she still plans to begin a family.

    "Yet as much as I tried to talk myself out of it, and I knew there were difficulties, I also knew this was the right thing for me," she said. "I like taking care of women and keeping them healthy through their reproductive and post-reproductive years."
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  2. #2
    NNDoctor2004 is offline Junior Member
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    Obstetrics is failing to draw new doctors

    Quote Originally Posted by azskeptic

    Although they insist it hasn't happened yet, many veterans worry about an ultimate decline in the quality of doctors competing for training slots in obstetrics.



    But this year, just two-thirds of new residencies in obstetrics and gynecology nationwide were filled by graduates of U.S. medical schools - down from 86 percent eight years earlier. The slippage has forced hospitals to look toward graduates of foreign medical institutions.
    Who said that competition in a field leads to better quality doctors? Don't forget the other side of the coin. Any competition leads to bitter disappointments among QUALIFIED individuals.

    The good thing is that Ob/ Gyn is more likely to attract those who LOVE the profession rather than better pay associated with it. Plus, if residency programs are concerned with quality, it is THEIR COMMITMENT to prepare better doctors, instead of relying on bright individuals coming from somewhere else.

    Finally, residency programs should drop arrogant attitude toward foreign-educated physicians. It's not only Ob/ Gyn that considers foreign-educated docs lower-class specialists. It's high time to reconsider the arrogant attitudes!

  3. #3
    Fornis J. Plebney is offline Senior Member 525 points
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    Obstetrics is failing to draw new doctors

    Quote Originally Posted by azskeptic
    But most discussions about changes in obstetrics begin with economics. The Mutual Liability Insurance Society of Maryland, which insures 80 percent of the state's doctors, plans to increase premiums for obstetrician-gynecologists to $160,130 next year, up from $115,919 this year.

    In this regard, the specialty leads all others. Neurosurgeons pay the next highest premiums - $87,860 this year and $121,464 next year.

    Can you spell T-O-R-T--R-E-F-O-R-M?

  4. #4
    wolfvgang22 is offline Moderator 514 points
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    Altruism is next to Godliness

    The good thing is that Ob/ Gyn is more likely to attract those who LOVE the profession rather than better pay associated with it.
    I LOVE delivering babies, having helped in several deliveries myself as an EMT. But I don't LOVE it to the tune of $100,000 a year. I guess I'm just shallow for wanting to pay of my student loans without all those headaches.
    Saba University School of Medicine, Class of 2009
    Diplomate, American Board of Psychiatry and Neurology

  5. #5
    arya is offline Junior Member
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    Altruism is next to Godliness

    Quote Originally Posted by wolfvgang22
    The good thing is that Ob/ Gyn is more likely to attract those who LOVE the profession rather than better pay associated with it.
    I LOVE delivering babies, having helped in several deliveries myself as an EMT. But I don't LOVE it to the tune of $100,000 a year. I guess I'm just shallow for wanting to pay of my student loans without all those headaches.
    paying 100K for insurance is bad. getting sued and spending time/effort fighting it is worse. put the 2 together and you have a field that i wouldnt want to touch with a 100 foot pole.

  6. #6
    teratos's Avatar
    teratos is offline Jedi Moderator 658 points
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    Sure

    10 years from now people will get an instruction book:


    1. Boil Sheets
    2. Push
    3. Cut unbilical cord

    Warning: There is no place for duct tape in this job.



    People don't realize that medicine is a luxury, and nobody HAS to deliver their baby. We get too hung up on rights, and think everything is our "right". Thank god i have all the children I need. G
    AUC Class of '99
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    I may be a jerk, but I'm a Jedi jerk like my father.

    Some say I look like Buzz Lightyear....
    (They're right)

    DISCLAIMER: I have no financial stake in ValueMD, or any medical school.

  7. #7
    wolfvgang22 is offline Moderator 514 points
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    Sure

    Quote Originally Posted by teratos
    10 years from now people will get an instruction book:


    1. Boil Sheets
    2. Push
    3. Cut unbilical cord

    Warning: There is no place for duct tape in this job.



    People don't realize that medicine is a luxury, and nobody HAS to deliver their baby. We get too hung up on rights, and think everything is our "right". Thank god i have all the children I need. G
    Right. We could always do like some tribes in Africa do....cut the cord with a straight razor blade provided by a missionary, and tie up the cord with a piece of twine we'll need to save for later. Lots better than the rusty knife used to prepare dinner.
    Saba University School of Medicine, Class of 2009
    Diplomate, American Board of Psychiatry and Neurology

  8. #8
    ducman is offline Moderator 511 points
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    I agree!

    Access to medicine is not a right bestowed upon a human being when they are born - it is a privilege provided to them by dedicated doctors who endure extreme hardship to be in this PROFESSION!

    A doctor cannot decide how much to charge patients for services (insurance companies do this for them!), whereas money grubbing lawyers can decide how large of a lawsuit they would like to file!

    TORT - REFORM!!
    Ducman
    Saba University School of Medicine

  9. #9
    libowski323 is offline Junior Member
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    Loser Pays

    why can't we have a loser pay lawsuit system like the rest of the friggin world!!! that would deter so many frivolous lawsuits. In order to do this you would have to challenge the Trial Lawyers Association in court which is like trying to challenge MJ to a game of HORSE.
    "Hey did you go to Hollywood Upstairs Medical College too?
    -Dr. Nick Riviera from The Simpsons

  10. #10
    teratos's Avatar
    teratos is offline Jedi Moderator 658 points
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    Loser Pays

    Quote Originally Posted by libowski323
    why can't we have a loser pay lawsuit system like the rest of the friggin world!!! that would deter so many frivolous lawsuits. In order to do this you would have to challenge the Trial Lawyers Association in court which is like trying to challenge MJ to a game of HORSE.
    That would be too logical, and would cut what lawyers (including a certain VP candidate) make by millions. Ever notice what a lot of our esteemed law makers have in common? A good many with J.D. after their names. G
    AUC Class of '99
    Bored certified
    I may be a jerk, but I'm a Jedi jerk like my father.

    Some say I look like Buzz Lightyear....
    (They're right)

    DISCLAIMER: I have no financial stake in ValueMD, or any medical school.

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