Clinical Review

The unbearable unhappiness of the ObGyn: A crisis looms

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Recommendations—for physicians in training

  • Limit work hours to 65 or fewer per week. The current 80-hour week is not conducive to improving physician satisfaction or safe care. There is evidence that work exceeding 18 hours a day may impair a physician.31 No physician likes working long hours, and it is clearly not safe for patients. Elimination of responsibilities of no or marginal educational value would make a 65-hour work-week practical. Training institutions will need to add more support staff, including physician extenders, to implement a shorter week.
  • Increase the use of teaching simulators. This improvement would assist in the development of technical skills. The training institution would be responsible for developing a simulation center. In areas with multiple training programs, a central location would be developed, with cost shared by all parties. Some of the cost would be recouped by the time saved in the operating room. There is also the potential to prevent medical errors and reduce liability cost. (See OBG Management’s recent article, How simulation can train, and refresh, physicians for critical OB events, which describes, among other issues, the use of regional simulation centers. The article appeared in the September 2008 issue, available at www.obgmanagement.com.)
  • Teach physicians in training time- and money-management skills. Many of the stressors experienced by these young physicians relate to understanding how to budget time and money.
  • Sponsor 24-hour, on-site child care at reasonable or no cost. This recommendation for the training institution is important because child care for the dual-career couple is difficult to arrange, often incompatible with the couple’s schedule, and expensive. Any training institution that sponsors a residency program and benefits from this low-cost workforce should be required by the Accreditation Council of Graduate Medical Education to fund this benefit. It is the right thing to do and is certainly a valuable recruiting tool. It will make physicians who have children feel more comfortable working the hours required for their training while removing a major stressor—worrying about their child.
  • Supply extra support for residents when a co-resident is on maternity or paternity leave. The training institution should implement this protection to prevent working residents from being penalized when it is necessary for a co-resident to be on leave.
  • Create the option of job sharing during residency. In the business world, job sharing has become common and increases satisfaction and productivity. A resident would work half-time, with salary and benefits prorated so that the cost to the sponsoring institution is revenue-neutral. This would be a valuable recruiting tool among residents who are willing to accept a prolonged period of training.

We need a dialogue on these and other recommendations Such a conversation will allow the medical profession to continue to attract and retain the best and brightest professionals. As the satirical poet Auguste Marseille Barthélemy pointed out, way back in 1832: “The absurd man is he who never changes.”

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