Women dominate the training ranks in obstetrics and gynaecology
When Dr Louise Farrell completed her specialist training in the early 1980s, she was one of only a handful of female trainees in obstetrics and gynaecology. Today, 80% of the training cohort are women, and in the next 2–3 decades obstetrics and gynaecology will have a predominantly female workforce.
Dr Farrell, now vice-president of the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG), says obstetrics and gynaecology was one of the first specialties to attract women, so there have always been many role models for women. Also, she says many patients express a preference for women obstetricians and gynaecologists.
Still, she says, it’s a challenging specialty for women. “If you do obstetrics, there is a lot of after-hours work”, says Dr Farrell, who practises in Perth. “I was lucky to have a husband who was a general practitioner and not on call at night, so he was able to keep the home fires burning when I was on call.”
RANZCOG president Dr Rupert Sherwood, who practises in Melbourne, says obstetrics and gynaecology is recognised as a specialty with a significant after-hours commitment, but this too is changing.
“To some people, [the after-hours commitment] has been a detractor from our specialty”, he says. “But as we move more towards working in group practices, rather than in solo practice, we can share that after-hours commitment, which makes our specialty more attractive.”
The big issues
With a growing proportion of female trainees, workforce planning becomes more difficult, Dr Farrell says. As many women take time out from their career to have children and are more likely than men to work part time, there will be a need to train more obstetricians and gynaecologists to ensure adequate cover, she says. And with more trainees come other hurdles.
“The opportunity to get experience becomes limited when you have more trainees and they’re working the safe hours as recommended now by all authorities”, Dr Farrell says. “Trainees don’t have the opportunity to get as much surgical exposure as they did in the past.”
While surgical competence remains crucial and a challenge to maintain, Dr Farrell says gynaecology was the first specialty to embrace laparoscopy and there is now a host of minimally invasive treatments for benign gynaecological disease.
“We have radiological options for treating fibroids, uterine artery embolisation and high-intensity focused ultrasound destruction of fibroids, so there are a lot of other non-surgical options available for benign gynaecological disease short of hysterectomy”, she says.
Advances in reproductive technology have had a major impact on the specialty, expanding the opportunity for women to have babies, Dr Farrell says, adding that this older cohort of new mothers brings many difficulties.
Dr Sherwood says adapting to new technologies is a constant challenge. He says it is important to ensure that new technologies, such as robotic surgery, are used appropriately and not just because they are new.
And common to many medical specialties, lifestyle factors, such as obesity and diabetes, are also a key challenge for obstetricians/gynaecologists, he says.
In the past, obstetrics and gynaecology has been characterised as a paternalistic speciality. And while Dr Sherwood says this misconception has been largely laid to rest, it is still occasionally aired in the media.
“The obstetrician is sometimes portrayed as the interventionist, the person who does things to people against their best interests”, he says. The hackneyed example of a woman having to have a caesarean because her doctor had to play golf “just doesn’t happen,” Dr Sherwood says.
There’s also a perception that patients choose specialists based on their gender. Dr Sherwood says some women prefer a female gynaecologist, but for many patients their choice of specialist is determined by a doctor’s skills and attitudes.
“The gender thing is not as important as it’s made out to be. I think people are smarter than that — they choose their doctor on the skills and attitudes of that doctor, not on their gender”, he says.
Dr Farrell says it’s important for the specialty to continue to attract male doctors as well as females.
“It is important for a healthy profession to have wide representation in the specialty, not only of gender, but ethnic groups as well”, she says. “Each gender has different strengths, and I think it would be a loss to our specialty not to have adequate numbers of men to provide balance.”
The inside story
Obstetrics and gynaecology is a competitive specialty, with more than 200 eligible applicants vying for the 90 new positions each year across Australia and New Zealand. The college aims to attract a broad spectrum of doctors. “We want a range of people — from those who might pursue an academic career through to people who might want to work in a regional centre, or perhaps a combination of both”, Dr Sherwood says.
In its selection process, the college looks for doctors who appreciate the complexities of women’s health and who have strong clinical, research and academic skills. An appreciation of the problems of rural Australia and of disadvantaged communities, including Indigenous and immigrant communities, is also important.
“The training program aims to produce a balanced graduate, so there are aspects that address all of those areas — there’s a compulsory rural rotation, there’s an academic proportion in a research project, there’s obviously surgical skills targets to be met, ultrasound capability and understanding of all the basic sciences”, Dr Sherwood says.
In addition to clinical and academic ability, obstetrics and gynaecology requires people skills,
Dr Sherwood says. “You have to have good people skills to have a satisfying and successful career in O&G. You are engaging with people at some difficult times, some trying times, as well as some very happy times through pregnancy and childbirth.”
For Dr Farrell, her profession continues to provide the privilege of being involved in people’s lives at a joyful time.
“It was a love of obstetrics that attracted me to the profession in the beginning — just the excitement of being involved in a very exciting time in people’s lives — and that has been undiminished.”
The training program
The 6-year program comprises a 4-year integrated program of basic training in obstetrics and gynaecology, which is prescribed by the college, followed by a 2-year elective program. Trainees are required to submit a plan for an elective program that is appropriate for their training needs. The college must approve the plan.
The college also offers five subspecialties — reproductive medicine, gynaecological oncology, fetal and maternal medicine, urogynaecology and ultrasound. Training in one of these areas takes 3 years on top of the generalist training term.
Dr Sherwood says that while only one in five of the college’s fellows are subspecialists, many obstetricians/gynaecologists develop areas of special interest, such as endoscopic surgery, colposcopy, ultrasound and infertility.
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