How to… work in obstetrics and gynaecology
Recruitment in O&G has fallen dramatically over the past decade. Sara Williams looks at one of the oldest and most valued specialties in the wake of MMC.
What is O&G?
It is estimated that one woman gives birth every 90 seconds in the UK, so essentially you can never have enough doctors in this speciality. Statistics aside, few specialties allow trainees to work as surgeons and physicians and preserve two lives at the same time. At the heart of the specialty is women’s health and the profound physiological changes of pregnancy; obstetrics is care provided during pregnancy and childbirth, and gynaecology monitors any future reproductive health problems. It is often described as a surgical art, where doctors work with women to deliver babies, while putting their critical experience in preventative medicine to the ultimate test by delivering lifesaving antenatal care.
This mixture of surgery and general medicine has seen obs and gynae develop enormously over the last 30 years. It now combines clinical disciplines such as endocrinology, sexuality, pharmacology, pathology and neonatology. Despite the numerous advances in this field and the huge potential for growth, recruitment numbers have been dwindling over the last decade. In 2002, only 2.8% of graduates specified obs and gynae as their first choice – which is low, considering the specialty has been around since the beginning of medicine.
Training
The training programme is currently being restructured, but after five years of training it will offer the chance to undertake advanced skills or subspecialty training, either working as a consultant across a diversity of fields or working in one field, such as fetal medicine. Subspecialties range from materno-fetal medicine and gynaecological oncology, to gynaecological urology, reproductive medicine and community gynaecology.
The Royal College of Obstetricians and Gynaecologists has developed a centrally coordinated, locally developed selection process, which has been running for three years. All applicants fill in the same application form and the deaneries use the same scoring system. Not only does this maximise fill rates at interview, but the system prevents the appointment of trainees who are not suitable.
Working in Obs and Gynae
Research by the RCOG found that the main attractions to obs and gynae were:
- A mixture of medicine and surgery (23%)
- An interest in the specialty itself (21%
- Job satisfaction (17%)
- A broad choice of activities (13%)
The main deterrents were:
- Current working hours, conditions and shifts (25%)
- Fear of litigation (13%)
- Bad undergraduate experience (11%)
A career in this field is flexible and rewarding, but at times challenging and stressful. Medical advances, such as the introduction of preconceptual preparation, prenatal diagnostic techniques, routine antenatal care and fetal monitoring, have improved paediatric and neonatal care. Obstetricians can really influence the outcomes of pregnancy by working closely with midwives, paediatricians, radiographers, radiologists, anaesthetists, surgeons, genitourinary physicians and scientists.
The role is becoming increasingly invaluable as more family planning and sexual and reproductive healthcare clinics are closing across the country, which has resulted in poorer access to services and choice for women. Working outside the hospital walls is part of the job, to foster learning about primary care gynaecology by spending time in family planning and GUM clinics.
What the future holds
The future is looking bright, as more consultant posts are being developed and increasing numbers of medical students are being drawn to the specialty. Community gynaecology is growing and there is greater flexibility in training. Read how Melissa Whitten mixed her training with her academic pursuits, so that she not only practises medicine but teaches and mentors juniors and trainees. Not every specialty is as exciting and fulfilling as obs and gynae, so read on to see if you have what it takes.
Boxout
- Personality: Empathetic, good stamina, manual dexterity, team player, clear communicator, non-judgmental
- Best bits: Treating patients with profound medical problems, strong emotional elements, range of clinical interests, saving two lives for the price of one
- Worst bits: Strenuous night work and on-calls
- Requirements: MRCOG
- Stress: From moderate to highly stressful
- Salary: £80,000-£300,000
- Competition: Moderate
References
1. Turner, G. et al. Career Choices for Obstetrics and Gynaecology: National Survey of Graduates of 1974–2002 from UK Medical School. BJOG 2006.
2. Royal College of Obstetricians and Gynaecologists A Career in Obstetrics and Gynaecology Recruitment and Retention in the Specialty. London 2006