Calling Current and Prospective Ob/Gyns

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The Ob/Gyn specialty has become increasingly popular in the past several years. To accommodate the growing demand, the specialty expanded to 255 programs for a record high of 1,336 positions in the 2018 Match. Yet there were 1,745 total applicants for only 1,336 spots, which equates to a 76.6 percent match rate. In this cycle, there are 1,911 U.S. and Canadian applicants. Due to the inadequate supply of Ob/Gyn residency spots, more and more applicants are not matching. In the 2018 match, 145 U.S. allopathic applicants did not match into Ob/Gyn, the fifth highest specialty in its number of unmatched applicants. There were 1.31 applicants per available position—comparable to Orthopedic Surgery, Plastic Surgery, Neurosurgery, and Dermatology, all specialties notorious for being highly competitive.

In the past, 12 was the ubiquitous number of interviews to maximize your chances of matching into an Ob/Gyn residency. This cycle, I constantly hear that 15-20 interviews is the norm from program directions. Students who are couples matching are pressured to attend even more interviews. For the 2018 Match, the median number of applications per candidate was 53.3, and this cycle it is 61.8 (excluding foreign graduates).

Prior to applying, I was warned about regional bias, the theory that programs tend to favor students who reside in the program's location or have an obvious connection to that location. I strategically applied to all the Philadelphia programs, which is where I lived as an undergraduate and where I had some of my most gratifying experiences in working with the underserved West Philadelphia community. I was rejected from all but one. On the interview trail, I met two bright, personable young women who unexpectedly failed to match into Ob/Gyn last year, and enrolled in preliminary General Surgery programs. I frequently hear students lament, "it's just this year," while shaking their heads in disbelief, acknowledging that this cycle is terribly challenging.

With so many brilliant applicants, program directors must make extremely difficult decisions. The average number of applications per program is 444, up from 376 in the 2018 Match. The large programs I've visited have received 700-1,000 applications this year, and will only interview 75-110 for a class of 10. To alleviate permeating anxiety, my program director emailed us in October after receiving panicked emails about fewer-than-expected interview invites. His message was clear: program directors are reviewing an astonishing number of applications and thus interview invitations were delayed—a common trend. Meanwhile, interviewers have been slyly asking me how many interviews I plan to attend, highlighting the uncertainty and unprecedented nature of this cycle.

According to the American Congress of Obstetricians and Gynecologists, by 2020 there will be a shortage of up to 8,800 ob/gyns. By 2050, the shortage may grow to 22,000. A major contributing factor to the shortage is the aging ob/gyn population—16 percent of ob/gyns are under age 40, while 36 percent are over 55. Due to significant burnout, ob/gyns tend to retire at an earlier age compared to other physicians, leaving younger physicians overworked. Ob/Gyn is the number one specialty with the highest rate of both depression and burnout.

These statistics are jarring. An ob/gyn should be able to feel career satisfaction without the expense of personal wellness. One question I like to ask program directors is: "Can you give me an example of a time when a resident was struggling and you supported them?" Over half of the responses described an example wherein a resident was severely depressed or overwhelmed and the faculty provided therapy or a leave of absence.

Given the workforce shortage and overabundance of qualified applicants, the Ob/Gyn specialty could certainly benefit from expanding the number of residency programs and residency spots. Obviously, this is easier said than done. I have been asking all program directors if they foresee any growth in their department, such as increasing categorical/preliminary positions or adding new faculty. Multiple directors have expressed the need and enthusiasm for growth, but are ill-equipped due to lack of faculty to train residents. Sometimes, they simply lack the office space.

The Ob/Gyn department at the University of Wisconsin-Madison was the first in the nation to offer a rural women's health track, a separate match from its parent program. Perhaps more programs could take Madison's lead and implement similar tracks in urban, high-need areas. The Doximity 2018 Ob/Gyn Workforce Study identified the top ten U.S. cities most likely to suffer a shortage. Hospitals in high-need metropolitan areas could create residency programs or expand existing programs. The U.S. government could offer grants to help fund hospitals and residency programs in shortage areas. If hospitals in high-need areas recruited more ob/gyns, it would increase the workforce in those areas. By redistributing the workload across more physicians, older physicians could continue working instead of retiring earlier, and ultimately teach new residents.

Because I have been so deeply enmeshed in my own interviews, I haven't thoroughly contemplated the broader implications of the ob/gyn shortage. Increasing stress and work hours among ob/gyns will continue to exacerbate burnout. A shortage of ob/gyns, as the major providers of healthcare to women for pregnancy-, gynecology-, and preventive health-related services, will negatively impact women's health. Although I can't help but feel anxious during this opaque process, I feel honored to have met so many incredible medical professionals who are aspiring to dedicate their lives to caring for women. To the ob/gyn boomers of our generation, I am more encouraged than ever to join in the movement of mitigating the ob/gyn shortage and its serious implications on women's health.

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