A new generation

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.

The misconceptions

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.”