What’s it like to be a doctor these days, as opposed to 30 years ago? I met a doctor in an online group and we struck up a conversation. Her views were so interesting that I asked her to join me in a series of conversations for ClearHealthCosts. She is a D.O. (Doctor of Osteopathic Medicine) in private practice who also has a leadership role in obstetrics and gynecology at a Midwestern hospital system. She spoke on condition that we not use her name. Here is our third conversation, lightly edited for length and clarity. Links to the first two are at the bottom of this post.
Jeanne Pinder
We’re going to talk about women, men and non-binary people. Take education and hiring for women, non-binary people and men, what are the differences? What are the trends?
Dr. X
Coming out of physician programs in obstetrics and gynecology at this point I would say over 90 percent are women. One of my partners is a recent graduate, as of maybe five, six years ago, and I think they had seven or eight residents in a year. And they probably had one male each each year, and a lot of times they didn’t have any males.
JP
That’s so different. I’m 70. All of my gynecologists when I was younger were men.
Dr. X
Actually, that’s one of the reasons why I chose obstetrics and gynecology — because of having a bad encounter with a male physician when I was really young. He was just very insensitive and unkind. It kind of always stuck with me. I could do better.
More doctors who are women
JP
So, so that’s a big change. When you were in school, I’m sure there were men?
Dr. X
I had 10 People in my residency class, I think, at least three, maybe four, at least were men. It wasn’t 50-50. But it certainly wasn’t 90.
I mean, it makes sense. Because I think women feel more comfortable having women physicians – people who identify as women. You feel more comfortable in that space. Does that make sense?
JP
This may be a premature question, but I’m going to ask about education and training for LGBTQ, non-binary people. Do we see a change there now as we see a change in society?
Dr. X
Yes, definitely. I don’t feel like I can speak to this. In our nearest major metropolitan area, there are a couple places that do gender-affirming care, and have clinics for that. And they’re very well thought of and highly regarded. So, yes, the people coming out are trained on this. This is probably new as of 10 years ago, I’m thinking.
More aware of biases
JP
Has medical education changed a lot? Maybe you don’t know, because you haven’t been in the medical education system recently, but to reflect this sort of changes in society, has medical education changed?
Dr. X
I think because of the social determinants of health and the adverse effects that can have on the patients that we treat, I think we’re much more aware of our biases. There’s education about dealing with implicit and explicit bias.
For instance, when we interview a patient, typically back years ago, we’d say, “Are you sexually active?” and you assume that they were having sex with men. Now it’s much more open-ended. We ask for people’s preferred pronouns. If you ask, if a person is sexually active, you say, “with men, with women, or both?”
It’s a good feeling, because it’s just very accepting. Hopefully, we’re saying to the patient, “whatever you bring to this place, it’s safe to lay your cards on the table.” So we can best see what you need and how we can help you better.
JP
Did you have to go through things in your practice, like rewriting your intake questionnaire to include “Do you identify as male female, none of the above, non-binary?”
Dr. X
Yes. Because of the [electronic medical record], with updates, they did it for us.
Hiring and job-hunting
JP
Then what about hiring? And in job-seeking, like the two sides of the same coin – how has that changed? For men, women, non-binary people? When you’re hiring, are you looking particularly for men, women, non-binary? What are you seeing as far as the job seekers? Are you seeing more non-binary people?
Dr. X
No, I mean, we’re not seeing more non-binary people. If it was a non-binary person that was applying to the job, we would, we would definitely consider them, however, there’s not really many people that identify as such. So I mean, we’ve I think we’ve only gotten CV’s from women at this point.
JP
It may be that non-binary people are finding jobs in clinics where people who haven’t been able to find treatment are able to find it now.
Dr. X
I would think, because if you have an opportunity to help those who are like you, that’s a great opportunity.
JP
Are there any med school programs that are known for teaching non-binary or trans or LGBTQ people? Or is that sort of not something that’s part of your experience?
Dr. X
Not that I know of, but I’m certainly not an expert on that.
OB-GYN is a competitive field
JP
All right. So, as far as the hiring process is concerned, you said most of the people who apply to you are women. Are they choosing OB-GYN over other specializations and why?
Dr. X
OB-GYN spots are pretty coveted. I looked at the numbers from who matched after medical school. It was a pretty competitive field. As far as residency positions, I don’t think there were many unfilled spots, which is, you know, good for the profession.
People still go into it, probably for the same reasons that I did 30 years ago — that they felt a need, and a desire to treat this population of patients. They wanted the variety of surgery, primary care, intensive care. It’s such a great variety of what you do in a day. So, I think people are still choosing the profession, because of that, in spite of the negatives.
The downsides of OB-GYN
JP
And what are the negatives?
Dr. X
The negatives are being up at three o’clock in the morning. And having to think coherently.
Malpractice is a big negative. The statute of limitation for malpractice is 18 years, when the baby is no longer a minor. Also some outcomes are not avoidable and yet the physician can be sued for things that may be out of her control.
The pressures of private equity, the hospital practices, the loss of autonomy. I think that’s felt in nearly every profession, but some probably much more than others. I would say those are the biggest negatives.
JP
Do you think those downsides, the pressures, the loss of autonomy and so on are felt more in OB-GYN than in other professions or other specializations?
Dr. X
Good question. I don’t know. People who are in primary care really feel it. There are even fewer private-practice people in primary care, because the referral bases are so skewed to whatever group you belong to, or are affiliated with, and if you’re not affiliated with anything, the referral base can easily dry up. I don’t have the numbers to say if it’s better or worse, my specialty versus another specialty.
Word of mouth referrals
JP
But when you say the referral base, I think for a lot of people who are going to be reading this, they don’t really understand what a referral base is – basically in lay person’s terms, how you find your patients, where they come from. Either they find you in the phone book, or they find you on Yelp, or they’re referred by a friend or referred by a hospital. Do you have a general idea of where your patients come from in that global term “referral base”?
Dr. X
We’ve really looked into it, because in our group, we’ve never done any advertising. It’s word of mouth. I mean, it is so incredibly word of mouth.
It’s funny, because I’ll go to my hairdresser. And most of the people in her salon come to our practice, Women talk and we work collaboratively. We’re kind of socialized to collaboratively manage problems. So, you know, if I need to find a new doctor, I say, “Hey, who do you go to, and do you like them?” I’m not really looking for my primary care doctor to tell me who should deliver my baby.
JP
That’s so profound. I live in a small village in the suburbs of New York City. And we have a Facebook called the Moms of Pelham. I see people all the time asking: physical therapist, ophthalmologist, who do you like?
Dr. X
Who do you like, because you have experience with them. Yeah, we have a similar thing. And every time I see, “I’m new to the area, and I’m trying to find an OB, who do you like?” And I will stalk and look through it. I can kind of like take a deep breath, you know, because they’ll be like, “Oh, [XXX] Women’s Health is really great.” And then, of course, you’ll get the [XXX] Women’s Health sucks. I would never go to them.”
JP
It is, you know, the wisdom of the crowd. You learn to be discerning because before this era, we had the telephone book. How much good is that?
Dr. X
We did have the telephone book. But we also had the moms that were sitting at the playground, the playdates that you had with your kid, your kids’ friends’ moms, you know? I love the collaborative management of problems. I think it’s just like, the best of who we are personally.
Frequent GYN visits
JP
That is an aspect of OB GYN care that I think a lot of people don’t realize, many women see their GYN more frequently than they see any other practitioner. With your annual checkup, at least in past years, anyhow, that made your GYN your primary care provider. Is that still true?
Dr. X
With the Affordable Care Act, preventative care is covered. That’s better. It lends towards people getting that history and physical exam by their primary. I mean, some people will treat general medical problems, but I try to work in conjunction with their primary care doctor. Just for them to get the most up-to-date care. I just don’t feel like I’m capable of doing that.
JP
That’s so interesting. That’s another sea change. When I was younger, I didn’t have a primary care provider, because who did, but I did have a gynecologist because you have to.
Dr. X
I honestly think I only probably two or three years ago got a primary care doctor myself. Mostly I just had one of my partners do whatever.
Women’s health vs. men’s health
JP
Let’s talk about women’s health issues, and how they take a back seat in this country. As far as things like osteoporosis, PCOS, endometriosis. It’s all still in the Stone Age, but we’re happy to treat erectile dysfunction and testosterone deficiency. Are women’s health issues always going to take a backseat? And or has it improved? Is it going to improve?
Dr. X
It’s gotten 10 times worse. For the last two years. People who treat women and are pro-choice are just gobsmacked. That we can live in a place in a time like this. It’s crazy.
To go from maybe five years ago, thinking about things like how research needs to be inclusive of pregnant people. We need to look at how women and men are different within the context of cardiovascular care, for example. And now I feel like, OK, yeah, that’s important, but we also have to have the basic human rights that are afforded to men now.
I’m just a bit crestfallen from these events. Look at what happened in the debate on Thursday. It’s disgusting, absolutely disgusting, that our politicians are talking about how we abort babies in the third trimester, and we abort babies after birth. This is the world we’re living in.
So how important is it that we’re trying to get research skewed towards women’s issues? We’ve got bigger fish to fry at this point.
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Here are other parts of the series:
What patients don’t know: Dr. X talks (Part 1 )
TikTok childbirth and less personal access to doctors: Dr. X talks (Part 2)
