Pamela A. Promecene

Burnout in residency: a statewide study.

Objective: To determine the prevalence of burnout in residents in obstetrics and gynecology through the use of a validated tool. Methods: The Maslach Burnout Inventory Human Services questionnaire is a previously validated tool that measures burnout. Obstetrics and gynecology residents from Texas were invited to participate in this study in 2002. The Maslach Burnout Inventory Human Services questionnaire and a demographic survey were distributed to each resident. Responses were anonymous and returned by mail. Contingency coefficient and χ2 tests were used for analysis; values of P < 0.05 were significant. Results: Residents (n = 368) from 17 programs in Texas were surveyed. Responses were received from 14 programs (82.4%), with 136 surveys (37%) returned. Overall, 38.2% reported high emotional exhaustion, 47.1% reported high depersonalization, and 19.1% reported reduced personal accomplishment. The number of residents experiencing true burnout (high emotional exhaustion, high depersonalization, and low personal accomplishment) was 17.6% (n = 24). Conclusions: High levels of emotional exhaustion and depersonalization occur in some residents. Burnout in residents included in this study was approximately 18%.

Work hours for practicing obstetrician-gynecologists: The reality of life after residency

Abstract Objective Recently the Accreditation Council for Graduate Medical Education placed restrictions on all residency programs that limited work hours to 80 hours per week. The objective of this study was to determine the work hours for practicing obstetrician-gynecologists in an urban center. Study design A questionnaire about physician demographics and work hours was mailed to all obstetrician-gynecologists in Houston in June 2002. χ 2 testing was used for statistical analysis. Results One hundred eighty-nine surveys were mailed. One hundred surveys (56%) were returned complete and analyzed. Sixty-two physicians reported working >80 hours per week. Physicians were more likely to work >80 hours per week if they were men or if they were >50 years old. Marital status and having children living at home did not affect work hours. Conclusion Most obstetrician-gynecologists in Houston work longer hours than the number of hours that is imposed by the Accreditation Council for Graduate Medical Education resident work hour guidelines.

Laparoscopy in Gynecologic Emergencies

Laparoscopy is ideal for the diagnosis of acute pelvic pain and the treatment of gynecologic emergencies. It is as safe and effective as laparotomy for the treatment of ectopic pregnancy, ovarian cysts, dermoid cysts, and adnexal torsion. Treatment with laparoscopy results in shorter hospital stay and faster recovery. Future fertility is not compromised and in some cases may be improved with laparoscopic treatment. There are also studies suggesting that laparoscopy can be used safely for the diagnosis and treatment of gynecologic emergencies in the first and second trimester of pregnancy. Copyright 2002, Elsevier Science (USA). All rights reserved.

Occupational stress among obstetrician/gynecologists.

Objective Our objective was to assess occupational stress in obstetrician/gynecologists using a standardized, validated tool. Methods The Osipow Occupational Stress Inventory, which measures occupational stress (occupational roles questionnaire [ORQ]), psychological strain (personal strain questionnaire), and coping resources (personal resources questionnaire), was distributed to 277 obstetrician/gynecologists in Houston. The &khgr;2 or Fisher’s exact test was used where appropriate. Results Sixty-nine surveys were analyzed. Median T scores for all subscales were within the normal range. Abnormal scores were recorded by 22 physicians (31%) on at least one subscale of the ORQ, by 5 physicians (7%) on at least one subscale of the personal strain questionnaire, and by 6 physicians (9%) on at least one subscale of the personal resources questionnaire (P < 0.05). Abnormal scores occurred more frequently in the ORQ domain. Generalists had significantly more abnormal scores than did subspecialists (P < 0.05). Conclusion Occupational stress is common among obstetrician/gynecologists. This appears to be balanced by good coping skills.

Job satisfaction among program directors in obstetrics and gynecology: a national portrait.

OBJECTIVES The purpose of this study was to determine job satisfaction among program directors in obstetrics and gynecology with the use of a validated tool and to identify specific sources of dissatisfaction that might lead to job change. STUDY DESIGN The program director satisfaction and a global job satisfaction survey were sent to all program directors in the United States. Motivators for seeking a job change were assessed. The chi(2) test, Kruskal-Wallis test, correlation analysis, and multiple linear regression were used. RESULTS Seventy percent of 254 surveys were completed. Global job satisfaction (minimum, 4; maximum, 16) was 11.9+/-2.9; mean program director satisfaction score was 135+/-25.8 (minimum, 54; maximum, 200). Job satisfaction was highest in chairs, full professors, those whose age was >50 years, and those with >5 years of experience (P=.02) and in facets that were related to work with residents, colleagues, and patients. Dissatisfaction was highest with regard to salary, promotion opportunities, and resources. Forty-six percent of those who responded were considering a job change in 3 years; the most common reason for a job change that was cited was administrative hassles. CONCLUSION Although job satisfaction is high among program directors, administrative hassles may lead to high rate of rapid turnover.

Racial bias in patient selection of an obstetrician.

Objective: The objective of this study was to determine racial bias in patient selection of an obstetrician. Methods: Obstetrical patients referred for genetic counseling at a community hospital were included. Self-reported patient race/ethnicity were compared with obstetricians race/ethnicity. Results: The patient population (n = 1,519) was 27.8% white, 25% Hispanic, 22.5% black, 20.5% Asian, and 4.3% other. Physician race/ethnicity was 47.8% white, 28.8% Asian, 14.4% Hispanic, and 9% black. Patient race/ethnicity and physician race/ethnicity were correlated (contingency coefficient = 0.54, P < 0.001). White and Asian patients were more likely to select obstetricians of their own racial background (72.7% and 66.6%) than were Hispanic or black patients (36% and 24.6%, P < 0.001). Patients of all races were more likely to be under the care of a physician of their own race than of a different race. Conclusions: In an urban community with a racially diverse population, there is a strong racial bias in patient selection of an obstetrician.

Women's health care teams and the future of obstetrics and gynecology

Health care delivery is in a stage of transformation and a meaningful change in provision of care must also be accompanied by changes in the educational process of health care professionals. This article lays out a roadmap to better prepare obstetrician–gynecologists (ob-gyns) to succeed in interdisciplinary womens health care teams. Just as our current educational programs emphasize the development of competent surgical skills, our future programs must encourage and support the development of communication, teamwork, and leadership skills for ob-gyns. Formal integration of these fundamentals at all levels of the health care training continuum will create an educational system designed to equip all practitioners with a basic level of knowledge and provide opportunities to acquire additional knowledge and skills as needs and interest dictate. Integral to the implementation will be the evaluation of the effects of the contributions of interprofessional education on patient, practice, and health system outcomes. Successful demonstration of value will lead to the sustainability of the educational programs through recognition by physicians, health care teams, academia, health care systems, and payers.