Strengthening Research in Academic OB/GYN Departments (1992) / Chapter Skim
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3 CAREER CHOICES
3 CAREER CHOICES
Pages 87-108
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From page 87... ...
Such models may include ones ~ which basic scientists provide the underpinnings on which clinical scientists build, basic sciends;~ bring research expertise to He deparun~t ~t He physician investigators lack, or clinical and basic scientists conduct investigations ~ He same department but with little at 90 communication Moreover, there are physicianJscientists whose interest and Mining have extended so far into basic science Cat them work is mdistin-Table Tom the work of the Ph.D. scientist.
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From page 88... ...
Similarly, itch experiences during medical school are strongly associated with postg~ad~.~. research involvement.2 A group lhat examined ways of expanding He supply of clinical investigators made the following statement: During medical school, tile firm critical career decisions are made Hat determine whether an individual may become a clinical investigator.
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From page 89... ...
, physical medicine (S47, 792) , and surgical subs~ialties ($46,162~.6 OB/GYN Ad emergency medicine had the highest proportio~16 percents medical school grades with debt levels in excess of $75,000, Compaq with an average of 11 Sent for all ppecialties.7 In addition, between 1986 and 1989, the average level of debt for those inter cling to enter ~Av~hlc ~t~cc doe ninth the rchtio~hip between debt Impels ~ specialty choice, ant indicates that ohm a weak relationship crises.
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From page 90... ...
Taking into account the repayment schedules of the different types of lent a medical student is likely to use, as well as Me definitions formulated by lending agencies of ~comfortable. repayment-tin income ratios, a physician owing $50,000 must earn nearly S79, 000 per yea' five years after g~sduabon to comfortably repay the debt; it is ~difficult.
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From page 91... ...
ENDINGS: Debt, when newed ~ He context of the ac~nulated weight of the many other d4 - rmts to an ink - igative career, does result In the lo" of talented mdinduals to the pool of OB/GYN instigators. The anecdotal evidence, their own expenence, and data on specialty choice and debt Payment burdens, together with~e very sell number of OBJGYNphysici~ ~ the research training pipeline, convinced committee members that them is a need for a program that would Grease He dot effect of debt rant.
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From page 92... ...
Forgone Eandngs For most physicians, Be decision to pursue an academic or investigative career means that their income will be substantially below Hat eamed in clinical practice. It is often claims that it is particularly difficult to aft physicians into academic positions in OB/GYN bemuse, as a relatively high earning socials, the difference between Anemic Income and alternative earnings is gamer than the difference that occurs for other specialties.
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From page 93... ...
Assuming some parallel between the choice of a specialty and the choice of a career in research, evidence on the role of expected income in ~ physician's choice of ~ialty may be viewed as surrogate clata. Surveys of graduating Helical school students and some econometric analyses generally indicate allot future income is not an important factor in Specialty cho~ce.~3~4 But one study found a collation between Me median net income of a specials and Me proportion of Ardency positions filled by U.S.
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From page 94... ...
ENDINGS: OB/GYN, like other clinical departments, lose mitigators bemme of the discrepancy between practice and academic incomes There is little appreciable difference in foregone income between OB/GYN Ed the over specialties for which data were available. Since the specialty choices of female physician are driven less by income considerations don by other factors, the high proportion of women in OBIGYN may work to He advantage of the field.
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From page 95... ...
However, advances in molecular biology and He increasing convergence of basic and clinical res~ch have changed the nalme of much research conducted by physicians and expanded its range. Cams Wy~gsardeD, in an article entitled The Clinical Investigator as an Endangered Species, defined the physicianJsciendst in terms of both Raining and activity: An individual thoroughly trained in clinical medicine and also thoroughly Wed in a scientific disciple, and unto, in addition, par~cipa~ in both clinics and e~cpenment~1 endeavors as a career role.
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From page 96... ...
A physician who has maximized such opportunities may be sufficiency prepared to undertake some uncompliant-clinical resmreh, but Here is genera} agreement that substantial additional training is needed to embark on an investigative career. Sp~ial~ id Sum TO ~ OBIG~ The conventional training paw for an individual who intends to enter Anemia ~ OB/GYN stat th residency, which red four years ~ a graduate medical education program mat has been awaited by He Accreditation Council for Grad= - Medical Edu~on.
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From page 97... ...
inc~iIlg basic knowledge ·~ Although He extra years of subspec~alty braining may not be needed i! an individual mtends to pursue a career in research, the uncmaindes of such a career cause many to believe that the physician must be fully qualified for a career in clinical practice.
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From page 98... ...
Deppite the apparent emphasis on research dig the fellowship years, the e~cpenence of committee members and others suggests that two to three years of additional intensive research training is usually needed, both as Pygmalion for a research career and to below competitive witch others seeing R01 su~pport.An exception to Be ~emic's need for endive Oh training would occur for ~ndi~duals whose principal occupations would be clinical practice and Thing, with only a Or involvement In the conduct of bedside clinical research. In a presentation to Be committee, Be president of Be American Board of OB/GYN emphasized that Be encouragement of research Is not included in the objectives and purposes of Be board.
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From page 99... ...
The goal is to ease may into research by permittiIIg the Gaines to mom to the laboratory any time after finishing medical school, to become c-fled ~ internal medicine after only two years of Icy paining, and ~ be examined for bond ce~fic~ion with his or her medical school graduation cohort The trainee is then able to pi into subspecialty training arid resmrch.32 A subspecialt~r examination can be taken six or seven years aft" medical school g~ad''~tion, by which lime a Me Residency Review Committee accredits residency programs for a specified mmber of residents for each posq~aduatc year. Tous ~ pn~grasn Inch get pcnn~on for a rc~dcm To ho Icft the program for research to rig to Coon it at a later tale, because a pn~g~sm that has filled its redly slots will then }arc an CXCCS5 when the indi~dus1 Guns.
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From page 100... ...
As in final medicine, however, the accele~a~ route was used by too many candidates who did not enter Lemma, "d ABP is therefore consid~g its discondouation.34 Because the ABP conceives of the generalist pediatrician as Slicing care of most clinical pediatric practice and of pediatric subspecialists as berg academicians, it has extended sub~ecialty paining from two to three years and added a research competency training req~ment. There is today ~ Mast take for candid at" for subspecialty paining who have demons research commence, such as those with an M.D./Ph.D.
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From page 101... ...
Women and Church Women have a substantial rep~ntation in anemic Carets of OBIGYN -- partic~'l~rly at lower academic levels but in general, Key have a lesser propensity than mew to enter research. This is likely to incurs Me shortage of msearch personnel uric special efforts are made to encourage research careers for women and to meet their particular needs.
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From page 102... ...
Furthermore, many insertions lack formal mechanism for handling tilde pregnancies of residents (only 57 percent of t~hing hospitals have majority leave policies3, and this, too, can lead to disruption and stress.36 There is evidence Cat women in me~cme feel ~ they must delay childbearing: 45 parent of respondents to a 1988 survey of women faculty in documents of medicine had their Fist child after completing paining. If childbearing is delayed, however, the demands of young children must be accomm~amd in the early phases of Me academic career years when tenure decisions are made and when faculty members are under pressure to conduct productive research and publish their results.37 Although several "searchers have reported chat family responsibilities do not consi~tly reduce the publication rates and salaries of women scientists and en-eem, ~ also suggest that advance with family responsibilities, such as prodding child care, helps women sustain fill}-~e employmen~38 Some institutions have initialed policies (bat effectively stop the tenure clock for a limited period.
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From page 103... ...
However, according to one report, women students who chose women role models looked for The exemplification of a career wombs total lifestyles; men in Me We situation looked for role models with outstanding reputadons.42 ~ survey of women with fit time appointments ~ academic d~arb~ts of Unsnap medicine revealed that 94 percent agreed Mat women medical students need role models of successful, tended women facult~r.43 1be encouragement, support, and advocacy of a mentor will undoubtedly be formal convcr~tions with i~riduals Screech in Tic promos of women in academia suggest Hat women arc lilccly to become sidc~clced by clinical care ~ Aching tub the early faculty years, ~ arc not well infonned about the cruder ended to achic~rc teDurc. This laucr factor may contribute to> the cling of women ~ low acadc~c positions; it also ~ to tlic need for mcD6or~g.
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From page 104... ...
RECOMMENDATIONS: The committee recommends that OBIGYN department leaders pursue ways to ameliorate the so that amend He life of women In Spencer Id particular, He ~mrmffee recommends that even effort be made to find women mentors and role models for women investigators, If not ~ He department of OB/GYN, then through networks of women physician investigators, across departmental lines, or at another medical school. ~cta1 leadership should emph~ He value it plans OD women accepting mentonog relationships win young women mvesiigators" This should not, however, preclude mento~g relationships between men and women, which the committee also considers to be of major importance.
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From page 105... ...
once the commitment was ~e. These differences may be due ~ Pam to the sbess" of family life in particular, ~onsibilides for childbearing and child care that fall on their shoulders, and in part to a deal of women role models and mentors, who could play an important role ~ the development and career t~ajectones of women physician Vestiges.
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From page 106... ...
Lee Rcpon of the Ad bloc Co~ttcc on Clinical Rcsc~h Baaing. Washi~n, D.C.: Emaciation of American Medical Colleges, Feb~u~y 1980.
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From page 107... ...
Report OD Medical School Faculty Salaries 1901991. -motion for Opcastional Smdica.
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From page 108... ...
108 SIRENG711ENING RESEARCH IN~C~IC OB/G~D~ 38. Com~t~cc on Women us Scicacc ~ Enginc-nag.
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