The challenges facing recruitment and retention of doctors in obstetrics and gynaecology in Ireland

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O'Sullivan, Suzanne
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University College Cork
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Obstetrics and gynaecology is a medical specialty which includes all aspects of sexual and reproductive health across the life course of a female. It is traditionally perceived as a “lifestyle unfriendly” specialty, and future specialist shortages have been identified internationally. Irish maternity services have low consultant numbers, understaffed units, predominantly female trainees and have been exposed to high levels of litigation and intense media scrutiny for years. Using a combination of quantitative and qualitative research, this thesis presents a detailed exploration of attitudes to and experience of obstetrics and gynaecology as a career from the perspectives of the following groups: 1. Medical students from an Irish medical school (University College Cork), 2. Current specialists in training across all levels of experience, and 3. Consultant obstetrician gynaecologists. The quantitative research involved detailed surveys of all penultimate year medical students in UCC (n=134, response rate 68.7%) and trainees in obstetrics and gynaecology (n=124, response rate 70.8%). The qualitative research involved semistructured interviews using deductive thematic analysis, of 17 consultant obstetrician gynaecologists from different ages, genders and geographical locations across the country. For medical students, factors that increased the attraction to the specialty were continuity of care (p= 0.002), delivering babies (p=0.004), female patients only (p=0.026), limited focus of disease (p=0.01), intellectual content (p=0.001), combination of obstetrics and gynaecology (p=0.014), predominance of female practitioners (p=0.002), career opportunities and interaction with consultants (p=0.016). Protection from litigation was deemed by 85% of students to moderately or strongly increase the appeal to the specialty. When trainees were asked how much they enjoyed working in the specialty on a scale of 1 to 10 with 1 representing no enjoyment at all and 10 representing immense enjoyment, 85.3% responded with a value of 7 or higher. When asked if they would recommend a career in obstetrics and gynaecology to their family member or child, only 3% strongly agreed. 86.7% of trainees felt that the media did not have a positive impact on patients and 94.1% felt that the media representation of obstetrics and gynaecology was fair and balanced. 82.3% felt that the media negatively influenced patients’ attitudes to doctors. 37.1% of trainees have been involved in a medico-legal case and 79.5% state that the medico-legal climate has a moderately or strongly negative impact on recruitment and retention, while 84.2% feel it has a moderately or strongly negative impact on patients. In terms of future workforce planning, female trainees are significantly more likely to consider job-sharing (p=0.006) and are less likely to do private practice in obstetrics and gynaecology (p=0.002). 50.4% of all trainees plan to take parental leave and 33.9% plan on taking a sabbatical. The qualitative part of the study reflected themes of gender imbalance, reduced experience of new consultants due to EWTD, increased patient demand and unrealistic expectation, harm due to negative media coverage and the litigation culture, new entrant consultant pay disparity and lack of advocacy for doctors from professional bodies and the Health Service Executive. Solutions to the problems raised included restoration of pay parity, increased consultant numbers, improved advocacy, formal mentorship, and tackling negative media coverage and the litigation culture. Robust workforce planning, flexibility in training and consultant posts, diversification of the specialty to include community gynaecology and interdisciplinary spread of clinical care were also recommended. The voice of the current and future physician was at the centre of this work and the opinions and perceptions of these doctors is what I wish to address in this thesis. Their knowledge of the particular problems facing obstetrics and gynaecology in terms of clinical need and medical recruitment is unparalleled. Policymakers would do well to partner with the professional and training bodies to ensure, practical, economical and evidence-based solutions to the problems facing recruitment and retention in maternity services.
Recruitment , Retention , Doctors , Obstetrics and gynaecology , Retention of doctors
O'Sullivan, S. 2020. The challenges facing recruitment and retention of doctors in obstetrics and gynaecology in Ireland. MD Thesis, University College Cork.
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