Ob-gyns revere their specialty

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Obstetrics-gynecology residency program directors say they like candidates with good grades and scores on the Comprehensive Osteopathic Medical Licensing Examination—USA (COMLEX-USA), but high rankings are not the topmost priority. “We want applicants who are highly intelligent but also well-rounded human beings—not technical geeks who are superb test-takers but can’t relate to others,” Dr. Hubka says. The minimum COMLEX-USA score her program typically accepts is 450.

According to Osteopathic GME Match Report 2009, students matching into their first-choice AOA-approved residency in obstetrics-gynecology had a mean score of 469 for COMLEX-USA Level 1, with 91% passing on the first attempt.

Dr. Sanjaghsaz notes that he does value high board scores in addition to letters of recommendation, curriculum vitae particulars and personal statements. “I want someone who will make us proud in five years when they take their board certification exam, someone who will glow amongst others in the profession,” he says. “I won’t take someone who, for example, has not passed COMLEX Level 2 twice.

“But at the same time, I have picked some applicants I’ve made a judgment call on, and I am so proud of them. If I had gone strictly by grades and board scores, I would not have accepted them.”

“I’ve taken people who have super high scores, and I’ve taken people who have barely passed their boards,” adds Dr. Glines. “But I’m not going to take someone who doesn’t have the right personality.”

Obstetricians and gynecologists need to have excellent interpersonal skills, residency program directors agree. “You are dealing with patients at one of the most critical yet fulfilling times of their lives,” Dr. Glines says. “Having a baby is such a special moment. You need to have the personality to make it a wonderful occasion. You don’t want someone who has a stone face during delivery. On the other hand, you don’t want someone who is inappropriately excited because professional decorum has to be maintained.”

For the ACGME-accredited residency he directs, Dr. Forstein values medical knowledge and test-taking skills. “Board-certified physicians today will take high-stakes examinations for the rest of their lives,” he notes. But he also looks for candidates with communication skills and indications that that they are team players.

“We look at volunteer activities,” says Dr. Forstein. “Did the applicant serve at a local free clinic or work at a health fair in the community? Did he or she take part in a medical mission or volunteer for Habitat for Humanity?”

Dr. Sanjaghsaz, however, prefers work experience over volunteer activities. “Volunteering is noble, but you have no responsibilities really,” he says. “If you’ve worked at any job where you have a manager to answer to—where you get criticized and could get fired—that is more valuable preparation.”

Indeed, according to the AACOM match report, those matching into obstetrics-gynecology residencies ranked third among 19 specialties in the average number of work experiences.

Besides intelligence and breadth of experience, Dr. Hubka seeks enthusiasm and passion in her residency prospects. “We look for people who work well with the residents and other students, people who enjoy and have fun with what they do,” she says.

Dr. Hubka also favors candidates who are flexible, noting that you can’t predict what will happen from day to day. “If a woman’s labor takes longer than anticipated, then your next event may be delayed,” she says. “That’s the way it has to be. You can’t get upset or worried about it.”

The chairman of obstetrics-gynecology at the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Ill., Dr. Hubka observes students’ adaptability when they serve rotations under her. “If they get disappointed when something doesn’t occur or they can’t adjust to change on a regular basis, that’s a negative indicator,” she says. She also gauges flexibility by seeing how interviewees for residency positions respond to case scenarios.

In addition, obstetrician-gynecologists need to have intellectual agility to keep abreast of ever-evolving scientific evidence and clinical practice guidelines, Dr. Glines says.

A former president of the Illinois Osteopathic Medical Society, Dr. Hubka is also impressed by candidates who have demonstrated leadership skills and commitment to the profession through their involvement in the National Student Society of ACOOG, the AOA and state osteopathic medical associations.

Practice variations

In recent years, Dr. Jeck has urged residency graduates to join group practices. “The days are over when you go into practice by yourself, which is what I did many, many years ago, because you don’t have a life if you do so,” he says. “I always encourage residents to join a group in the area where they’d like to practice. That way, you get a decent salary. Your malpractice insurance is paid for. You have time to yourself. And you’re not on call 24 hours a day, seven days a week.”

Bucking this urban-area trend by remaining in solo private practice, Dr. Hubka has her own views on maintaining work-life balance. Rather than work fewer hours, limit her time on call and compartmentalize her professional and personal lives, she involves her 14-year-old son and 9-year-old daughter in her practice. “My kids get excited when they know one of my patients is having her first baby or her third one,” she says. “I don’t say, ‘Oh, my God, I’m leaving you again.’ And they don’t say, ‘Mommy, don’t go.’ I try to make my career fun for them instead of a drag.

“Both of my kids have gone on hospital rounds with me, which they enjoy. My daughter is always bringing little birthday gifts for the babies.”

Dr. Hubka believes that the work-hour restriction for residents has led many new physicians to place a priority on personal time. “My training took place before the 80-hour work rule, so I’m used to the long hours,” she says. “You learn a certain style of practicing and perfect it, your body gets accustomed to it, and it’s doable.”

But Dr. Hubka is glad that obstetrician-gynecologists today have a number of career options to choose from. Many are employed by medical schools, hospitals or group practices, while others form their own practice groups or practice independently. Although Dr. Hubka relishes the diversity of her field, she understands why some of her peers limit their practices to just gynecology, surgery or obstetrics.

For example, one of Dr. Hubka’s friends is employed by a hospital as a laborist, delivering babies three days a week. “When she goes into the hospital, she works very hard. And when she’s off, she’s off,” Dr. Hubka says. The hospital takes care of her medical malpractice insurance and her credentialing. And she doesn’t have to worry about all of the responsibilities of running a private practice, from overhead costs to employee management.

“She loves her style of practice,” Dr. Hubka says. “And I love mine.”