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    Sign Out: Do you have to be crazy to practice obstetrics?

    Sarah J. Kilpatrick, MD, PhD
    We have a problem in womens' health: Fewer US-trained medical students are entering ob/gyn residencies. The number of PGY-1 slots has stayed the same, but today fewer medical students consider ob/gyn a top choice. Why are students who train with us less likely to want to stay in our field? Fear, frustration with the malpractice situation, decreasing physician salaries, increasing student debt, and negative perceptions about the ob/gyn lifestyle, to name a few factors. So who but a crazy person would want to go into our field? And why do those of us in practice continue to stay in obstetrics?

    I've been taking care of women for nearly 20 years, and every day I feel honored to do it. I can't imagine another career that would be more fun, interesting, or rewarding. I do what I do because of the patients. There are some I will never forget:

    • A poor, Latin American teenager who, at her 6-week postpartum visit, brought me two pillowcases she had embroidered herself. Her vaginal delivery was one of my first as a resident; I spoke English and she spoke Spanish. I don't remember her name but I will never forget her or her appreciation.
    • A woman with symptomatic cardiomyopathy who was hospitalized in the intensive care unit at approximately 22 weeks. She and her husband declined to terminate the pregnancy and she got progressively worse. The baby was delivered for maternal complications at 26 weeks and lived; the mother was doing fairly well at discharge. Four months later, the woman's husband called to tell me she had died and to express his gratitude because we had honored his wife's wishes to maintain the pregnancy, and he now had a daughter.
    • An academician pregnant with twins whose husband had terminal brain cancer. Both parents were very happy about the pregnancy, and we talked about his prognosis and their children. The husband was at the delivery, which was performed near term. He died about 2 weeks later, having lived long enough to meet his children, which is what both he and his wife had wanted.
    • A teenager with premature rupture of membranes at 27 weeks, who was admitted and given steroids. She wanted to comply with our recommendation to stay in the hospital for expectant management but couldn't because she had a 2-year-old child and no one to take care of him for a prolonged period. About every other day, when she could get a babysitter, she returned to the hospital for monitoring. Our residents and students had difficulty understanding the situation, but I found it an important lesson in the reality of one woman's life. Luckily, the patient and her baby did fine and she went home on birth control.
    • And finally, there was our outpatient clinic's favorite patient, a Spanish-speaking woman with gestational diabetes who was cheerful all the time. Her visits were three-way conversations between her, a friend who spoke English, and me (my Spanish is still marginal). One day, the friend came in with a cane, and when I asked why, the patient started to cry. Her friend, I learned, had metastatic breast cancer at age 35. She accepted her diagnosis but decided to live life to the fullest, including being at my patient's side, in a wheelchair, during labor and delivery. The friend died a few weeks later, after returning to Mexico to see her son on a trip paid for by my patient.

    Sharing patient's lives is a priceless gift and it is truly rewarding to be able to help with their outcomes. That's why I do what I do. Sure I could have chosen a field with fewer malpractice issues, greater earning potential, and no night hours. But then I would never have had the privilege of caring for so many extraordinary women. I know I'm not the only obstetrician who feels this way. If you do, share the joy of obstetrics with medical students. They really need to know why it's not crazy to enter the specialty today.

    Sarah J. Kilpatrick, MD, PhD
    Dr. Kilpatrick is the Helping Hand Endowed Chair in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los ...


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