Match Day 2006: Liability becoming a lesser factor in specialty choice

U.S. medical students show a little more interest in high-risk fields.

By Myrle Croasdale — Posted April 3, 2006

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In recent years, the medical liability crisis may have made high-risk specialties less attractive to U.S. medical students, but the results of this year's Match show reluctance to join those fields is easing, particularly for obstetrics and gynecology.

In the 2006 National Resident Matching Program held March 16, graduates of U.S. allopathic medical schools filled 72.4% of obstetrics and gynecology programs, or 835 of the 1,154 positions. It marked the first time that U.S. allopathic graduates matching in ob-gyn has climbed out of the 60% range in three years.

Emily Binkley, a senior at Vanderbilt University School of Medicine in Nashville, Tenn., is among the U.S. graduates who helped improve those statistics. Binkley found out that she's headed to the ob-gyn program at Pennsylvania Hospital in Philadelphia. She said she isn't put off by the liability issues in her field, or the state where she will train, which the AMA says is experiencing a medical liability crisis.

"Lifestyle was my biggest concern, much more so than medical liability," Binkley said of her specialty choice.

However, when she interviewed at Pennsylvania Hospital, doctors there brought up the liability issue. As she considered her career options, many discouraged Binkley. But she said she had to follow her heart.

"I did my OB rotation, and I just loved it," she said. "I like the variety, from surgery to primary care. I saw the great relationships residents formed with their patients. I really want that."

The American College of Obstetricians and Gynecologists has been working hard to attract more students after the early 2000s saw a decrease in interest in ob-gyn, said Haywood Brown, MD, chair of ACOG's council on resident education. In recent years, ACOG began an active education campaign with ob-gyn departments at academic medical centers, forming student interest groups to give physicians in training a clearer picture of life as an ob-gyn. Dr. Brown said they believe the liability climate and the perceived lifestyle of an ob-gyn were making students less interested in the field.

"We've worked extremely hard to explain to students what obstetrics and gynecology really is," he said. "It's not just delivering babies and performing hysterectomies, but it's the whole spectrum of women's health."

ACOG also worked to educate students that most ob-gyns practice in groups that share call, instead of the old model of solo physicians shouldering call on their own. Liability concerns may not be so easily addressed, but students seem willing to look beyond them, Dr. Brown said. "They realize if you have a love for women's health you shouldn't let liability drive you away from doing it," he said.

Resident duty-hour limits also may be supporting a resurgence in ob-gyn, Dr. Brown said.

At Duke University School of Medicine in Durham, N.C., where Dr. Brown chairs the ob-gyn department, there were only five students in the student interest group three years ago; now there are 25. Last year, he had only one student choose ob-gyn, this year he has five.

At Vanderbilt, Melinda New, MD, resident director for the medical center's ob-gyn program, said her department interviewed five of Vanderbilt's medical students this year, compared to one or two in previous years. One of them ultimately matched with the medical center's six openings.

Other high-risk fields, like neurosurgery, haven't felt the big dip in U.S. applicants that ob-gyn experienced. One reason may be that these programs are smaller overall, making the limited number of training positions very competitive. Also, specialties like neurosurgery offer a lot of options for academic careers, where faculty are covered through their institution's liability plans.

Philip Weinstein, MD, chair of the residency matching committee for the American Assn. of Neurological Surgeons and past president of the group, said that while the liability crisis has had a tremendous impact on practicing neurosurgeons, it hasn't changed the number of students interested in the field. In fact, many neurosurgical programs have had to expand in order to accommodate the new duty-hour limits, and they haven't had problems finding good candidates.

"We're pleased about that," Dr. Weinstein said.

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Primary care and the Match

This year's National Resident Matching Program saw an all-time high of 26,715 medical graduates participate, with a record 24,085 finding positions. Family medicine saw an end to an 8-year slide in its overall fill rate. Internal medicine saw the third straight year of a slight increase in the number of U.S. graduates taking offered positions.

Field Positions offered U.S. students filling slots Total positions filled
Family medicine 2,711 41.4% 85.1%
Internal medicine 4,735 56.3% 97.9%
Obstetrics-gynecology 1,154 72.4% 97.9%
Pediatrics 2,288 72.9% 96.5%

Source: National Resident Matching Program

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