The worst of times for OB-Gyne?

Do women need workaholic doctors, who risk their own health to care for them? Who is willing to make such sacrifices? In the NYT, Dr. Alexander Friedman writes:

Obstetrics-gynecology is quietly reeling from a crisis: not the hot, loud, nasty one involving politicians, lawyers and lawsuits but an insidious one of students voting with their feet.

In the last decade, the number of students entering the specialty has plummeted. In 1996 and 1997, applicants for obstetrics and gynecology residencies were lined up around the block. Since then, the number of applicants has gone into free fall. Only 743 graduating medical students in the United States applied for 1,142 residency slots in 2004. More than a third of the slots went to foreign medical graduates or remained empty.

...During my residency interview at Columbia, Dr. Richard Berkowitz, a prominent high-risk obstetrician, assessed the extent of the crisis. "I've been through the best of times and the worst of times," he said. "This is the worst of times."

...Crisscrossing the country and interviewing at different programs, I asked residents, professors and department heads why the specialty had fallen on such hard times. "Lifestyle" was the predominant response.

More than any time in the past, medical students want careers with predictable schedules.

They want to go to their children's soccer games, read for pleasure and not be called in to the hospital at night.

Specialties like dermatology, radiology and anesthesiology offer flexibility. Obstetrics and gynecology does not, and students are turning away from the most demanding specialties in unprecedented numbers.

Obstetrics is consuming and unpredictable. The hours are long and caring for sick patients can blot out all other priorities. The stakes are high: very often you are caring for two patients and not one, and bad outcomes can be catastrophic for a family.

When you do go home, you worry, sleep uneasily and wake up early the next morning. Yet the payoff is always there: you help patients and bring life into the world...

Dr. Friedman is clearly thrilled with his work, but he has also had moments of doubt. When he rotated through a high-risk service, he had no time for relationships, and was not able to visit his own sick grandmother. Yet he says he's prepared to make personal sacrifices. He is completely committed to his profession.

There have always been doctors like him. But if workaholism is a job requirement, and the sacrifices are so extraordinary, then how on earth can we expect to have any obstetricians? I hope we hear more from him, and from the OB-Gyne medbloggers (paging Red State Moron and Well Timed Period!).