Specialty Spotlight Podcast, Episode 11: Obstetrics and Gynecology

Introduction to the Podcast and Episode Overview

[00:00] Welcome to the WMed Specialty Spotlight podcast, your virtual guide for exploring medical specialties and planning a career in medicine. In each episode, we interview practicing physicians to learn about their specialty, the decision-making

[00:20] process that led them to determine that the specialty was right for them and then for advice about long-term career planning regardless of the field they went into. I'm your host, Dr. Brent Shaw, Assistant Dean for Career Development at W Med, here to guide you through the broad array of medical specialties. Before introducing

[00:40] today's guest. A quick reminder, you can find the show notes for this episode and all previous ones on our website at wmed.edu forward slash specialty spotlight. If you're interested in supporting the podcast through sponsorship or if you're a physician willing to discuss your specialty in an

Guest Introduction: Dr. Kevin Ault’s Background

[01:00] interview, please email me at brendotshaw at wmed.edu. The specialty of today's show is obstetrics and gynecology, aka OB-GYN. And the physician here to tell us all about it is Dr. Kevin Ault. Dr. Kevin Ault is

[01:20] a board certified obstetrician gynecologist. He is a professor in the division of obstetrics and gynecology at Western Michigan University Homer Shreicher M.D. School of Medicine. He served as department chair of the department of obstetrics and gynecology at W.

[01:40] Med from 2022 to 2024. He is a graduate of Butler University and Indiana University School of Medicine, both in Indianapolis, Indiana. He completed his residency in obstetrics and catecholology at Ohio State University Wexner Medical Center and

[02:00] Columbus of Ohio. He's a fellow of the American College of Obstetrician and Gynecologist and a fellow of the Infectious Disease Society of America. His clinical and research interests include women's health and infectious diseases. So without further ado, Dr.

[02:20] having all Welcome to the show. It's great to have you here. So you heard me read your bio. Is there anything that you'd like to add and then maybe you can take us back in time before medical school and walk us through your decision to go to medical school in the first place.

[02:40] Well, I don't think there's anything I want to add. I mean, I think my journey is probably typical of a lot of other people that get into medicine, at least unique to my background. I'm a first generation college graduate.

Journey into Medicine and Choosing OB-GYN

[03:00] You know, I grew up in a small town. When you grow up in a small town, you know, everybody takes an interest in your wellbeing and people certainly promoted my interest in science from a pretty early age. So that certainly led me towards a career in medicine. I had considered when I was an undergrad whether to

[03:20] do just stuff in the laboratory, but I was much more interested in the human aspects of life, of medicine and of science. And so I ended up getting a medical degree. I think it's a good time to transition to the first part of our interview where I basically ask you to tell us everything

[03:40] about obstetrics and gynecology. And the way I like to start off this interview is by reading you a description of your field from the Careers in Medicine website, which is hosted by the Association of American Medical Colleges. And then I'll ask you what you think and we'll take it from there. So here it goes.

[04:00] Obstetrics and Gynecology. An obstetrician-gynaecologist focuses on the health of women before, during, and after childbearing years, diagnosing and treating conditions of the reproductive system and associated

[04:20] Disorders that's all they had how much of that do you agree with and what would you add or ensure that anyone listening was well informed of the practice of obstetrics and gynecology. I mean I think that's accurate but it's certainly bare bones you know the field has been very dynamic.

[04:40] especially in the very recent past. You know, 30 or 40 years ago, there were beginning to be advanced training in infertility and in cancer and in high risk obstetrics. And that was kind of static for a long time. And people that had done that who didn't do fellowship

[05:00] were grandfathered in and then there began to be more and more fellowship training. And then just in the past maybe 10 years, there's kind of been an outburst of more specialized training. So you have pediatric and adolescent gynecology, you have family planning, you have minimally invasive surgery, you have neurogynecology.

[05:20] And all those things have kind of been added. We're part of the specialty originally that have been added is advanced training beyond what you get in your four years of residency. You certainly get a flavor of all those things by your resident. You can certainly practice some of those things when you're done.

[05:40] I think there's even further subdivisions. If you look at the way people practice now, there might be somebody who we would call a hospitalist, I think, who just spends all their clinical time on labor and delivery, delivering babies, triaging patients, and that type of thing.

Understanding Obstetrics and Gynecology as a Specialty

[06:00] And then there are probably a large number of people that also just spend time in the office, just do outpatient surgery and outpatient gynecology. So it's a very diverse field. I didn't even get into the kind of stuff that I do. There are certainly more and more OB-GYNs that have a public health angle, and I think that's

[06:20] kind of been the past 10 or 20 years of my career talking about big picture type of things. The COVID pandemic has been an example of that because it's unique problems that present to some pregnancies. So I think the problem that I would have with that three or four sentence definition is it doesn't capture

[06:40] dynamic nature of our specialty and I think it's going to continue to be that way for the foreseeable future if you're a medical student listening in right now. I think that change is going to be part of the equation. You touched upon one of the things I wanted to ask you about and that is fellowships. Is it quite common that after

[07:00] residency of an Ob-Gyn residency that graduates further on and go on to do a fellowship or is that not so common? At the time I think the statistics are about 20% right now go on to do fellowship. So that obviously

[07:20] 80% of people practicing OB-GYN the way you might think it has been practiced in the past with the possible exception of, you know, in hospital duties 100% of the time or off of eschatology. So I think the thing that has happened in all of medicine, including my

[07:40] specialty is people are aggregating in large groups now. And so, you know, the old office in the suburbs with six or eight practitioners is for better or for worse is becoming a thing of the past. So people tend to be congregated in multi-specialty, multi-provider

[08:00] groups now and that has a lot of lifestyle advantages and economies of scale. So I don't think we're going to go back anytime soon. So and most young physicians who finish their residency get hired into those situations. I know you wear many hands and but I'm

[08:20] Can I ask you from an angle if you could provide for a general OB-GYN physician what a typical daily, weekly routine, maybe a typical patient or patients that you typically see in a typical outcome for these patients?

[08:40] patients and what that would look like. And you can kind of take it either whether daily or weekly, whatever fits best for you. Well, I mean, I think weekly is probably the best way to look at it because most people that I know and practice in Kalamazoo and Western Michigan and everywhere else

[09:00] kind of follow a modestly set pattern. Usually you're in the office one or two days a week. Your office hours would probably be a mix of prenatal care, preventative care, what we would call a well women check, as well as

[09:20] problem visits. So that's pretty set and typically a busy OB-GYN might see 15 or 20 patients kind of depending on the acuity of the patient in a day. Then you would probably have a day that you were assigned labor and delivery and that is feasible.

[09:40] family and the medical students that are listening in who have done their OB rotations can tell you that some days not much happens and some days we don't sit down at all. So you would probably do a day of that and or a day of surgery depending on the nature of your practice. I think one of the things that's happened in my

Typical Daily and Weekly Routine of an OB-GYN

[10:00] specialty for the better is that we really don't expect people to work the next day. You have the day off if you've got a night shift. And so that's, I think that's pretty standard. I think the kind of alluding to what I said to you before, the weekends are usually covered as far as

[10:20] labor and delivery duty by a larger group. So that's one of the advantages of Economy of Scale. They're hospitalists or your partners. They're having those responsibilities so that being on call two or three weekends a month and or several holidays in a year is kind of going away. So.

[10:40] Great. What would you say is the most exciting about your specialty as well as conversely, what would be, do you consider most mundane? I mean, I really enjoy what I do. So I'm not sure if there's anything that's really mundane per se.

[11:00] You mentioned my interest in infectious diseases. I think the thing that you have to think about and comes up pretty frequently in women's health is I saw this on the internet. I saw that the vaccine you're recommending causes infertility and that's a new phenomenon.

[11:20] I think physicians have to deal with that. So I don't know if that's mundane or just something that is the function of social media in the day and age in which we live. So as far as what's most exciting, I think most OBGYNs would say that

[11:40] You know, you get to take care of a patient longitudinally and you kind of start it out with the definition from the AAMC. You know, you probably see a patient through a couple of pregnancies and maybe talk to them about contraception, you know, before they conceive a pregnancy and between pregnancies and then, you know,

[12:00] they have abnormal uterine bleeding later in life, you might take care of that too. So you get a longitudinal relationship with your patient's unique TAR specialty. Yeah. Now that's a very, very, very nice aspect about OB-GYN that longitudinal relationship has

[12:20] As far as the labor and delivery floor, one of the things that it's kind of interesting to see is that midwives seem to function almost autonomously, and then there's physicians.

[12:40] This can often be quite surprising to students. And can you speak about that in terms of the relationship between the physician and the midwives and how that interaction works? I mean, everywhere I've practiced in the recent past has had midwives. So I mean, I think I have a pretty good answer to that.

[13:00] to that. I think if you look at the data or in hospital birth, you start out by saying as a professor, so we'll go back to the data. For an uncomplicated pregnancy, the outcomes are equivalent as far as neonatal outcomes or vaginal delivery rates or that type of thing. So it's hard

[13:20] make a case that physician care is superior to midwifery because by and large things go well. I think in obstetrics, I think the other thing that's happened was the book maybe 15 or 20 years ago, The Checklist Manifesto. So we tend to have

[13:40] a very regimented, and I don't mean that in the negative sense of the word, but a very regimented way of giving oxytocin or handling a postpartum emirate or those type of things. So bundles and that type of thing are good and certainly help with our maternal

[14:00] morbidity and mortality we have in our country. And moodwives and physicians are certainly both capable of following those protocols. I think the difference is going to be the people who have hypertension and diabetes and multiple gestation and some other complicated

[14:20] patients of pregnancy that make them higher risk are going to need care from an OB-GYN or high risk obstetrician. Not that the midwives are still involved, but you know, consultation and collaboration and collegiality are all the keys to that. There's certainly that somewhat similar phenomena

[14:40] going on in the office. Most offices, I mentioned office gynecology, employ physicians assistants and nurse practitioners and midwives to do office work. So I think that kind of multidisciplinary approach is here to stay and I've certainly enjoyed it everywhere I've been. Great. Thank you.

[15:00] for that. Well, what is one thing that you would have wished you would have known before entering Obie Kine? And what would you encourage a medical student to think about in earnest before committing to go into Obie Kine? You know, somebody asked me this question

[15:20] during medical student orientation a couple of months ago. And I think what I said is still accurate, although it sounds like a real downer. So, but I'll tell you why it's downer and not tell you why it's gotten better. So I think what I was not prepared for when I was a young physician

[15:40] was the amount of social injustice and social inequities in care and women's health. And of course, I was an OB-GYN before the Affordable Care Act, so we were telling women who had insurance, you cannot get birth control.

Challenges and Rewards in the Field of OB-GYN

[16:00] can I have an abscessor, can I have a mammogram? Things that younger physicians find appalling. We found it appalling back then. It just took some political unce to push that through. I think as you get to have some experience in the field, you begin to realize that things like

[16:20] domestic violence and childhood sexual abuse and things like that show up later in life in various ways and can make caring for chronic gynecological problems much more difficult. Pelvic pain is the classic example of that, chronic pelvic

[16:40] pain. I think the reason it's gotten better is that the attitude of medical students currently and you know going back the past few years has been to be much more aware of that and to do work in that area. We you know when we interview people for residency we we

[17:00] almost always see something that involves community work, working at the homeless shelter or with women who've been victims of domestic abuse and lots of other examples. I think when I was a medical student, probably up until pretty recently, you know, you would spend those hours, you know, doing

[17:20] research project to buff up your CV and I think current medical students are much more socially aware than prior generations and all for the better for women's health. Well thank you for that. You touched upon this earlier a little bit, but how

[17:40] does the practice of OB-GYN change based on setting in terms of inpatient versus outpatient academic versus private practice, urban versus rural, civilian versus military and maybe international as well?

[18:00] Well military is one setting I've never worked in so that's going to be a hard one to answer. There are a fair number of very good residencies in OB-GYN. They're associated with military bases and so if you're a medical student with a military obligation,

[18:20] Certainly, obstetrics and gynecology is still an option for you. I think it's hard to know when you're a medical student whether you're interested in an academic setting or not. And, you know, it all comes down to whether you enjoy teaching and lecturing and general clubs and diaspora.

[18:40] actic lectures and those kind of things that many medical students of course are familiar with but get to do in a much more detailed setting when they get into their specialty, into obstetrics and gynecology. Simulation is a big part of our specialty. So if you look

[19:00] like those kind of things and you like being around young people, then certainly academics might be for you. I think the other thing that I've appreciated and still appreciate is somebody will say, you know, there's a paper that says we should always do it this

[19:20] And I think, gosh, I've never seen that paper. And then I go and I realize, I read that paper last year. Yes, I knew this. So it's fun to be challenged, I think, in that way. And since everybody has a cell phone at their ready, being challenged is probably

[19:40] probably even more readily available for learners. And so there's an art to that. And I frequently ask our learners, where would you look that up? And AI makes it even more interesting. So as far as private practice, I think

[20:00] There's a lot of flavors to private practice. As I said, most people are hired by big groups and hospitals across the country. And I think that's a good trend. That's my opinion. Not everybody would think that, but I don't think my opinion is going to change the trend.

[20:20] way or another. So we encourage our residents as they're finishing to look at their contract, to make several visits, to ask pointed questions. Right now is the interview season for jobs in 2025. So they're thinking about this quite a bit. And so you want to see what the best

[20:40] Fed is for you for both residency selection as well as your first job at a residency. There is a shortage of OB-GYN trained physicians right now and it's supposed to get worse over the next five years so it's a little bit of a little bit of a seller's market. If you have that training you can probably

[21:00] go a lot of places in the United States and be gamefully employed. What do you think is the biggest challenge facing OB-GYN? Where do you predict OB-GYN to be maybe 10 or 20 years from now? Well, again, thinking back to this session,

[21:20] had with the students as they were starting their clerkships, somebody asked me a very similar question. I said, well, our specialty gets argued in front of the Supreme Court on a regular basis. So that's no fun to know whether you're going to be able to prescribe this medication this week or that medication next week. And politics has

[21:40] has gotten into OB-GYN and to some extent medical students are voting with their feet and avoiding states where politics is heavily involved in women's health. And so I feel bad for some of those states because I have lived in those states in my career. So I think that's probably

The Role of Subspecialties and Fellowships in OB-GYN

[22:00] going to be a problem. It's been a problem for my whole career. I don't think it's going away. So I think that'll still be here five or 10 years or 20 years from now. I think as far as a specialty, it's probably a lot of other things we've talked about already. I think we're going to see more subspecialization.

[22:20] And that, you know, for people who just want to work in the office or just want to work in the hospital or just want to see pediatric and adolescent patients. The downside of that, however, and I think this is recognized, is we lose a lot of rural health. I lived in rural areas.

[22:40] Iowa at one point worked at the University of Iowa and I was a very rural state and there are certainly a majority of counties in Iowa and Indiana you know where there's no OB-GYN, no labor and delivery you know and an hour or two drive is the norm to get women's health care. So

[23:00] So we need to work with nurse practitioners and family medicine people and up the care of those women. I don't think that's an easy answer. It's something that we talk about in western Michigan and talk about in our national meetings both. So I think we're just going

[23:20] have to keep after that is really the cure for that particular problem. So I think those are kind of the big short term and maybe longer term trends too. Well thanks. Thank you for that. My next question is something that I get asked about and you know you certainly

[23:40] are a male physician and OB-GYN, but is it still okay to be a guy and be an OB-GYN or are there challenges? It's been stable as far as the mix for maybe a decade. So it's about

[24:00] 75% female, about 25% male. So yeah, it's still okay to be male interested in OB-GYN. So it doesn't come up as much as you might think because if you're there,

[24:20] having a baby, you want the best outcome for your pregnancy and delivery. And if there's a male on call that night, then that's who's going to be helping you with that experience. And so it seems like it's less of a hot topic in the recent past, as I said, probably because it's been

[24:40] stable for such a long time. The year that I was finishing my residency was about 50-50. So, you know, over the past couple of decades it's shifted a fair amount. But since it's been stable, I'm not sure it's going to shift anymore. The other thing that our specialty has that

[25:00] I like to brag about or talk about is we have a fair amount of diversity in the ranks. As far as medical students and residents that choose our specialty, we have pretty diverse groups of men and women that want to be in our specialty and that works to our

[25:20] advantage as far as patient outcomes. How much more often do OB-GYNs get sued as compared to physicians of other specialties? Well, certainly that comes with the territory. I think the average OB-GYN has three lawsuits in their years of practice.

[25:40] Many states, of course, have CAHPS, which discourage frivolous lawsuits. So that's been a hot topic for OB-GYNs for a very long time. That's probably one of the barriers

[26:00] to rural care as well that people making the business decision on whether or not to keep their labor and delivery open or not probably depends a lot on how much they have to pay malpractice insurance to keep it open. So again, that's kind of an ongoing topic.

[26:20] nationally it's not going away. But I think in the recent past it's gotten a little better because a lot of states have caps. So basically the reputation of Obie Gein's getting sued is legitimate one. But would you say more so than any other specialty or?

[26:40] I mean, I think there are some specialties, neurosurgery, orthopedic surgery, OB-GYN that certainly attract lawsuits. I'm not sure that if you look at the number of lawsuits, the outcomes of lawsuits, that it's going to be much different than those other specialties.

[27:00] If you could go back, would you do OB-GYN again? Yeah, I think I would do OB-GYN again. I mean, I think a lot of the things that were going on when I was making a career decision and some sense are still going on, prenatal diagnosis.

[27:20] was relatively new as far as ultrasound goes when I was young and now we have genetic testing that's more, much more advanced with self-read. DNA, we can actually look at fetal genetics in detail from maternal blood samples. So that's something that

[27:40] people find attractive is the evolution of that. We were just beginning to get medical treatments for common conditions like abnormal uterine bleeding and uterine fibroids and those have expanded. So not everybody needs a hysterectomy anymore. We have more options along that lines. My own interest

Long-Term Career Outlook and Future of OB-GYN

[28:00] has been in infectious diseases and now we have very sophisticated ways to look at the microbiome and I've participated in some of that research and there's certainly microbiologic clues on why women have preterm birth which is one of the things in our

[28:20] specialty that we worry the most about and spend the most time about along with our colleagues in pediatrics and neonatal medicine. So maybe someday we'll have a treatment for disturbed microbes and communities in the vagina. I would hope it's sooner rather than later, but that's

[28:40] certainly something that attracted me and what's going on when I was a young physician, all those things where they continue to evolve. Great. Thank you. And I think this really nicely ties to the next part, which is kind of really telling our listeners everything about how you

[29:00] decided that the specialty was right for you. And so I would ask of you as if you could tell your story as to how you decided that Obie Gein was that right specialty. Any struggles that you may have had during that journey in terms of trying to discuss

[29:20] cover this specialty was right for you? Well, I always find it interesting that I found my personal statement from when I was a medical student when I was moving recently and read it. And then, you know, a few months later, we were interviewing people

[29:40] to come to our residency and their personal statements. It's amazing how similar what people are writing today is to what I wrote back then. Of course, I'm very biased looking back at my own experience. But I think people that go into OB-GYN are interested in a variety of things.

[30:00] There aren't that many specialties where you get to do advanced robotic surgery and do primary care, preventative health type of things in the same week since you asked me or scheduled by week. And so that has a lot of appeal to people and I think I see that

[30:20] When I talk to the medical students about their experience on the clerkship, a fair number of them say, we were doing something different every week and I never got a chance to get settled into a routine and labor and delivery is always a mess. And then the next student will say, I loved it because labor and delivery was always a mess and there's always something different.

[30:40] going on. And so I think that's the kind of people that are attracted to OB2N or the people that like variety and like change and like excitement. So maybe some overlap with specialties like emergency medicine in that regard. So as I kind of said, there aren't a lot

[31:00] lot of specialties where you get to do surgery and non-surgery things at the same time. So I think that, you know, I think my own journey is kind of reflected in that. Maybe something that is a little different about what I've done more recently, and I don't know that this was really planned, but, you

[31:20] the public health aspects of what we do. You know, I've been involved in some guidelines for pap smears and vaccination and that type of thing. And you know, you think about those big picture kind of things when you're seeing patients, but you don't always get to apply them at a higher level. And I think

[31:40] Our specialty, the American College of Obstetricians and Gynecologists has gotten more and more involved in those kind of aspects instead of worrying about malpractice carrier rates and those kind of things. More tools to the trade type of thing that we might have talked about in our

[32:00] meetings 20 years ago, I think there's a lot more public health and a lot more social justice themes. Not that, you know, the best way to do a hysterectomy is in a passé subject or is it going away as far as a topic for specialty, but I think it's a much broader specialty in that regard now than maybe it was a

[32:20] decades ago. Was there any other specialty you were considering other than Obie Gein or are you pretty much you had your mindset on Obie Gein? Well, I mean, I've given Grand Rounds at Indiana University a couple of times over the years and my clerkship director

[32:40] My mentor back then was Dr. Muncic. He was a little bit of a character. He would ride a motorcycle to work every day regardless of the weather. And he unfortunately died relatively young, so I didn't get to continue my relationship with him. And so I kind of

[33:00] regret that. So whenever I go back to Indiana, I usually tell the story of a night that I was on call with him that kind of cemented my interest in OB-GYN. There was a patient who was having a very difficult labor and there were lots of people running lots of different directions and he came into the delivery room and kind of opened the door

[33:20] kind of like John Wayne might, you know, in an old movie. And he didn't talk to the residents, he didn't talk to the staff, you know, even though things were going horribly awry. He just went to the woman who was having a difficult labor and of course was legitimately concerned about the outcome and said, I just want you to know

[33:40] that everything is going to be okay. And so I thought that if you have the skill set to fix the problem, and this was an appealing specialty to me, and he did fix the problem after he talked to the patient and he started talking to the residents and the staff and got everybody on the same page and the

[34:00] outcome was good. And so I think one of the real appeals to OB-GYN is that you usually have a toolkit to fix the problem. And the toolkits are getting better, I think, too. So I think if you're somebody that getting a better outcome is really important to

[34:20] That's one of the appeals of this specialty. And that was one of my first rotations in medical school. So I always went back to that experience and said, okay, is this next rotation going to offer me the same feeling that that did and nothing did? And so that became pretty...

[34:40] pretty easy to make that determination. And fortunately, I said this in my introductory interview when I was a new chair and faculty here, I was very fortunate to have some very forward-thinking mentors back then who'd be perfectly comfortable in the current environment.

Advice for Medical Students on Choosing and Matching into OB-GYN

[35:00] many of them are gone as far as advocating for women on a state and national level. Even though since we're doing this by audio, you can't see the poster behind me. I have a Marine recruiting poster from World War II. And one of my real mentors, Dr. Zespin from Ohio State, was a Marine during World War II.

[35:20] When you wouldn't think of a Marine who'd seen combat in the Pacific would be somebody that would be empathetic to women, but he certainly was. And what a great role model for people. And there's plenty of that still in modern times, but that was the big influence on me when I was a medical student at a restaurant.

[35:40] Great, thank you for that. And I think, you know, mentorship is really important and really shapes the minds of students. So this is a question that I say is the third year question. If you are a third year medical student undecided on the special

[36:00] specialty with limited time remaining before residency applications were to be submitted. What do you think would be the fastest high yield route to make the decision about the specialty? One of the things that we do here that I

[36:20] What I really like is, and I did this too when I was a medical student so I don't know that it's changed a lot, is spend some time on labor and delivery because you get to see lots of different disciplines interacting with each other, anesthesia, midwifery, physicians, nurses.

[36:40] to see lots of emergencies and decide if you want to live that lifestyle. You also get plenty of downtime if it's a slow day. So you can listen to people kind of make off the cuff remarks about the specialty, especially if they know you're a third or fourth care medical student considering OB-GYN.

[37:00] So I think that's usually low-hanging fruit. So every once in a while, a medical student will say, well, it's not busy enough here. I really want to be someplace that's busy. And there are certainly places you can do away rotations that might not have the same flavor because you might not know people there and you'd only be there a limited time.

[37:20] But still, I think that's probably a good way to judge whether or not you're going to like this specialty. Right. Are we electives necessary for OB-GYN? I don't know that they're necessary.

[37:40] I think that some of that has probably changed now that we've gone to virtual interviewing because this generation, the pandemic generation of the last four or five years is a lot better at picking up those nonverbal clues and the gist of the residency.

[38:00] by teams and Zoom meetings. And so, plus there's so much more information out there on the internet about residencies. So I don't know that they're necessary. I think it's kind of fun to get away though. It's probably, you know, the, is the best thing. I went really far away when I was a

[38:20] president to King's College in London. And so that's probably further away than most people want to go. Although some people do international electives in our student body, you know, it was just fun to see how people did it differently. The same problems with a different approach. And you don't have to go 4,000 miles on

[38:40] Obviously, you can just go to Chicago or Detroit or Indianapolis or someplace regionally. So yeah, I mean, I think it's good to get out of your comfort zone is one of the reasons to do, in a way, electives. And how important is research or scholarly productivity

[39:00] for matching into OB-DIN. I think it's very important, OB-GYN, as a competitive field. I think the thing that I worry about is not every medical student has an equal opportunity to participate in those type of things. They're very dependent just on

[39:20] the environment they're in and the time constraints that they have. So we have so many new residencies and so many new medical schools in the United States. There's kind of been an outburst of both things, OB-GYN residencies and new medical schools. So I try to be mindful

[39:40] about that when we're doing resident interviews as somebody's from medical school that doesn't really have an OB-GYN department or has a very small OB-GYN department, I try to gauge their interest. I think the main thing that you get out of research when you're

[40:00] training, whether you're a medical student or a resident is just learning something about the process. You know, I think the process is important. So when we do journal clubs, the residents and with the medical students, I usually say think about how

[40:20] when somebody thought of this idea, how they had to implement it. I was thinking about a case control study actually yesterday about respiratory syncytial virus and newborns. And I'm like, do we have the data for this? What IRB training do I have to do? Who can help me pull the data? The process is the same.

[40:40] same whether from time immemorial going back decades. So I think the process and the process of making your own dataset and analyzing it makes you appreciate datasets

[41:00] and things that come into your practice now. And so you're able to more critically analyze literature in your field as well as clinical guidelines. So I think that that's a real advantage. That skill may be

[41:20] has become more important because of predatory journals. You know, you can get a lot of stuff published that's not great quality now. And so if anything, that skills become more important in the last five or 10 years. Great. Is there anything else a student can or should do to be a competitor?

[41:40] competitive applicant? Well, I think I mentioned some of those things before and almost everybody does this. Some opportunity for advocacy or social justice or volunteer work in your community looks good on a CV.

[42:00] and also gives you something to talk about during an interview. It's pretty easy to figure out who just did it for a slot on their CV versus somebody who's really passionate about advocacy. You can see their face light up even on Zoom and Teams. You can see their face

[42:20] light up and hear their tone of voice and the way they talk about the work they did as opposed to just saying, oh yeah, I was part of the research team and I met one afternoon with them and they put my name on the abstract. That's probably not a good approach to

[42:40] research or to other things that make you competitive, you know, do something that you really have a passion for in the social justice area, I think would be my advice. And almost everybody does that. I don't think I've cornered the market on that platform. Great. Is there any resources

[43:00] that you would recommend to a student to kind of learn more about the specialty? I think one of the things that I tell students frequently is to go to a national OB-GYN or regional OB-GYN meeting. And again, that's something that's challenging.

[43:20] changed in the relatively recent past five to 10 years, and so I said at our national meeting, which a couple of our WVN medical students went to last year, they had a whole day on a Saturday independent of the rest of the meeting that was just focused on them, that was simulation and talking

[43:40] about a lot of the things that we talk about and of course the American College of OB-GYN has an entire arm for education and we're tinkering with the match process right now. So you know I think there's and it's usually free it's certainly not free to attend a conference in San Francisco or Chicago or that type of thing.

[44:00] But we usually don't charge people registration fees when they're at the beginning of their career. So I think that's good. Plus, kind of similar to what we said about away rotations, it lets you listen to somebody you've never met before. So kind of get an outside fact check on what you may have been told at your own.

[44:20] home institution. Generally for OBGYNs, the regional meetings are in the fall, our regional meetings at the end of September, and then the national meeting is usually April or May. So it may be a little late to get to the regional meeting, not impossible, but a little bit late. But

[44:40] We call those districts in OB-GYN for the district meeting in the fall, but it's certainly, there's an abstract deadline on the horizon for the national meeting. So it's a great place to present your research too if you have something that's OB-GYN oriented. It's usually a very friendly

Final Thoughts, Career Advice, and Recommended Resources

[45:00] situation. I know that when I went to our regional meeting last year, there were multiple people from Indiana and Ohio State. I did, as you mentioned in the introduction, I went to medical school at Indiana and did my residency at Ohio State. They're both in my ACOG district. So, you know, I got to talk about things that were

[45:20] really germane to their to their poster and I think that helps the candidates relax and enjoy the meeting a little bit more. Great and and we'll make sure to put in our share notes for our listeners the Amerian College of Obstetrics and Gynecology in their website. It's also

[45:40] also free to be a member. I probably should have said that right. Then you get access to everything that's on the website. That's not the part of the website I usually look at, but that would be a great resource to put in the notes. Great. And we'll do that. I want to move on to our last part, and that is give

[46:00] advice for long-term career planning irrespective of choice of specialty. And if you could go back and do it all again, what would you do differently and what would you do the same and why? I mean, I think a lot of things I would probably

[46:20] do the same. I think something that you gain with experience is like, is this going to be the next big new thing? Like when the HPV vaccine came along, I had been out of residency for about 10 years then. And

[46:40] And I think I realized if this works, it's going to be the next big thing because of cervical cancer is the fourth most common cancer on our planet for women. And there are certainly countries, including many countries that have immigration.

[47:00] that are in our country from our own hemisphere that cervical cancer is very common in Central America and South America. So, you know, I knew that was going to be a big thing and now I've been after it long enough, I've seen it become a big thing. Sometimes things that you think are going to be a big thing don't turn out

[47:20] that way and so there's a certain amount of judgment that you have to develop. I'm not sure I can think of one off the top of my head. Sometimes things kick around for years before they before they take off. So you know I think there's some experience that you have to develop to decide what

[47:40] next big thing is before you dive into it. I guess I can think of one thing that evolved. We used to use laser to burn off the lining of the uterus as a treatment for abnormal urine bleeding, and we still do that to some extent. We just use different technologies.

[48:00] But if you would have said, I'm going to change my practice to where I do this exclusively all the time and spend tens of thousands of dollars or maybe more on the iridium laser, you probably would have made a bad choice because there's cheaper, less

[48:20] technologically challenging ways to do that now. So I mean I think that's one of the challenges in our specialty and to be honest is probably in a lot of specialties that do surgery and imaging for your specialty. So I think that comes along with just experience. So I'm not sure I would

[48:40] do anything different. I mean, I think one of the things that's nice about the variety in OB-GYN is if you want to do something different, you know, at one point I was doing a lot of lectures in our School of Public Health, you know, that's open to you. You know, there's enough variety in our specialty that

[49:00] if you want to go talk to the MPH students about cervical cancer screening, you certainly know more than they do and you're probably much more of an expert than you realize on that topic. And so I'm going to the University of Texas Southwestern to give a cervical cancer screening, talk to their

[49:20] MPH students here in a couple of months. So, you know, I think that's kind of fun and you have opportunities to do that in academic practice as well as private practice as far as kind of getting out of your box and changing your routine a little bit. Great. What is a career mistake that you've seen

[49:40] other physicians make. And what is something that you've seen a physician do well that has made you want to emulate it? I think that, you know, it's not unusual for people to change jobs fairly early in their career. And I'm not sure that

[50:00] makes it a mistake. That's just something that happens. You know, I think the data are about one third of people change jobs in the first five years, how their residency, that's probably a function of it being your first job as well as, you know, the age of the people in their late 20s and early 30s.

[50:20] that go into those jobs. So I'm not sure I would call that a mistake, but there's a fair amount of turnover in our field. So as far as emulating things, I kind of alluded to this before. I mean, I mentioned Dr. Zesplanov.

[50:40] doctor. Muncie also worked with Dr. Klein at one point who was the first email president of ACOG back when I was a medical student and then kept with still practicing in her 70s in Atlanta by the time I was there. I think people that get a good idea stick

[51:00] with it. And her thing was adequate prenatal care in urban Atlanta. And so she kept after that and all the various nuances and changes and midwifery and other things to keep that going.

[51:20] for decades. You know, and I think people that have a good idea and stick to it are the people you want to emulate and observe and learn something from. What is one thing that you're struggling with or lamenting about your career today? What are you doing to remedy it? And what would you encourage a medical

[51:40] student to do right now to help avoid this problem entirely later. I think one of the things that people are going to OB-GYN struggle with, myself included, is downtime. You know, to really say I am going to walk away from

[52:00] you know this call shift and go home and have a nice breakfast and put my feet up since I'm off today. There's always something more to do you know and so that you know it's hard to it's hard to turn off and when you are when you're somebody that likes to

[52:20] anxiety and excitement and that kind of thing. I think that that's a hard thing because that's the kind of people we attract into the field. I have somewhat, as per one of our wellness programs, somebody asked me a somewhat similar question and I think one of the keys for me at least

[52:40] is to plan what to do in your downtime. One of the things I like to do, and Dr. Broke, if I can drag her into this interview in our department, likes to go to plays and musicals. And we actually celebrated her birthday recently by going to see Oklahoma at the Barn Theatre.

[53:00] Oklahoma has been around since long before I was born, ended up long before Dr. Roque was born, but it was fun. And the people at the Barn Theater, of course, are usually college age. So it's kind of fun to see young people doing that. And so I'm never going to,

[53:20] stand up in front of people when you have a Shakespearean silhouette, please. So maybe I appreciate that more since I see people doing that well. And so to kind of develop a hobby or something on the side that's relatively structured that you can do. Fortunately, when you live in a

[53:40] area like western Michigan, there's a lot of variety of those things going on all the time. And so, you know, so I think that getting something you'd like to do that's not work related is key to sanity in my particular specialty. Great, thank you for that.

[54:00] You know, I like to end the interview by asking what is one book, medical or non-medical, that you think every person pursuing a career in medicine should read? So, I, you know, slowly I've been getting rid of my medical books and so I'm looking at my bookshelf,

[54:20] with books that are non-medical because those are the ones that are taking the places of the textbook. There's a book by Cream of Dual to Barr and one of our interns is from Martinsville, Indiana and one of our interns is a UCL or one of our residence, upper level residence.

[54:40] He's a UCLA grad. And so I think about that book pretty frequently because Karima Biljbar is probably in his 70s now and has written a lot of wonderful books. But he wrote a book about his coach, John Wooden. And John Wooden was probably in his 60s and lived for a long time.

[55:00] lived to be almost 100 when Jabbar was a freshman and, you know, Karima Joel Jabbar was a kid from New York City, you know, an only child and grew up in as different circumstances as possible as John Wooden grew up in Martinsville, Indiana. And so, you know, they, that

[55:20] book is about how they came to find commonality with the coach being the mentor and Kareem being the student and how that relationship changed over the course of five decades. And so it's really a great

[55:40] great read. And if I could do anything in life, it would probably be more like, you know, be more like a coach like John Woodner be more clear in my writing like Kareem because that was the first book I ever read by Kareem Abdul-Jabbar and I've gone back and read several of his books and he's a wonderful writer and now I understand why Barack Obama gave him

[56:00] the Presidential Medal of Freedom when he said it's not just about basketball because he is a wonderful communicator. So that would be the one book that I would probably recommend. And what's the, and certainly I want you to do the second book, but what's the title of that book? Do you happen to know? And we'll make sure we put that in the show.

[56:20] I don't know. The type is so small I can't read it from across the room, but in the title it's My 50-Year Friendship with John Wooden is part of the title. So the other book that I think about, and we actually talked about this

[56:40] couple of June's ago is the book in the band Played On because that was happening, you know, when I was a medical student and a resident. It's about HIV in America and it's a very depressing

[57:00] book about all the pitfalls of public health in the 80s and 90s and how we didn't confront HIV. And so that's a book that I've given to young doctors who are removed from that. Of course, we can treat HIV and have some wonderful antiviral drugs for that. But given young

[57:20] doctors is everything that's bad about medicine as far as prejudice and politics and fumbling public health responses and that type of thing. And there are a couple of books from that era that are along that lines. But that's my favorite book of that.

[57:40] Arab mainly because I can remember a lot of the events in real time that show up in the book as well. Great. We'll definitely add that in the show notes. Dr. Alt, is there anything else that you'd like to add that we didn't talk about? I don't think so.

[58:00] So I think that I very seldom hear people, you asked me this a couple of different ways, but as I think back again to downtime on labor and delivery when I'm sitting in the physician's lounge, there are certainly people that have been practicing in my area for 30 years and I very seldom hear anybody say, I

[58:20] wish I had not done OB-GYN. Everybody says I'm glad I'm still doing what I was trained to do and I still enjoy it. So I mean, I think we're pretty frank about a lot of the downsides, but I'm curious to hear people say, you know, this wasn't for me in retrospect. So I think that's very encouraging for people.

[58:40] want to go and to over-joy it. Certainly. Well, thank you for that. Well, for everyone listening, we'll wrap up the show with that. Well, I hope you enjoyed the conversation with Dr. Ault for the resources and other tidbits that were mentioned in this episode.

[59:00] can find them in the show notes on the WMED website, wmed.edu forward slash specialty spotlight. If you like what you heard, please share this episode with your fellow medical students, especially if they're having some queer anxiety. It is truly my hope that these conversations with physicians who've been there

[59:20] and that will help you move forward with your own career choices. For any questions or if you'd like to reach out to me for any reason which I encourage you to do, you can do so by emailing me at Bren.Shaw at Wmed.edu. But until next time, take care.

[59:40] you