Eighty-four percent (105 of 125) of all departments had part-time faculty, with an average of 21.2% of total faculty in those departments having part-time positions. Two-thirds (67.2%) of those departments had 1 to 6 part-time faculty, with only six departments having more than 15 part-time faculty. The size of the department was not predictive of the number of part-time positions. There was a higher percentage of women than men having part-time positions (23.0% compared with 16.2%, P=.023), although the number of part-time faculty who were women was similar to men (539 compared with 445).
Department sizes were affected by the ownership of the school and by the emphasis on research productivity. As shown in Table 3, private schools had significantly more faculty than public institutions (F 1,124=5.6, P=.02). This difference was completely accounted for by the number of MDs (F 1,124=8.4, P<.005). The top 40 research-intensive schools, according to 2008 National Institutes of Health funding, had significantly more faculty than at the less research-intensive and the community-based medical school departments (F 1,124=30.8, P<.001). This difference was accounted for by the number of MDs (F 1,124=32.7, P<.001) and the number of PhDs (F 1,124=13.3, P<.001). Many of these larger departments were private schools in the Northeast (American College of Obstetricians and Gynecologists districts I, II, and III) or schools in Texas (American College of Obstetricians and Gynecologists district XI). In contrast, departments with the smallest number of faculty were at public medical schools located in the South Central states (American College of Obstetricians and Gynecologists district VII). Community-based medical schools had the fewest faculty, consisting primarily of MDs.
Two-thirds of all chairs anticipated that there will be an increase in the number of faculty in the next 5 years. This proportion of chairs who projected an increased need for faculty was significantly higher than that reported in 1994 (67.2% compared with 48.8%, P<.0001). Only two chairs anticipated a decrease, which is significantly less than reported in the 1994 survey (1.6% compared with 22.0%, P<.0001). The greatest needs now and for the next 5 years were for general obstetrician–gynecologists and maternal–fetal medicine specialists at any rank, but most notably as entry-level assistant professors. These needs are similar to those reported in prior surveys.2–7 Twenty-seven departments reported not having specialists trained in female pelvic support and reconstructive surgery.
When asked to anticipate requests for part-time positions, chairs predicted that both current and future faculty will desire fewer working hours. For current faculty, two-thirds of department chairs anticipated that the number of part-time positions will increase (48.8%) or remain the same (46.4%), rather than decrease (5.6%). For faculty to be recruited, chairs anticipated the requests for part-time work will either increase (63.2%) or be unchanged (36.8%).
Written comments from the chairs were revealing. Repetitive comments related to more faculty wanting to work part-time, the current economic downturn prompting research to take a “backseat,” projections of faculty recruits being difficult if the chair was interim, and limited space (and resources) prohibiting more growth on campus.
According to the Liaison Committee on Medical Education in 2007, faculty in obstetrics–gynecology constituted 4.8% of all full-time clinical faculty and 3.9% of all faculty at U.S. medical schools.11 Current data, trend data, and projections reported here remain vital information for the specialty. Despite what have sometimes been viewed by chairs as financial limitations ahead at the time of each survey, they still projected growth in faculty sizes of their departments. The continued rate of faculty growth in the current survey was the lowest compared with prior surveys. This finding may be explained by the larger number of faculty, leveling off in the median number of residents taught per department (from 21 in 1977 to 23 in 2008), limited office or clinical space (and other resources), and a more competitive and costly health care environment with budgetary constraints.2–7
As documented in other specialties, most departments of obstetrics and gynecology have part-time faculty.11–16 It is not surprising that the chairs anticipate an increase in requests for part-time positions by future faculty. A recent study demonstrated an increase of part-time faculty in internal medicine by 88% in the past 20 years.17 Part-time faculty positions were seen as advantageous for the chair, faculty, and patients.16–18 Institutions are now developing policies to optimize recruitment and promotion of part-time faculty because the future of academic medicine is dependent more on maintaining part-time faculty members.19
Over the course of the past 30 years, the relative representation of women as medical students, residents, and faculty in the United States increased steadily.20 The percentage of women selecting residencies in obstetrics and gynecology remained unchanged over the past 30 years, whereas the percentage of women in each medical school class increased steadily.21 The numbers of men in each medical school class remained relatively stable, whereas the percent selecting the specialty declined from 10% to 2% over the past three decades. Findings in our investigation and the AAMC Women in U.S. Academic Medicine 2007–08 report confirm that half of all faculty in obstetrics and gynecology are now women.21 This proportion of women who are faculty is higher in obstetrics and gynecology than in any other clinical and basic science department.21 This increasing proportion of faculty who are women may be due to a larger number of women who wish to continue their scholarship in medicine and science.22 Perhaps the expansion of medical schools opened the door to more academic opportunities at a time when medical school–based practice presented a more controllable lifestyle than the predominant small-group private practice opportunities available to graduates in earlier years.22,23
Of interest, half of faculty continued to be generalist obstetrician–gynecologists. This contrasts with the finding that one in every four academic chairs in obstetrics and gynecology is a generalist.24 This nearly equal balance in faculty between generalists and subspecialists likely reflects the continued importance of generalists as educators and their roles as models for residents who mostly graduate to general patient care or other professional activities.25
The lack of increase in PhD faculty is disconcerting. Surgically oriented departments such as obstetrics and gynecology have always had the smallest percent (0.9%) of medical school PhD faculty.25,26 Not surprisingly, we found the highest number of PhDs to be among the top 40 research-intensive schools. By 1999, PhD faculty accounted for half or more of the total principal investigators on National Institutes of Health grants in surgical departments and from clinical departments at less research-intensive medical schools.26 Furthermore, the percent of principal investigators who are physician–scientists continues to decline in clinical departments.
In the comments section of our survey, several chairs stated that much time is spent with patient care, leaving less for academic pursuits. This survey was conducted after institution of more restricted duty hours for residents, and we did not query about the effect of faculty sizes and the reduced residency duty hours. If academic obstetrician–gynecologists’ clinical responsibilities become more, with less time for academic pursuits, the greater autonomy and income potential afforded by a more private office setting may become more attractive. Although not new, this concept may be more apparent as perceived lifestyle constraints and debt incurred from past medical education become more significant considerations. In addition, a loss of qualified faculty to private practice would add more of a teaching load on clinical faculty who already became more committed to patient care.
Larger departments, mostly at private medical schools in the Northeast, may have more financial stability, with little or no dependence on state appropriations and accompanying restrictions, more endowments, and more resources to attract and retain those faculty pursuing academic careers. Larger departments are more likely to have part-time faculty. Future studies to understand the roles of department size, geographic location, and other unassessed factors on the variation in recruitment and departure rates may shed light on the efforts to increase the academic workforce.
Our investigation had several strengths and certain limitations. Surveys from all schools (100% compliance) are presented here. The data were retrieved electronically and double-checked when necessary. Bias in reporting by chairs was minimal because recall was for the current period. Our data differentiated between the types of schools, examined sex more closely, and included the new subspecialty of female pelvic medicine and reconstructive surgery (or urogynecology). We observed trends over more than 30 years using the same basic questionnaire. We compared trends for full-time academic obstetricians and gynecologists with data from other surveys, while exploring the part-time positions. A potential limitation involved whether faculty appointments were provided to fellows in training and to other non-MD, non-PhD faculty who may have qualified as instructors at another medical school.
In conclusion, the number of full-time faculty in obstetrics and gynecology at U.S. medical schools more than doubled in the past 31 years. The modest growth since the reported survey in 1994 was only among MD faculty. Half of faculty continues to be generalist obstetrician–gynecologists. The most substantial change was the increase in women, who now constitute half of all faculty. The change in workforce to more part-time faculty is critical for academic chairs and deans to track so that faculty needs can be more accurately projected. Recruitment and retention of productive faculty who train our next generation of obstetrician–gynecologists will require the identification of nonclinical sources of funding (eg, department reserves, endowments, dean’s startup funds, university hospital, contracts with community hospitals), aside from patient care revenues, to support our critical missions, provide a balance between professional and lifestyle activities, and prepare for the expanded numbers of medical students and residents. To more accurately assess reasons for attrition, future studies should target those who left academia altogether or who move to another institution.
1.Spellacy WN, Birk SA, Buhi WC. A national survey of medical school obstetrics and gynecology departments, 1965 to 1975. J Med Ed 1977;52:901–5.
2.Messer RH, Pearse WH, Fielden JG. Academic manpower for obstetrics and gynecology in the United States. Obstet Gynecol 1979;53:649–52.
3.Pearse WH, Davidson EC Jr, Fielden JG. Trends in obstetric-gynecologic manpower—1980. Obstet Gynecol 1981;58:233–6.
4.Pearse WH, Davidson EC Jr, Fielden JG. Trends in obstetric-gynecologic manpower—1983. Obstet Gynecol 1985;65:147–50.
5.Pearse WH, Fielden JG, Sherline DM. Obstetric-gynecologic academic manpower—1986. Obstet Gynecol 1987;70(pt 1):403–5.
6.Pearse WH, Graham KK. Trends in obstetric-gynecologic academic manpower and research. Obstet Gynecol 1991;78:141–3.
7.Pearse WH, Poole KG. Current trends in obstetric and gynecologic academic faculty manpower. Obstet Gynecol 1995;86:1018–20.
8.Salsberg E, Rockey P, Rivers K, Brotherton S, Jackson G. US residency training before and after the 1997 Balanced Budget Act. JAMA 2008;300:1174–80.
9.Association of American Medical Colleges Center for Workforce Studies. AAMC medical school enrollment plans through 2013: analysis of the 2008 AAMC Survey. Available at: http://www.aamc.org/workforce
. Retrieved April 20, 2009.
10.Socolar RRS, Kelman LS. Part-time faculty in academic pediatrics, medicine, family medicine, and surgery: the views of the chairs. Ambul Pediatr 2002;2:406–13.
12.Levinson W, Kaufman K, Bickel J. Part-time faculty in academic medicine: present status and future challenges. Ann Intern Med 1993;119:220–5.
13.Kahn JA, Degen SJF, Mansour ME, Goodman E, Zeller MH, Laor T, et al. Pediatric faculty members’ attitudes about part-time faculty positions and policies to support part-time faculty: a study at one medical center. Acad Med 2005;80:931–9.
14.Thrall JH, Meehan MJ, Whelton DG. Comparison of productivity and cost of full-time and part-time faculty members in an academic department of radiology. J Am Coll Radiol 2006;3:335–9.
15.Lugtenberg M, Heiligers PJM, de Jong JD, Hingstman L. Internal medicine specialists’ attitudes towards working part-time: a comparison between 1996 and 2004. BMC Health Serv Res 2006;6:126–35.
16.Sanfey H, Savas J, Hollands C. The view of surgery department chairs on part time faculty in academic practice: results of a national survey. Am J Surg 2006;192:366–71.
17.Mechaber HF, Levine RB, Manwell LB, Mundt MP, Linzer M. Part-time physicians … prevalent, connected, and satisfied. J Gen Intern Med 2008;23:300–3.
18.Parkerton P, Wagner E, Smith DG, Straley HL. Effect of part-time practice on patient outcomes. J Gen Intern Med 2003;18:717–24.
19.McMurray JE, Heiligers PJ, Shugerman RP, Douglas JA, Gangnon RE, Voss C, et al; Society of General Internal Medicine Career Satisfaction Study Group (CSSG). Part-time medical practice: where is it headed? Am J Med 2005;118:87–92.
22.Seltzer VL. Changes and challenges for women in academic obstetrics and gynecology. Am J Obstet Gynecol 1999;180:837–48.
24.Rayburn WF, Schrader RM, Cain JM, Artal R, Anderson GD, Merkatz IR. Tenure of academic chairs in obstetrics and gynecology: a 25-year perspective. Obstet Gynecol 2006;108:1217–21.
25.Smart DR, Sellers J, American Medical Association. Physicians characteristics and distribution in the U.S. Chicago (IL): American Medical Association; 2008.
© 2010 by The American College of Obstetricians and Gynecologists.
26.Fang D, Meyer RE. PhD faculty in clinical departments of U.S. medical schools, 1981–1999: their widening presence and roles in research. Acad Med 2003;78:167–76.