Only women know what it's like to have a baby, but for decades, male physicians usually delivered those babies. · That is rapidly changing. · Today, young women physicians going into obstetrics and gynecology outnumber young men by four to one.
Although national statistics are available only to 2010, the trend line indicates that the number of women obstetrician-gynecologists for the first time surpassed the number of men in that specialty in 2011 or 2012.
The shift reflects a huge increase in female medical doctors of all kinds, a jump that is more pronounced for ob-gyns. More generally, it reveals a change in societal notions of what a woman can do in her career.
Decades ago, women who wanted to work with patients usually went into nursing. Today, they are less constrained and more likely to pursue big dreams.
Dr. Michelle Knolla said she was one of two active female ob-gyns in Omaha after she completed her residency program in 1983. Some women patients said: “Ooh, I don't want a woman looking down there,” Knolla, 62, remembers.
Today, female med students and resident physicians are pouring into obstetrics and gynecology, the specialty that involves pregnancies and deliveries, and deals in pelvic pain, infertility, menopause and post-menopausal medicine.
The increase is evident in Nebraska and Iowa. Only one of the 16 ob-gyn resident physicians this year at the University of Nebraska Medical Center is male. At the Creighton University School of Medicine, female med students who go into ob-gyn residencies have outnumbered males every year since 1999. And in Iowa, 75 percent of ob-gyns under age 40 are women.
Nationwide, more than 80 percent of the doctors in ob-gyn residency programs are women, according to the American Congress of Obstetricians and Gynecologists.
The momentum had begun to build by the time Dr. Sarah Cada was 10 years old. It was the late 1970s and her mother was a labor and delivery nurse in Lincoln. Cada wanted to be the doctor who delivered babies, and her parents didn't discourage her.
“I always had the idea that's what I wanted to do,” said Cada, now 43. “I mean, seeing a baby born is really an amazing thing. It's pretty fulfilling.”
Cada is one of five doctors in an all-woman Lincoln ob-gyn clinic.
Knolla came out of her residency and joined an Omaha clinic, where more than one woman told her she wanted a male, not a female, examining her.
She said she had to give talks at churches to generate a patient base and go to physician breakfasts to meet doctors who would then refer women to her.
“It was lean,” she said of the first few weeks of her initial practice. Business was so sluggish that she licked envelopes and repainted the bathroom that her patients would use.
But once women started to come, they liked the fact that she knew what it was like to be pregnant and immobile with swollen ankles.
“You understand me,” they would suggest. “It became an asset after the first couple years to have a female” in an ob-gyn clinic, she said.
After Knolla performed a yearly pelvic exam early this month on patient Gail Krejci, Krejci explained why she switched about 15 years ago from a male ob-gyn to Knolla.
“I wanted a woman,” said Krejci, 51, who lives in the Elkhorn area. “There's more empathy with a female. I was just more comfortable because they understand.”
“Smaller hands,” Knolla said, referring to using her hand to examine a patient in tight places.
“There is that,” Krejci agreed.
The majority of older ob-gyns are male. Among those 50 years and older in Iowa, for instance, 69 percent are men.
Dr. Carl Smith, professor and chairman of ob-gyn at UNMC, said patients generally want ob-gyns with good training and who are kind and available when they need them. They want doctors who are skilled.
“You do all of those things, regardless of your gender, and you'll be successful,” Smith, 58, said.
Smith said he intended to become an internal medicine physician until he delivered a baby as a med student.
“It became apparent that that (ob-gyn) was the specialty that I wanted to do,” he said. “I don't know that I can describe it specifically.”
But being able to help a woman and family in the birthing process is something few people get to experience, he said.
Dr. Jeanne Conry, president-elect of the American Congress of Obstetricians and Gynecologists, said a cardiologist doesn't have to have suffered heart disease to do his job well. Similarly, an ob-gyn doesn't have to be a woman, she said.
Ob-gyns must be caring providers, good communicators and know their speciality, Conry said. Some patients want female ob-gyns and others want males. She has male partners to whom patients are extremely loyal, said Conry, who practices in the Sacramento, Calif., area. It's a matter of personal preference.
Dr. Todd Pankratz, a 47-year-old ob-gyn in Hastings, recalled having little interest in that specialty until his ob-gyn rotation in med school. He recalled his wife saying to him a short time later: “So you're going to be an ob-gyn.”
Pankratz asked what she meant. “This is the happiest you've been all year,” she responded. And he agreed.
He said he loves having patients for the long term as opposed to treating a disease and never seeing that patient again. He enjoys feeling part of the family, involved with mothers and fathers at a blissful time. The patients almost always do well, too, he said.
Jessica Gregg, a registered nurse in Hastings, said she asked co-workers for recommendations and learned that Pankratz had a fine reputation. He has been Gregg's ob-gyn now for about 18 months and delivered her second baby.
“I don't think there was any reluctance there,” Gregg, 26, said. “Dr. Pankratz has been practicing for a long time now. I didn't think that a woman could identify more with me. ... He is very understanding.”
Further, she said, he had an appreciation of what her husband was going through and communicated well with him.
Stacy Tiemeyer, a University of Nebraska-Lincoln doctoral student who is analyzing health-care occupations, said the numbers of women applying to med school began to shoot up in 1970s. Women and medical degrees became far less incongruous at that time, in part because of the power of the women's movement and because medical schools feared a looming physician shortage, she said.
“It became a well-accepted path for women,” Tiemeyer said of medicine. “And women have really taken it on with gusto.”
The number of female physicians in all specialties jumped about 8.3 times from 1975 to 2010. In the ob-gyn specialty, it has gone up close to 12 times, according to the American Medical Association.
Dr. Michelle Knolla now practices among a large group of ob-gyns at Methodist Physicians Clinic Women's Center, adjacent to Methodist Women's Hospital in far west Omaha. Of the 19 ob-gyns in that clinic, only four are male.
Knolla had planned to be a family physician. Then, as a medical student, she was the only one in the room when a woman who was about to give birth coughed. The baby “came out like a rocket,” Knolla said. Knolla caught the umbilical cord and grabbed the baby.
The doctor was hooked.
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