Job decision-making for new family physicians who intend to do obstetrics: themes and illustrative quotes
| Code | Code definition | Illustrative quotes | Do OB n (%) | No OB n (%) |
| Theme: personal influences and preferences | ||||
| Geography/ location | Constrained by or preference for looking for a job in a particular city, region or type of geographical area | “[This town is] beautiful. I grew about an hour and a half away from here. So it's near grandparents, it's one of the most beautiful small towns in the state). Tons of outdoor activities, rivers, mountains, hiking, telemarking, all those things that we loved to do.” (Female doing OB in the West) “I only looked for jobs in Oregon. If it was left to just my career trajectory, I definitely would have stayed where I trained because I had built a lot of professional connections there and I knew that there were a lot of opportunities there for me to practice full scope.” (Female not doing OB in the West) | 21 (72) | 17 (63) |
| Family | Importance of family (spouse, parents, etc) in selecting job and/or location | “…I’m in a two-career household, and both of our careers are very important to us. Because my spouse had already established during my residency at one location and that was why I had come back to [this state] in first place, I knew that I had to stay somewhat near the [City] Metro area.” (Female doing OB in the Northeast) | 12 (41) | 10 (37) |
| Balance/ lifestyle | Impact of doing OB on their lifestyle in terms of family obligations, free time, convenience or uncertainty | “The expectation was to see like 40 patients a day on top of like going in and delivering, and just finding a way to make that work… didn’t sound very realistic to me. I, you know, have a young family. I need to have like a little bit more predictability as far as my hours.” (Female not doing OB in the West) | 3 (10) | 9 (33) |
| Theme: job characteristics | ||||
| Practice characteristics | Attracted by some aspect of practice size, composition, structure, etc. | “I took the position I am in now because it’s a smaller hospital that is independently owned, so if I have issues I just go talk directly to the CEO instead of 50 other people. And it was a group of family practice physicians, I think there’s six or seven of us…that share call and duties, and I run clinical with time to talk to and build collegial type relationships.” (Female doing OB in the Midwest) | 13 (38) | 0 (0) |
| Call/backup | Call schedule offered by job conducive to lifestyle or backup available/call schedule not ideal or work hour expectation too high | “I also was very interested in joining a place that had OB call pool… If there wasn’t an opportunity to be in a pool, I don’t know if I’d be doing OB. Because the idea of having my own continuity deliveries and not having kind of that built in time off and kind of that idea of always being on… I really wanted to be in a pool, so basically, I have time when I’m on and I have my time when I’m off…. So that was something that was harder to figure out like – kind of get to the phone interview stage with folks and ask that question and really, really wanted that.” (Female doing OB in the Northeast) | 6 (21) | 3 (11) |
| Payment | Financial aspects: job paid well/job could not pay enough for work expectations | “I feel like it's actually a really big money-maker because I go in for uncomplicated deliveries all the time, like, not of my own people…we do all of our own, but obviously, if I go out of town for the weekend, somebody has to cover my OBs. So, I'm covering for people all the time. …. I cover for a lot of people, so sometimes I get huge bonuses I'm not even anticipating. I'm like, why is that? I'm like, “Oh, I did four or five or six extra deliveries.” So I think it adds up.” (Female doing OB in the West) | 3 (10) | 2 (7) |
| Theme: professional considerations and career goals | ||||
| Good fit | Found a job that was a ‘good fit’ for them professionally | "And when I interviewed at X residency program for a faculty position I really liked it and it seemed like it was going to be a good fit for me professionally and personally and then also for my husband’s job and our family is all in the [City] area so it was a really good fit.” (Female not doing OB in the Midwest) | 4 (14) | 7 (26) |
| Academic | Desire for academic position or one in which they teach | “The other part that was very attractive to me was because I wanted to be a teacher. I wanted to still teach medical students, I wanted to teach residents just because it was such a meaningful experience for me on the other side. So I also looked at many places where they had teaching openings but … there were places where you would be on faculty but there is no OB, almost no pediatrics… So that is why this kind of just checked all the boxes for me. (Male doing OB in the Midwest) | 7 (24) | 2 (7) |
| Compromise | Job offered something else, related to OB, like women's health, prenatal care, peds, etc. | “If this job would have involved delivering babies, it would be perfect. But it didn’t. So it was kind of like well you never get exactly what you want in a job and I was able to get 9 out of 10. It ended up pretty well. But I hear my residency colleagues talking about delivering babies and I still get some pangs of jealousy that I’m not still doing it.” (Female not doing OB in the West) | 0 (0) | 8 (30) |
| Mission focus | Importance of working with underserved populations | “[My residency] clinic is an FQHC. I fell in love with care for needy communities and my wife is a pharmacist at the hospital as well and she had done some rotations for training with Indian Health Services, so we started our career search in November in our third year and was sort of focusing on Indian health sites….” (Male doing OB in the Southwest) | 5 (17) | 2 (7) |
| Other specialty/interests | Had competing interests (sports med, urgent care, ER) and could not ‘do it all’; fellowship trained in something other than OB | “During my last year of residency I was looking for a full scope family medicine OB with surgery that was within an hour or so within a large city… During my last year I did a rotation in urgent care, and they were just a good fit. So, where I did rotation, the owner chief medical officer there really liked that I could do all the procedures I could, which is basically like a mini ER. With all the surgical background totally hired me.” (Male not doing OB in the West) | 0 (0) | 6 (22) |
| Mentorship in job | Attracted to job because of mentor in the practice | “Especially out of residency I wanted people I could ask questions to and mentors. There was another reason I didn’t like [the idea of] working in that particular practice even though my volume would have been much higher… I just didn’t feel comfortable with me being the only person in the practice doing OB coming right out of residency.” (Female doing OB in the West) | 5 (17) | 1 (4) |
| Full scope | Importance of the ability to do full scope and/or continuity care | “I think being put in that environment really forces you to stretch your brain and maintain as much the skills that you're trained in as possible. And that was—that was my primary goal after finishing residents choose to come out to a remote location where I would be practicing in a full spectrum capacity, managing OB patients, working in the ER, managing in-patients and really using all of the different assets to the training that we receive.” (Male doing OB in the Southeast) | 5 (17) | 1 (4) |
| Theme: role of agency | ||||
| Self- determination | Advocated for themselves to be able to do OB at job | "[Recruiters are] my point of contact when I’m in the job search. So, if you’re not determined, and sure [that] this is what you want, and you’re not aggressive and assertive in finding the opportunity that will allow you to do what you really enjoy, you may get easily discouraged and stop searching, you know what I mean?” (Female doing OB in the Southeast) | 7 (24) | 0 (0) |
| Had choice | Could have done OB, but chose job without for some reason | “I was looking for jobs where I could do prenatal care. By the time I started looking for jobs I was pretty sure I didn’t want to do deliveries unless my dream job was going to make me do it as a contingency for the job.” (Female not doing OB in the Midwest) | 0 (0) | 4 (15) |
Bolded ‘n (%)’ indicates a notable difference between those who do and do not do OB in the authors’ eyes; it does not represent statistical significance.
OB, obstetrics.