Boston Med: Tale of Two OB- GYN Residents

July 29, 2010— -- Dr. Rachel Clark is always in a small state of dread when she's on the job.

"I'm always worried because when things go wrong, they go terribly wrong," said the OB-GYN resident, about working on the labor floor of Boston's Brigham and Women's Hospital. It's where she sees some of "the sickest pregnancies in the world."

In terms of statistics and morbidity, "being pregnant is the most dangerous thing an American woman will do in her lifetime," Clark believes. With that in mind, the Kentucky native, in her second year of training, can never quite relax. Typically, she puts in an 80-hour work week, many times working night shifts, and is often on-call.

With no margin for error, Clark admits work is her first priority. She must put everything else second, including her boyfriend Jeff, who works as a venture capitalist.

"Your home life kind of goes to crap, for lack of a better word," she said. "I would not want to date me right now."

With five more years of training ahead of her, Clark didn't know if her long term relationship with Jeff could stand the strain, but she knew she wasn't willing to let her work slip. In a year when hundreds of healthy babies are delivered, it takes just one tragic complication to haunt young doctors-in-training and sometimes taint their career outlook.

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Clark recalls becoming emotionally torn up after a bad patient outcome and seeing the family's reactions.

"It's just like seeing people's hopes just go down the tubes. It's terrible," she said. "And I understand because of that, why the malpractice is so out of control in obstetrics."

Concerned about the dwindling number of medical students interested in the specialty, the Association of Professors of Gynecology and Obstetrics (APGO) and the American College of Obstetricians and Gynecologists (ACOG) launched a recruitment campaign five years ago to examine and combat the negative views of the trade.

One of the concerns cited by students was the economic factor. The field involves a lot of malpractice suits, where OB-GYNs must also personally pay, at times, skyrocketing malpractice insurance premiums.

Resident: Childbirth Is 'Not a Perfect Science'

According to Dr. Kelly Wright, a fellow resident of Clark's, in the last half century other medical specialties have changed "leaps and bounds" while obstetrics and childbirth hasn't.

"It's not a perfect science...I think we can only go so far," Wright said. "There are still going to be bad outcomes in obstetrics and the expectation to have it your way, you know, like the Burger King mantra, have it your way -- I think that's what leads to the litigation."

In last week's episode of "Boston Med," Wright recounted the story of "two really wonderful obstetricians" she knew who worked at Brigham and Women's. They lost a multi-million dollar lawsuit and ended up quitting medicine completely.

"How can you recover from that?" Wright asked. "From a patient who is yours, who you tried your best, and they told you, 'you were a bad doctor.' And they sued you and they won and the jury told you you're a bad doctor."

That kind of fear is real for Wright, who knows that everything she's worked for -- college, medical school, residency, her work with mothers and delivering babies -- could all be over with one unfortunate case.

Balancing Personal, Professional Life

Like Clark, Wright is all too aware there are no guarantees in life, not only professionally but also in her own personal life.

"It's the same thing in a relationship," Wright said. "You think that you've built something great and then in a second, it can all be gone."

Wright, who is gay, was dating a woman outside of the medical field "who does things on the weekends and wants to plan trips and wants to go do things." Wright's busy schedule made doing these things together extremely difficult.

They broke up and Wright said she discovered that her girlfriend had been seeing other people, which was a devastating blow.

"This was the person who was my support system and who never complained about my schedule, who was always very understanding until the day that she wasn't, until the day that she left," Wright said.

Wright started to have major career doubts. She said she was on the verge of quitting, asking herself if her career was worth ruining relationships.

Is a Love Life Possible on the Labor Floor?

A vast majority of all OB-GYN residents -- more than 75 percent -- are women, according to the latest data available from the Association of American Medical Colleges. There's a perceived notion in the field that most female patients prefer to see female OB-GYN doctors. Therefore, many in the business of helping to start families for others must also consider how to fit in raising families of their own. Lifestyle issues rank high among medical students when considering a specialty.

Between phone pages and checking in with patients, Clark found herself texting various apologies to her boyfriend Jeff for not being able see him. Although they started looking at a house to buy together, Clark realized that maintaining the relationship was becoming too difficult when she consistently was not there for him.

"They know they can't call you and count on you to answer because you might be doing something else," said Clark. "So once you accept that you have kind of gone m.i.a. on your own life, you have to think about how to deal with that."

Clark and Jeff mutually decided to end the relationship. "It wasn't lost on me there was no way I was meeting Jeff's needs," she said. "It was hard but it was the right thing to do. I think it's always easier to do a hard thing if you know it's the right thing."

Clark is unapologetic about turning into a workaholic, rationalizing that while she may not be able to solve her personal problems, she can focus on solving problems at work.

Currently, she is interviewing around the country, on track to pursue her goal of becoming, an "amazing" gynecological cancer surgeon. Or so she hopes.

"I applaud Rachel," Wright said about her friend's chosen profession. "I think it's a field that consumes your life...but it's a very noble field to go into."

Five years after the ACOG and APGO began their recruitment campaign, all but five of the 1,187 available residency positions this year nationwide in obstetrics-gynecology were filled. Interest in training in the specialty has increased steadily.

There has also been growth of OB-GYNs practicing in certain states, which some attribute to those states adopting limits in recent years to the amounts awarded in malpractice cases. One example is Wright's home state of Texas, once ranked abysmally low in the number of physicians per capita, now has an influx of doctors, particularly obstetricians, who view it as a friendlier malpractice climate.

Ultimately, Wright got over her career indecision, remembering her first delivery and how she was in such awe.

"Somebody told me it's like a marathon...all you want to do is walk off because gosh, you have so much farther to go," Wright said. "But if you don't and you keep going things get a little better. It's something I know will be worth it in the end."

Wright remains determined to have a life and a family outside work. "I also want a life at the end of this...I am still figuring that out. I'm still making my life," she said.

Slowly, Wright started to enjoy going out again and dating. She went on Match.com and clicked instantly with a woman who also happened to be from Texas. More than a year after her difficult break-up, Wright said she has found love.

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