Factors Associated With Junior Residents' Choice of the Obstetrics and Gynecology Specialty: A Longitudinal Survey Based on 2025 Career Decisions

ABSTRACT

Aim

In Japan, the chronic shortage of obstetric–gynecologists exists in reality. To tackle the issue, we aim to identify the factors that promote or discourage junior residents' choice of the obstetrics‐gynecology (Ob/Gyn) specialty.

Methods

We conducted a questionnaire survey of junior residents at the Summer School (SS) in 2023 and the Plus One Project 2 (POP2) in 2024 (preparatory educational events). One hundred and twenty‐two and 179 junior residents responded, respectively. In 2025, they decided whether to specialize in Ob/Gyn. We collected anonymized data on their decisions. Using the data, as a longitudinal study, we conducted a logistic regression analysis to examine how their preferences regarding working conditions are associated with their decisions.

Results

There are several significant findings. First, those who consider the workplace's urban location more important are more likely to choose the Ob/Gyn specialty, according to the SS data. Second, concerns about the risk of lawsuits, fewer deliveries in the workplace, and low income prevent them from specializing in Ob/Gyn, according to the SS data. Third, those who consider annual income more important are more likely to choose the Ob/Gyn specialty, according to the POP2 data. Fourth, those who think that a sufficiently small number of night shifts is more important are less likely to specialize in Ob/Gyn, according to the POP2 data.

Conclusion

The findings are provisional. However, after further data collection and analysis updates, this study may inform what should be done to increase the number of Ob/Gyn specialists in Japan.

1. Introduction

In Japan, the chronic shortage of obstetrics–gynecology (Ob/Gyn) specialists exists in reality. The number of new Ob/Gyn specialists continuously decreased, reaching its lowest level in 2013 [1]. Then, the Japanese Society of Obstetrics and Gynecology (JSOG) established the MIRAI committee and the Japanese Trainees in Obstetrics and Gynecology (JTOG) to recruit new Ob/Gyn specialists. The JTOG has provided a variety of recruiting activities since 2015.

The JTOG conducted recruitment activities based on the following results of the questionnaire survey analysis, and the number of new Ob/Gyn specialists has increased since 2017 [2]. The analysis showed that medical students who had a chance to observe deliveries during hospital training were more likely to specialize in Ob/Gyn than those who did not [3]. Residents who trained in an Ob/Gyn department were more likely to choose the Ob/Gyn specialty than those who did not [4].

On the other hand, improvements in physicians' working conditions have recently been a hot issue. Many obstetric–gynecologists work overtime for more than 1860 h [5]. Moreover, there is a generational gap in perceptions of self‐improvement and overtime work [6]. This gap may discourage medical students and residents from specializing in Ob/Gyn.

It is crucial to continuously conduct questionnaire surveys to identify the factors related to preferences regarding working conditions among medical students and residents. A questionnaire survey was conducted with participants of the Summer School (SS) in 2023 and the Plus One Project 2 (POP2) in 2024 of the JSOG. This article aims to identify the factors that promote or discourage junior residents' choice of the Ob/Gyn specialty, using logistic regression. This study conducts a longitudinal analysis. The questionnaire responses regarding preferences for and concerns about future working conditions among first‐ and second‐year residents are associated with their ex‐post decisions on whether to specialize in Ob/Gyn.

2. Methods

2.1. Data Collection

A questionnaire survey was conducted at the end of the first day of the SS (August 19, 2023). One hundred and thirty‐five fifth‐ and sixth‐year medical students and 123 first‐year junior residents attended the SS program. They were interested in Ob/Gyn, though they had not yet decided on a specialty. We provided an online questionnaire after the face‐to‐face instructions. Respondents answered the questions by using their smartphones. Likewise, a questionnaire survey was carried out at the end of the second day (May 19, 2024) of the POP2, another educational event. There were 181 second‐year junior residents as participants in the POP2. They were interested in becoming an Ob/Gyn specialist, although they had not yet decided on a specialty. The questionnaire survey was conducted online after face‐to‐face instructions. Respondents answered the questions using their smartphones. The analysis in this article targets 123 and 181 junior residents, respectively, in the events. In 2025, they decided whether to choose Ob/Gyn as their specialty.

The questionnaire survey was composed of three categories: (i) the degree of importance of each working condition (15 questions), (ii) things that respondents are concerned about (2 questions), and (iii) future working conditions that respondents expect (16 questions). The first category asked the following working conditions: annual income; working hours; night shift hours; on‐call standby time; location of the workplace; whether there is a mentor at the place of work; whether there is collaboration with midwives, anesthesiologists, and neonatologists; number of deliveries and surgeries; number of obstetrician–gynecologists at the place of work; and availability of daycare centers at the place of work. The degree of importance of each working condition was assessed on a 7‐point Likert scale. As for the second category, respondents chose the items they are concerned about from a list of 19 items (three related to risks of medical malpractice and 16 related to working conditions). The third category asked respondents about the future working conditions they expect. The third category asked the following working conditions: types of employment status; annual income; working hours; number of night shifts; number of on‐call shifts; choice of clinics or hospitals; location of the workplace; whether there is a mentor at the place of work; whether there is collaboration with midwives, anesthesiologists, and neonatologists; number of deliveries and surgeries; number of obstetrician–gynecologists at the place of work; and availability of daycare centers at the place of work. The questionnaire is available as a Supporting Information File (see Supporting Information Material A).

In 2025, the target respondents, junior residents, decided whether to specialize in Ob/Gyn. Then, we obtained anonymized data on those who have chosen the Ob/Gyn specialty from the JSOG. The data on their decision to choose the Ob/Gyn specialty are coded as a dummy variable, with 1 indicating the Ob/Gyn specialty and 0 indicating others. We linked the data on their decisions to the questionnaire data by anonymized respondent numbers, treating it as anonymized and without any private information that could identify individuals.

This study was approved by the JSOG before its implementation. Ethical review and approval were waived for this study in accordance with the regulations of the Ethics Review Committee at Shiga University, which stipulate that ethical review is not required when the data are already anonymized and when subjects cannot be identified by any means. In this study, we did not collect any personally identifiable information.

2.2. Analytical Method

Using the connected data set, we conducted a logistic regression analysis to explain their decisions on whether to specialize in Ob/Gyn by their preferences regarding working conditions, obtained from questionnaire surveys of the SS and the POP2, respectively. See Table C1 in Supporting Information Material C about the variables included in the regression analysis. We should note that variables related to the reduction of concerns are interaction terms. If respondents are not concerned, they will not reduce their concerns. In other words, it is meaningful to ask only those who are concerned whether they can reduce their concerns. The variables ask whether a respondent who is concerned reduces their concern. If a respondent is not concerned, the interaction terms are always zero.

3. Results

3.1. General Information

We obtained responses from 122 residents (99.2%, N = 123) in the SS in 2023, 179 residents (98.9%, N = 181) in the POP2 in 2024. These response rates are high. Summary statistics of responses to the questionnaire surveys are available in the Supporting Information File (see Supporting Information Material B).

Figure 1 shows the gender distribution of the respondents. We should note an important feature of the respondents before showing the results. The Ob/Gyn specialty has been popular among female persons. 79.5% and 69.8% of the respondents were female in the SS and the POP2, respectively. Female persons are more interested in the Ob/Gyn specialty than male persons.

FIGURE 1.

Gender of respondents.

3.2. Decisions on Whether to Specialize in Ob/Gyn

Statistical information on junior residents' decisions about whether to specialize in Ob/Gyn is crucial. The rate of those who have specialized in Ob/Gyn is shown in Figure 2. The rate regarding total participants is 69.8%. The rate in the SS is 64.8% while that in the POP2 is 77.7%. The rate concerning those who participated only in the SS is 49.3%. The rate regarding those who participated in both the SS and the POP2 is the highest, 83.3%. Participants in the POP2 tend to specialize in Ob/Gyn more than those in the SS. Participants in the POP2 tend to be more interested in Ob/Gyn than those in the SS, mainly because they are second‐year residents.

FIGURE 2.

The rate of junior residents who have specialized in Ob/Gyn.

3.3. Logistic Regression Analysis

Figure 3 presents the logistic regression results for the SS (see Table C2 in Supporting Information Material C about the complete results). Some factors that promote first‐year junior residents' specialization in Ob/Gyn are found to be statistically significant at less than 5%. Respondents who consider the workplace's urban location more important tend to choose the Ob/Gyn specialty. Concerns about having no mentor, insufficient collaborations with neonatologists, and an insufficient number of surgeries in the workplace help them to specialize in Ob/Gyn. Some Ob/Gyn‐specific concerns may indicate interest in the Ob/Gyn specialty. Reducing concerns about long on‐call standby time and low income encourages them to choose the Ob/Gyn specialty. Those who expect longer working hours and more deliveries in the future tend to specialize in Ob/Gyn. These Ob/Gyn‐specific burdens regarding working conditions may show their acceptance of the specialty. Male persons are more likely to choose the Ob/Gyn specialty.

FIGURE 3.

Estimation results of logistic regression regarding the SS in 2023. N = 122. (1) Seven‐point Likert‐scale ordinal variable, (2) Dummy variable, and (3) Converted numerical variable. Only statistically significant factors are shown. See Table C2 in Supporting Information Material C about the complete results.

On the other hand, some factors that discourage first‐year junior residents from specializing in Ob/Gyn also show statistical significance of less than 5%. Respondents who consider collaboration with midwives more important are less likely to choose the Ob/Gyn specialty. Concerns about the risk of lawsuits, the rural location of the workplace, insufficient collaboration with anesthesiologists, fewer deliveries, and low income tend to prevent them from specializing in Ob/Gyn. Reducing concerns about fewer deliveries and difficulties in taking maternity and parental leave discourages them from choosing the Ob/Gyn specialty. Those who expect more surgeries in the future tend not to specialize in Ob/Gyn.

Figure 4 presents the logistic regression results for the POP2 (see Table C3 in Supporting Information Material C about the complete results). Some factors that promote second‐year junior residents' specialization in Ob/Gyn are found to be statistically significant at less than 5%. Respondents who consider annual income more important are more likely to choose the Ob/Gyn specialty. Concerns about long on‐call stand‐by time and fewer deliveries in the workplace help them to specialize in Ob/Gyn. These Ob/Gyn‐specific concerns may indicate interest in the Ob/Gyn specialty. Those who expect more night shifts in the future tend to choose the Ob/Gyn specialty. This Ob/Gyn‐specific burden may indicate their acceptance of the specialty.

FIGURE 4.

Estimation results of logistic regression regarding the POP2 in 2024. N = 177. (1) Seven‐point Likert‐scale ordinal variable, (2) Dummy variable, and (3) Converted numerical variable. Only statistically significant factors are shown. See Table C3 in Supporting Information Material C about the complete results.

On the other hand, some factors that discourage second‐year junior residents from specializing in Ob/Gyn also show statistical significance of less than 5%. Respondents who think that a sufficiently small number of night shifts, sufficient collaboration with neonatologists, and the availability of a daycare center at the workplace are more important are less likely to choose the Ob/Gyn specialty. Reducing concerns about the rural location of the workplace and the heavy workload outside medical practice discourages them from specializing in Ob/Gyn.

4. Conclusion

This article aims to identify significant factors that promote or discourage junior residents' specialization in Ob/Gyn. We conducted a longitudinal logistic regression analysis using questionnaire data collected during the SS in 2023 and the POP2 in 2024. Let us highlight some important findings to encourage or discourage junior residents' choice of the Ob/Gyn specialty.

As for first‐year junior residents in the SS in 2023, those who consider the urban location of the workplace more important are more likely to choose the Ob/Gyn specialty, although it might be difficult to maintain a sufficient number of Ob/Gyn doctors in rural areas. Reducing concerns about long on‐call stand‐by time and low income is associated with the choice of the Ob/Gyn specialty. Furthermore, concerns about the risk of lawsuits, the rural location of the workplace, fewer deliveries in the workplace, and low income prevent them from specializing in Ob/Gyn.

Regarding second‐year junior residents in the POP2 in 2024, those who consider annual income more important are more likely to choose the Ob/Gyn specialty. Moreover, those who consider a sufficiently small number of night shifts more important are less likely to choose the Ob/Gyn specialty.

We should note that the generalization of the results is limited. This is because participants in the SS and the POP2 may be more interested in the Ob/Gyn specialty than general junior residents. However, we can at least consider what we should do during educational events to increase the number of Ob/Gyn specialists.

The essential findings above are crucial for considering practical remedies to encourage junior residents to specialize in Ob/Gyn. However, the findings should be considered provisional, as we use only information about their decisions in 2025. Related to this limitation, the number of explanatory variables in the logistic regression may be large relative to the observations. We have been continuously conducting research and will accumulate the data and its analysis. We will update the data analysis annually. After collecting sufficient data over several years, we will discuss how to increase the number of Ob/Gyn doctors in Japan.

Author Contributions

Fuminori Taniguchi: writing – review and editing. Koichiro Mori: conceptualization, methodology, data curation, investigation, validation, formal analysis, supervision, visualization, project administration, writing – original draft, writing – review and editing. Masanori Isobe: writing – review and editing. Hiroaki Komatsu: supervision, writing – review and editing, methodology. Kazuki Sakaguchi: data curation, methodology. Mihoko Dofutsu: writing – review and editing.

Conflicts of Interest

Dr. Hiroaki Komatsu is an Editorial Board member of the JOGR Journal and a co‐author of this article. To minimize bias, he was excluded from all editorial decision‐making related to the acceptance of this article for publication. The other authors declare no conflicts of interest.

Supporting information

Supporting Information: A. Supporting Information.

Supporting Information: B. Supporting Information.

Supporting Information: C. Supporting Information.

Supporting Information: D. Supporting Information.

Data Availability Statement

The raw data used in this study are available as Supporting Information. See Supporting Information Files D.