Asleep at the wheel: leadership in obstetrics and gynecology

I read the recent perspective “Reimagining the Council of University Chairs of Obstetrics and Gynecology in evolving times”1Alvarez R.D. Chelmow D. Johnson D.D. et al.Reimagining the Council of University Chairs of Obstetrics and Gynecology in evolving times.Am J Obstet Gynecol. 2023; 228: 494-496Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar with initial interest. I understand that perspectives are brief commentaries with limitations on word count and references, but what a solitary document; bereft of any citations, it perfectly captures the solipsism of an isolated leadership. Racism is mentioned but only tangentially. The authors do not use that term, preferring instead the administrative integration of diversity, equity, and inclusion efforts. The current political assault on evidence-based reproductive health and bodily autonomy is minimized as “the Dobbs decision reversing Roe v Wade.” Moreover, crucial issues specific to the field of obstetrics and gynecology, such as the maternal mortality crisis, are unmentioned. Even the title’s identification of “evolving times” portrays the current state of the specialty as if naturally predetermined, thereby abdicating leadership of responsibility. This is an inward-looking document; it omits mention of the people we serve. The 1000-word limit of the perspective constricts robust proposal development, but this document is notable also for what it does not say, specifically the power dynamics of academic medicine, which have contributed to the devaluation of women’s health. The absence of awareness, much less discussion, of structural sexism is a tragic missed opportunity. In the decades since Council of University Chairs of Obstetrics and Gynecology’s formation, the quality of surgical care that gynecologists provide has worsened,2Ruiz M.P. Chen L. Hou J.Y. et al.Outcomes of hysterectomy performed by very low-volume surgeons.Obstet Gynecol. 2018; 131: 981-990Crossref PubMed Scopus (41) Google Scholar birth has become progressively unsafe, racial disparities in female-specific conditions have widened, and our workforce, which is composed predominately of women, is increasingly underpaid,3Watson K.L. King L.P. Double discrimination, the pay gap in gynecologic surgery, and its association with quality of care.Obstet Gynecol. 2021; 137: 657-661Crossref PubMed Scopus (12) Google Scholar harassed,4Heisler C.A. Mark K. Ton J. Miller P. Temkin S.M. Has a critical mass of women resulted in gender equity in gynecologic surgery?.Am J Obstet Gynecol. 2020; 223: 665-673Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar and burned out. True leadership requires courage, especially during a crisis. However, leadership in obstetrics and gynecology seems to be asleep at the wheel. It may be time to rethink the organizational structure of academic departments and how our leaders are chosen. We should consider models of leadership that are collaborative and inclusive and where responsibility is rotated and shared. The status quo is unacceptable. To truly advance women’s health, more thought into the evolution of the specialty is needed. Navigating an equitable course on more challenging roads: a responseAmerican Journal of Obstetrics & GynecologyPreviewWe would like to respond to comments raised in the letter to the editors regarding our recently published article entitled “Reimagining the Council of University Chairs of Obstetrics and Gynecology (CUCOG) in evolving times.”1 Our goal was not only to familiarize the readership with the history of CUCOG but also to describe our purposeful efforts to develop a new strategic plan for the organization that better represents the needs of those we serve. The article outlines the key components of the 2021 strategic plan, which was developed in collaboration with the CUCOG board of directors with input from several obstetrics and gynecology department chairs and facilitated by a professional organization with expertise in creating such plans. Full-Text PDF