02-04-2004, 05:48 PM
So... I'm finishing off L&D, and I loved it. But I have no desires of becoming OB/Gyn.
And so my question is, in the real world, how does it work for FP's who deliver babies? Do FP's have a room or two in the FP center/clinic devoted for monitoring and delivery? Does the FP send the patient to the hospital L&D, and if so, does s/he just sit there until they deliver? What happens if you're in the middle of labor or delivering, and you realize that she needs to get cut? Is there usually an OB back up in these situations? When patient gets admitted to L&D, does the OB also see the patient or do they wait until crap hits the fan to say hi?
At my school, I haven't seen FP's around... and all the normal vag deliveries are done by midwives.
I just don't know how it works... Hope someone out there knows.
02-04-2004, 10:33 PM
at our hospital all the fp groups in town do simple deliveries with each member of the group taking ob 1st/2nd/3rd call x nights/month. the pts who are known to be difficult are refered to ob months before. the setting is a hospital birthing center and there is always an ob on call for sections, etc
each fp doc has to do a minimum avg of 4 deliveries/mo to keep ob privileges. this is not a problem. in fact they often use nurse midwives as well because all of the group's ob call docs are already catching kids down the hall.
those members of the group who don't want to do ob don't have to but they make less$$$ as a consequence
02-05-2004, 06:51 AM
So are they only choosing to do easy deliveries?? I'd like to do some more complicated ones as well as sections too. Seems like the FPs should be able to do episiotomies, repairs, and D&Cs if necessary...or is that just living in fantasy land in world of litigation?
02-05-2004, 08:11 AM
Well... in any vaginal delivery you can have episiotomies and laceration repairs... I think that's part of any standard obstetrics and so any well-trained FP should be able to handle stuff like this, I would assume. There's really not much to it.
But after seeing what I've seen in L&D, I really want OB/Gyn to back me up because it can get really scary. And while I'm sure the couple of *months* in OB during residency will prepare me, I'm not sure if I want to commit to doing a crap load of OB to keep up with the latest skills. I mean, things can get really crazy that even Obstetricians need to call in Maternal-Fetal Medicine to come in and help manage both the medical and obstetrical issues. So while I'm confident that I'll be ready after a good FP residency, I'm not so confident that I can offer everything. And I'm not THAT crazy about OB that I want to do 1-year of fellowship to do higher risk stuff.
Do people really have difficulties getting hospital privileges for L&D or is it only for the FPs who want to do c-sections? See... the way I see it is that C/S aren't difficult surgeries... especially if you take the time and effort to train for it during residency. The problem for me is being trained and keeping current with what to do when things go down, because from what I've seen, they go down FAST. And I imagine most private practice deliveries don't have a team of nurses and students there to apply pressure AND call for help.
And while I'm at it, does anyone know what the break-even point in deliveries are in terms of malpractice? I've heard 2 deliveries per month. So 4 to maintain privileges sounds do-able in terms of being up all night.
Does anyone know of any FP's doing OB out there? Any FPs who do C-sections? And if so, what part of their practice do they tend to sacrifice if they want to keep current with OB? (1 FP doc I followed in Alaska does OB, but gave up pediatrics by bringing in a general pediatrician into the practice so she can do more OB work... she helps cover Pedi on calls and stuff, but basically lets her Pedi partner take it on.)
02-05-2004, 12:09 PM
4 is the requirement here for malpractice coverage so the hospital made it policy.
all the fp docs do episiotomy repair, etc.
what I meant by difficult ob pts was twins, breech, strange presentations, lots of comorbid factors, etc
if you want to do sections you need to do a bunch as primary surgeon in residency(> 30 or so for most hospitals) or do a fellowship.....