EM vs Ob/gyn Advice please!

[CaliCol]

I know this has been discussed a few times in the past, but it is beginning to become that critical point where I must choose between the two specialities for residency. I have completed 3 rotations in ob/gyn and 1 rotation in ER (level 1 trauma). I have to say I thoroughly enjoyed both specialities. I liked the pace and variety and the ability to do procedures. During my ob/gyn rotations, most of the docs tried to turn me away from it, which I found alarming. I want to have a family in the future and am worried about the ob/gyn call/stressful lifestyle.

ob/gyn pros: enjoy the subject, love having "my" patients, love the procedures, fast paced, variety, rewarding, possible fellowship
ob/gyn cons: stressful, high liability, dec reimbursement, lots of hours, high burnout, malignant residencies,? almost too much estrogen, some horrible outcomes

ER pros: great variety, fast paced, nice income, ability to move around, ability to do as many shifts as you want, laid back personality, enough ob/gyn, procedures
ER cons: works 1/2 nights/weekends/holidays, high burnout/liability, not memorable, everyone hates the ER docs, bad patients, hospital administrations overrule docs, no professional development

If anyone has any insight or was in this position, can you explain how you decided or what you ended up going into?
Thanks!

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[dchristismi]

If you ONLY love women's health care, operating, and delivering babies, do OB. If you can't imagine only doing that for the rest of your career, consider EM.

Do you like seeing kids? Old people? Men? Not much of that in OBGYN. The OBGYN lifestyle sucks. Not that ours is much better - shiftwork is nice, but someone has to work the sucky shifts. The ED never closes. Of course, last I checked, neither did L&D. We do plenty of procedures, but don't go to the OR. How much do you love the OR?

For me, the clincher was that I really liked the variety of EM. I saw little babies, and old people, and pregnant women, and teenagers making dumb choices... all in the same shift, and didn't want to limit myself to *just* any one group.

And whaddya mean "not memorable?" We have the best cocktail party stories in all of medicine. And we're more fun to hang out with than grouchy, stressed, overworked OBGYNs. I kid. Sort of.

 

[Birdstrike]

And whaddya mean "not memorable?" We have the best cocktail party stories in all of medicine.

"Man, that was one bad a$$ placenta"

 

[TheBlueBlazer]

ER cons: ... not memorable...

For real? Something makes me wonder if you understand the things that go on in the ED. We outpace most other specialties for the most crazy/interesting cases and REALLY outpace them for the "Holy Crap, you're not EVER going to believe the idiot I just saw" cases.

 

[Hercules]

I think the OP meant not memorable to the patients

 

[iish]

You should figure out how much it matters to you that you have your "own" patients. I find that when I talk to attendings 10, 15, 20 yrs out of residency, this seems to be the one thing they say they don't like about being an ED attending int he middle of their careers.

 

[styphon]

If you ONLY love women's health care, operating, and delivering babies, do OB. If you can't imagine only doing that for the rest of your career, consider EM.

Do you like seeing kids? Old people? Men? Not much of that in OBGYN. The OBGYN lifestyle sucks. Not that ours is much better - shiftwork is nice, but someone has to work the sucky shifts. The ED never closes. Of course, last I checked, neither did L&D. We do plenty of procedures, but don't go to the OR. How much do you love the OR?

Additional things to consider:

In OB your patient demographic is limited: You will see females. No guys, no babies (except for circumcisions) - if this bothers you ER would be the better choice.

OB/GYN does have the opportunity for shift work - they are called laborists, some ONLY cover the L&D (do no surgery or outpt clinic) at specific times w/ no oncall. To do this you would likely need to live in a major urban area/large suburb.

Often when OB/GYNs tire of getting woken up at random times, missing their kids plays/games/events they will go into GYN surgery only w/ outpatient consults - if you hate/love the OR this will factor in greatly.

 

[Birdstrike]

You should figure out how much it matters to you that you have your "own" patients. I find that when I talk to attendings 10, 15, 20 yrs out of residency, this seems to be the one thing they say they don't like about being an ED attending int he middle of their careers.

Most of the ED attendings mid career that I've known, wished they had no patients. Lol

 

[Transmogrifier]

What do you mean by no professional development for EM?

 

[CaliCol]

whoops, sorry I meant not memorable to the patients. Obviously to some pts the ER doc definitely is, but to the majority it is "the ER doctor." ER stories are definitely memorable though! I love the atmosphere and the craziness of it!
By professional development, I guess I mean that you really only can do shifts in the ER or urgent care, can't step down or pick things you like as in ob/gyn- by eliminating OB.

The hospital I rotates at really only had younger ER attendings, I only came in contact with a few attendings older than age 40, which surprised me.
What does the future of ER hold? How will practice be in 10 years?

 

[dchristismi]

Ah, but there are many options open in EM down the road. Administration, EMS, Toxicology, Ultrasound, Pain, Palliative Care, Sports Med... plenty of options. Cut down to part time, see the world, travel.

And maybe it's just that I practice in a small town, but yes, I do have regular patients. Sometimes that's a good thing. Sometimes it's not. Your mileage will vary. One of my midlevels knows every "crazy" person in town as she has managed to become our go-to psych gal. They call to wish her happy birthday on her birthday, and ask for her by name. Seriously.

Now, you realize you're getting the EM slant because of who you're asking. I hope you're asking the same thing in the OBGYN forum, because I imagine you'll get different answers. Or ironically, maybe you won't...

 

[Birdstrike]

whoops, sorry I meant not memorable to the patients.

I think Emergency Physicians are more memorable than they think. Read this, which first was an SDN post of mine, then moved here:

http://drwhitecoat.com/remember/

 

[Birdstrike]

The hospital I rotates at really only had younger ER attendings, I only came in contact with a few attendings older than age 40, which surprised me

That's because in this environment, they all undergo spontaneous human combustion on their 40th birthday. It's an EM thing.