family vs ob

[nmb]

So I've always been dead-set on primary care (I know it sounds cliche or old-fashioned...) and most notably family practice. However, it was during my clerkships that I became frustrated with the notion of family practice being just managers and not 'doers'. I grew up in the middle of freakin' nowhere (I mean nowhere... 1 room country school house, uphill to school both ways with 3 siblings all on a 3-legged pony) and the nearest physician was 50miles away -- this physician was God-like and did everything..... Well, of course, this feeling is nostalgic and now replaced with more knowledge and even some first-hand-type knowledge after clinicals and summers doing work in these rural clinics... Yada Yada Yadee......

Anyway... I decided Ob/Gyne was for me... love it... have personality to deal with it all (am very flexible and probably manic so hours are no big deal)... applied this fall... have all interviews set up and feel trapped at this posting. I have this feeling that I want to be doing and should be doing family med (I also failed to mention that I have a NHSC Scholarship so must do primary care or I owe the government some $400,000; hence, the impetus for a primary care field with no deviation from). Family med will also allow a little more time for my body building which I'm terrified of giving up, and my relationship which is a keeper and has plans for the duration which I'm also terrified of losing to the L&D trench battles!... Is it wrong or selfish to limit my career because of parts of me that I don't want to give up.

From the outside, of course, it looks like it's a no-brainer and family med it should be.... I also fear what others do in that NPs and PAs could squeeze us out.... Should it be family med or ob?

Can I apply to family programs now before all the deadlines are past.... will the Ob/Gyne programs know? I haven't talked with my adviser or dean about this... just wanted some feedback from others. I'm thinking of only going to a few of the ob/gyne interviews (or calling and cancelling them all) and just banking on family?... I am a solid candidate either way; I just feel my heart is in family medicine. Are there any snaffus with ERAS or NRMP that I should know about or logistics????? Policies on applying to multiple specialties???? I don't feel like asking my classmates just for fear of them or people thinking I'm whimsical or capricious... but this is my life, my career and my choice!

Any suggestions? Comments? Others in similar situations?

p.s. I don't know why I didn't use this before... I'm a little leary to post my questions and concerns though... be kind.....

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[bustbones26]

YOu know I can't help you with your application dilemas, but I did want to comment that I do share some of your opinions, please read my post "your opinions on FP" My personal thoughts on FP are that FP's in cities are almost useless. It is truly the rural FP's that get to do all and actaully do all, procedures, deliver babies, etc. I think if you are NHCS, and go FP, you will be in an office that does all.

Also keep in mind that FP's can do a fellowship in Obstetrics. Thsi fellowship gives them the privledges to do C-sections, tubal ligations, high risk obstetrics, etc. So do not give up on OB either is you do go FP.

 

[CambieMD]

I would say do Ob/Gyn as planned. Residency last for a few years and is over. FPs can deliver babies but this is a declining trend given the propensity to sue and high malpractice rates. If after you completing residency training in ob you find your life to be comepletely unbearable you could do subspecialty training in Ob/Gyn.I am referring to fetal- maternal medicine or fertility medicine.That is my two cents worth.

All the best,

CambiMD

 

[ckent]

A lot of OB/Gyn's do no OB and only gyn, creating very manageable hours (and better malpractice premium rates as well). If you love surgery, you should do OB/Gyn. If you could go without being in the OR, you should do FP (or IM). Your relationship could go sour irrespective of what specialty that you go into, and even though OB/Gyn residency hours are bad, with the new 80 hr work week, they aren't so bad that it should completely discourage you from doing the specialty if that's what you really want to do.

 

[BellKicker]

nmb, I think we have more in common than endurance sports and low body fat.

That doctor you described from your youth........ That's who I want to be. I know, like you said, they don't really exist anymore.

But, seriously, if you plan to live in a rural area (like I do) doesn't FP seem like a perfect choice? You could do sports medicine as a fellowship (I know that would work for you) or simply as an emphasis in your practice.

Just a thought.

But hey if it all doesn't work out then you can always apply to psych but 'ya gotta include that sentence "I'm manic so the hours don't bother me"....

Hey, not to change the subject, but what is NHSC? It sounds interesting.

 

[CambieMD]

I have to agree with ckent. Life style should not be the "major" factor looked at in deciding a specialty. There should be a deep interest and excitement about practicing in whatever area is chosen. I spoke to an Ob/Gyn who told me that he was having financial difficulties due to increasing malpractice premiums. He would never think of doing anything else because he loves what he does. A physician can determine his life style, for the most part.
Too many medical students base their decisions on "life style." They say things like ,"I loved surgery but I want to have a family."Looking back , I wonder what one thing has to do with the other.

 

[Adapt]

Originally posted by CambieMD
I loved surgery but I want to have a family."Looking back , I wonder what one thing has to do with the other.

Because they have no life!!! I shadowed a general surgeon and he was in the office from 8 in the morning to 8 at night. Plus he was on call most of the time and he even worked on Saturdays with relatively the same hours. He told me it was hard to have a family with that kind of lifestyle. Medicine is not life. People would like to raise families as well.

 

[VentdependenT]

Maybe you should check out law school or something that requires less sacrifice? Just kidding man. Lots of people are going through the same delimma of deciding what to go into. I say go OB. You don't have to operate or deliver. You may just want to enter the field of genetic counceling or only do fertility. The "lifestyle" options are out there. Plus you can also go for GYN/ONC which is hands down one of the coolest fields in medicine. There was a reason why you chose OB initially, go back to that feeling and figure out why it was so strong.

You can apply to FP right now without any problems. You will get interviews everywhere. If you think you will still end up in a very rural town then FP is a great option. That is the only situation where you are depended upon for, and can do almost everything. However, the caveat is, you are expected to provide a level of care commensurate with your big city counterparts (who can avail resources not found in the rural setting). So you may still be stuck outsourcing things just to cover yourself from litigation.

If you ever to get sick o' the country side you and decide to move to the city it would be wise to have that OB/GYN under your belt. It'll help prevent you from working in a clinic every day for the duration of your career.

Vent

 

[binswanger]

Apply to Family Practice, Keep your OB / GYN interviews. No one is going to find out, unless of course you interview both at the same place, which I wouldn't recommend. You don't have to figure it out right now, give yourself a little more time to evaluate what you want. There are still plenty of FPs who "do it all" and the above posters made excellent points about Fellowships after FP if you want further training be it OB or Sports Med or Rural Medicine.

 

[dj_smooth]

but where are the do-it-alls training at? I keep hearing about FPs doing appys, lap choles, and hernias...so far I have yet to a program that says you will do those. Procedures rural programs are keen to teach are the colpos, colonoscopies, EGDs, etc.

 

[binswanger]

When I say "do it all" I am more talking about deliveries, seeing hospitalized patients, covering the ER, office procedures and ASSISTING on the general surgeries you are talking about. I suppose in the right situation you could do more than just assist but I personally don't know of any FPs who do these general surgery cases by themselves, perhaps someone else could comment on that.

 

[deleted6669]

check out the fp residency at ventura county in ca, they do it all; trauma, appys. c-sections, etc

 

[CambieMD]

I agree with VentdependenT. Going all the way for Ob/Gyn will leave you much more options in the future. I am sure that there are residency programs where the residents do a lot. The question to ask is not if such programs exist. I would want to know if this represents true practice patterns. I would say not.
Unfortunately, insurance reimbursement and a hospitals' willingness to offer privileges determines what we actually do when we complete residency.

 

[secretwave101]

check out the fp residency at ventura county in ca, they do it all; trauma, appys. c-sections, etc

Good luck applying. They're the most competitive FP residency program in the country. I'd have a more stable plan if I were you.

 

[deleted6669]

I am obviously years away from applying but I have a bit of an in there. I used to work at the hospital, was well liked, and am friendly with several of the attendings who might write me letters of req, etc, etc.
but if that doesn't work out my list in no particular order:

ventura county
contra costa county
monterey county/natividad
tacoma family practice
uw rural/spokane
montana family medicine
klamath fall or. rural fp
several east coast rural programs (vermont, maine, nh, etc...)
several other small unopposed programs, mostly bicoastal.