FP Obstetrics fellowship or not?

[Shinken]

I'm interested in FP with obstetrics (including high-risk, C-sections, etc.). The AAFP website offers a list of programs that offer obstetrics fellowships, but the list of programs is limited, and very few are in states where I'd like to move my family to.

After speaking to several FP programs, many claim that although they don't offer an obstetrics fellowship per se, they do offer "extra" time and training in OB, and some even will train the FP resident to perform C-sections, tubals, etc.

My questions is, how realistic would it be to graduate from an FP program and be able to do OB without going through the extra 1 year fellowship? Is the fellowship more of an advantage when it comes to securing hospital privileges or malpractice insurance?

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[deleted87716]

how realistic would it be to graduate from an FP program and be able to do OB without going through the extra 1 year fellowship? Is the fellowship more of an advantage when it comes to securing hospital privileges or malpractice insurance?

Fellowship training is for your own benefit; it's not required to do OB as an FP. If your residency gives you enough training to enable you to feel comfortable, you should be fine. Your success in securing privileges will depend on many things, most of which will be specific to your practice locale, although fellowship training may make this easier. Your malpractice rates will likely be no different with or without the fellowship. And don't be fooled by your first-year insurance rates. They will go up after you've been in practice for a year or so, even if you have no claims.

 

[Anath]

I'm interested in FP with obstetrics (including high-risk, C-sections, etc.). The AAFP website offers a list of programs that offer obstetrics fellowships, but the list of programs is limited, and very few are in states where I'd like to move my family to.

After speaking to several FP programs, many claim that although they don't offer an obstetrics fellowship per se, they do offer "extra" time and training in OB, and some even will train the FP resident to perform C-sections, tubals, etc.

My questions is, how realistic would it be to graduate from an FP program and be able to do OB without going through the extra 1 year fellowship? Is the fellowship more of an advantage when it comes to securing hospital privileges or malpractice insurance?

From what I understand though, and from what I've garnered on my interview trail, many places will give you a OB heavy experience if you desire it, but I still got the impression that high-rish OB and c-section experience is still very limited without taking that fellowship. Many places said that the Ob/Gyn's handled the high-risk cases. I had been thinking about OB and even chose a program with a lot of OB (as well as a fellowship, might I add), although I will probably not take that route in the long run. But power to ya! Im not brave enough to want to realistically tread those waters, esp if i plan on moving back to the D.C. area.

 

[Shinken]

Sorry to resurrect this thread, but I have new questions related to OB in FP residencies.

Do academic programs seeking a family physician to teach FP w/OB prefer a fellowship-trained doc?

Also, I just found out that Summa Health System in Akron offers an optional 4th year in their family medicine residency. That 4th year can be used for whatever you wish to become better at (do research, do more OB, procedures, etc.). Would employers consider that additional year of OB training equivalent to a fellowship in OB? I guess I'm kind of fixated on that word "fellowship" and whether or not an 'official' fellowship makes more of a difference than simply more OB training during residency.

Finally, does a fellowship in OB result in a certificate of added qualifications? would an additional year doing OB (although not officially called a "fellowship") also lead to a certificate of added qualifications?

 

[erichaj]

Sorry to resurrect this thread, but I have new questions related to OB in FP residencies.

Do academic programs seeking a family physician to teach FP w/OB prefer a fellowship-trained doc?

Also, I just found out that Summa Health System in Akron offers an optional 4th year in their family medicine residency. That 4th year can be used for whatever you wish to become better at (do research, do more OB, procedures, etc.). Would employers consider that additional year of OB training equivalent to a fellowship in OB? I guess I'm kind of fixated on that word "fellowship" and whether or not an 'official' fellowship makes more of a difference than simply more OB training during residency.

Finally, does a fellowship in OB result in a certificate of added qualifications? would an additional year doing OB (although not officially called a "fellowship") also lead to a certificate of added qualifications?

Most FP programs say that they give you enough ob training. Reality is that most don't. You will be able to deliver babies and manage their before and after care. But, you will have to have a certain number of C-sections for a hospital to credential you. As far as tubals, I don't know of any FP program that will train you enough to be able to do them on you own.

Think about it, most FPs don't do these and if they are in programs that don't have ob fellowships the faculty most likely will not know how to do them. Even if they did, they don't get the number.

If you really want to do OB, you best bet is to suck it up and go to one those places you don't want to go to. It's only for one year.

 

[Tn Family MD]

We have an OB fellowhip here (UT Knoxville) that trains in C-section, tubals, and vag and abd hyst. It is run by the OB program here so all your training is under OB/Gyn docs. It includes weekly clinic with the Maternal-Fetal Medicine docs (i.e. high risk) so you get great exposure. The OB/Gyn program here is only three residents per year so they are always happy to have an FP fellow to share call with, etc. Finally, a fellowship does not result in a CAQ.

BTW, I am planning on doing the fellowship here. It's one of the big reasons I decided to come here for residency. That along with the procedural experience. And the location.

 

[drwatson]

Medical Student question here: Does an OB fellowship affect your insurance rates as well? Will your rates be lower due to the extra year of training?

 

[sophiejane]

Medical Student question here: Does an OB fellowship affect your insurance rates as well? Will your rates be lower due to the extra year of training?

Nope.

But...there are situations, hospitals, groups, etc. in rural areas (and I mean WAY rural) who have enough of a need for a doc to do deliveries that they will pay the difference in your insurance from what it would be without OB to adding OB.

These are rare, so one should not do a fellowship banking on such a situation unless you already have a job offer.

 

[Shinken]

We have an OB fellowhip here (UT Knoxville) that trains in C-section, tubals, and vag and abd hyst. It is run by the OB program here so all your training is under OB/Gyn docs. It includes weekly clinic with the Maternal-Fetal Medicine docs (i.e. high risk) so you get great exposure. The OB/Gyn program here is only three residents per year so they are always happy to have an FP fellow to share call with, etc. Finally, a fellowship does not result in a CAQ.

BTW, I am planning on doing the fellowship here. It's one of the big reasons I decided to come here for residency. That along with the procedural experience. And the location.

I just checked out their website and unfortunately the site states that the fellows must have completed their FP residency at Knoxville. I'm planning to stay in Ohio for FP, so Knoxville is not a possibility for me.

But...there are situations, hospitals, groups, etc. in rural areas (and I mean WAY rural) who have enough of a need for a doc to do deliveries that they will pay the difference in your insurance from what it would be without OB to adding OB.

Yes, I actually know a physician in a small, rural town that does OB including emergency C-sections (no elective C/S) and his malpractice is paid by the hospital where he has privileges at. Pretty nice arrangement.

By the way, sorry to reply so late but I moved to a new house and spent a few days without an internet connection (yes, it's possible to live without SDN!!). Luckily, I can now indulge in my SDN addiction again.

 

[Doc Oc]

Have you looked into Memorial HOspital in SOuth Bend? It's not too far from Ohio, has very high volume, is unopposed, and has an OB fellowship.

 

[Tn Family MD]

Sorry Shinken, I thought you were not yet in residency. Having a very strict set of criteria for what region you want to be in may make it difficult for you.

 

[Shinken]

Have you looked into Memorial HOspital in SOuth Bend? It's not too far from Ohio, has very high volume, is unopposed, and has an OB fellowship.

Yes, I've actually looked into that program seriously. The physician I spoke of before that had his OB malpractice paid by the hospital is a Memorial grad (didn't do the OB fellowship though...the experiences he got while a resident were enough. I think that's great).

They probably give preference to grads of their own program to fill the OB spot, but it's definitely on my list of possibilities.

 

[Shinken]

Sorry Shinken, I thought you were not yet in residency. Having a very strict set of criteria for what region you want to be in may make it difficult for you.

You're correct, I'm not yet in residency (will be in a few months! Woo hoo!). I'm pretty much set in staying in Ohio for the FP residency but I'm looking for fellowships pretty much anywhere.

Unfortunately, there's only one OB fellowship in Ohio and it's at Universtiy Hospitals in Cleveland. Good hospital, good program, but their FP program seems to be very academic and most definitely not unopposed. Right now if the Summa extra year and UH don't work out, it's very likely I'll go out of state for the fellowship.

 

[slim shanie]

That's really weird... I found two websites with listings of OB fellowships and not all hospitals are on each...

http://www.aafp.org/fellowships/obstet.html

http://www.aafp.org/residencies/felobst.html

I guess some just offer the fellowship to FP without having an FP residency there? I dunno... one of the schools I looked at that has the fellowship wasn't on the initial list and I found it on the other site.

 

[deleted87716]

That's really weird... I found two websites with listings of OB fellowships and not all hospitals are on each...

Fellowships are more loosely-organized than residencies. I believe a fellowship has to request to be included on the AAFP list, which explains why some may not be on there. If a fellowship is new, it may not make the list right away.

IMO, the better fellowships will likely be on the list.

This may help, as well:

ACGME Fellowship Definition

The Accreditation Council for Graduate Medical Education (ACGME) information section of the Institutional Requirements states the definition of a Fellow: A term used by some sponsoring institutions and in some specialties to designate participants in subspecialty graduate medical education (GME) programs. The GME Director and the ACGME use resident to designate all GME participants in ACGME-accredited programs.

ACGME calls the programs they accredit residencies and reserves the fellowships for those programs that do not fall with in the ACGME accreditation system.

These fellowship programs are private arrangements made between an institution and the individual who trains in them. They are not accredited by the RRC/ACGME and they do not lead to certification (CAQ) by the American Board of Family Practice (ABFP).

The only fellowships that are accredited by the RRC/ACGME and lead to certification (CAQ) by ABFP are in geriatrics and sports medicine.

Source: http://www.aafp.org/fellowships/#acgme

 

[Messerschmitts]

Hello all, I'm resurrecting this thread as I have some questions regarding an OB fellowship for FM. How competitive is this fellowship? What are job opportunities like for an OB-fellow trained FM doc who wants to incorporate a significant amount of OB? Is it simply not feasible outside of rural areas? Who's gonna trust their C/section to a FM doc in the large cities if OB/GYNs are available? Just curious, thank you!

 

[Nick Name]

What about working as a first assist? Even in large cities? Can doing alot of c-sections in residency help you work as a first assistant in c-sections?

 

[faith100]

It has been a few years since this thread was started. Has anyone completed a fellowship? If so, would you recommend it, esp since there are now some 4 yr FM residencies that give you an extra year to focus on a desired area.

Do you feel the fellowship is valued vs no fellowship?
Does the fellowship affect (lower) malpractice rates?
Any other advice greatly appreciated - interested in FM w/ OB in small city or rural area.

 

[Shinken]

It has been a few years since this thread was started. Has anyone completed a fellowship? If so, would you recommend it, esp since there are now some 4 yr FM residencies that give you an extra year to focus on a desired area.

Do you feel the fellowship is valued vs no fellowship?
Does the fellowship affect (lower) malpractice rates?
Any other advice greatly appreciated - interested in FM w/ OB in small city or rural area.

Wow, this thread brings back memories...

Just as an update, I decided against an OB fellowship, and decided against delivering babies, etc. due to the liability and the hours/lifestyle. I've been 2 years out of residency training now and I don't regret my decision.

 

[faith100]

Thanks for your reply, Shinken!

 

[deleted480308]

Wow, this thread brings back memories...

Just as an update, I decided against an OB fellowship, and decided against delivering babies, etc. due to the liability and the hours/lifestyle. I've been 2 years out of residency training now and I don't regret my decision.

Thanks, I've been wrestling with the concept of just avoiding birthing altogether

 

[Shinken]

If you really like delivering babies and don't mind the lifestyle, then it's OK, but you have to deliver quite a few babies to make it worth your while (economically speaking...making sure your reimbursement makes sense for the added liability).

 

[drcrispmd]

It is very difficult for FP docs to get C-section privileges at hospital, but possible. The hospitals are usually the small rural hospitals. ETSU (East TN State Univ.) in Bristol give you a ton of OB experience. Unopposed program. We provide 24/7 coverage to the 2 OB groups in Bristol in the L&D department, see all triages, do almost all deliveries and assist on C-sections. There are also 2 FP docs we do the same (they do not have privileges to perform C-sections in the hospital). We also have a very easy time getting our continuity OB patients (patients you follow in the clinic prenatal, deliver, see postpartum & take care of baby).

 

[aulive]

Wow - an old threat that keeps going. I have a question about the flip side of this equation.

Is there a track for OBGYN training that allows you to gain exposure into primary care?

I'm planning on going into OB, but really like the idea of being able to also be a primary care doctor for women. (This also seems attractive for times in life in which frequent call may not be ideal i.e. with young children or when I get older.) Recent literature I have read said that many OBs do not feel they have sufficient primary care training. My understanding is that you can do an OB fellowship after family medicine training, but there is not a way to do a primary care type fellowship after OB training.

 

[VA Hopeful Dr]

Wow - an old threat that keeps going. I have a question about the flip side of this equation.

Is there a track for OBGYN training that allows you to gain exposure into primary care?

I'm planning on going into OB, but really like the idea of being able to also be a primary care doctor for women. (This also seems attractive for times in life in which frequent call may not be ideal i.e. with young children or when I get older.) Recent literature I have read said that many OBs do not feel they have sufficient primary care training. My understanding is that you can do an OB fellowship after family medicine training, but there is not a way to do a primary care type fellowship after OB training.

So far as I know, there's no way to do this. You could study up on your own or via CME to get primary care issues specific to women (bone density for example), but do you really want to give up OB for hypertension and diabetes long term?

 

[keedz]

Does anyone have any idea about the overall process to apply for FM OB fellowships? There is NOTHING that I can find anywhere. Does anyone know if the interview season for this year is done?

 

[VenturaResident]

Each program has their own application process; there's not a unified system like the Match for residency. Best bet is to call or email the program to find out. Some places have already filled, some haven't decided yet. But if you are thinking about starting fellowship in summer of 2015, it does seem a little late in the season to start applying.

 

[styphon]

Look on the individual websites for dates/application process.

Most hospitals around my area require +200 c/sections to get hospital privledges. There also opporunities in places besides "very rural" - but it is usually places that struggle to recruit people, ex: inner cities, poor towns, Indian Reservations....