OB anesthesia, good living?

[BIGphysician]

A year ago this would have sounded like an oxymoron,

but after doing OB for a year+, I'm actually sort of liking it. We get a ton of OB experience at my residency, would it be worth doing a fellowship in OB? My ideal job would be doing general anesthesia and covering OB maybe 2-3 days a week... only DURING THE DAY. Does this job exist? I really never want to take call ever again (even with general OR, but im more willing to take OR call than OB). Whats everyones opinion?

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[Ezekiel2517]

worth it only if you want to stay in academics

 

[deleted171991]

A year ago this would have sounded like an oxymoron,

but after doing OB for a year+, I'm actually sort of liking it. We get a ton of OB experience at my residency, would it be worth doing a fellowship in OB? My ideal job would be doing general anesthesia and covering OB maybe 2-3 days a week... only DURING THE DAY. Does this job exist? I really never want to take call ever again (even with general OR, but im more willing to take OR call than OB). Whats everyones opinion?

Sure, this job exists... for the division leader.

If you want a mommy-track job, look for one in a surgicenter. For that, your best bet is a regional or pain fellowship, not OB.

Call is like investing: if you find the right place, they will pay you good money for doing much less than in your regular job.

 

[chocomorsel]

It is an absolutely good living. Reimbursement is good from what I hear. The OB group in town makes some nice cash. However, they work like dogs. Yeah, if you want mommy track, OB is not it. That's a 24/7 Horror show. I am glad I hopefully never have to do that again, even though I enjoyed it in residency.

 

[nimbus]

It's not common but there are situations where the bulk of heavily stipended OB night shifts are willingly taken by 1 or 2 people allowing the rest of the OB anesthesiologists to do mainly daytime shifts and easy gyn cases. Of course they take a heavy cut in income. It's not exactly mommy track but more like OB princess track.

 

[Planktonmd]

Anyone who thinks doing OB anesthesia exclusively is a good career choice is either crazy or on crack!

 

[narcusprince]

I have worked at multiple hospitals doing OB and some places I really enjoyed it. Mainly hospitals which had a full ob hospitalist model. Where the primary ob attending and the ob hospitalist cut together. C-sections took 20-30 minutes their was rarely a crash and dash to the OR. Ob is one of those areas when its good its good, but when its bad its horrible....... Good luck!

 

[Man o War]

Anyone who thinks doing OB anesthesia exclusively is a good career choice is either crazy or on crack!

One of my buddies from residency works 100% OB, doc only model. He has a crazy good lifestyle and excellent pay for how much he works. I too think this is somewhat risky though. Maybe he knows something I don't?

 

[Planktonmd]

One of my buddies from residency works 100% OB, doc only model. He has a crazy good lifestyle and excellent pay for how much he works. I too think this is somewhat risky though. Maybe he knows something I don't?

How old is your friend? When people are young and foolish they tend to do crazy things like bull wrestling, swimming with sharks, or 100% OB anesthesia practice. Fortunately they eventually grow up and realize how crazy they were!

 

[Man o War]

How old is your friend? When people are young and foolish they tend to do crazy things like bull wrestling, swimming with sharks, or 100% OB anesthesia practice. Fortunately they eventually grow up and realize how crazy they were!

Truth. He's in his 40s. Not going to lie, I have pangs of jealousy sometimes!

 

[nimbus]

One of my buddies from residency works 100% OB, doc only model. He has a crazy good lifestyle and excellent pay for how much he works. I too think this is somewhat risky though. Maybe he knows something I don't?

Vegas?

 

[Man o War]

Vegas?

No, but I heard about that place too.

 

[Consigliere]

A year ago this would have sounded like an oxymoron,

but after doing OB for a year+, I'm actually sort of liking it. We get a ton of OB experience at my residency, would it be worth doing a fellowship in OB? My ideal job would be doing general anesthesia and covering OB maybe 2-3 days a week... only DURING THE DAY. Does this job exist? I really never want to take call ever again (even with general OR, but im more willing to take OR call than OB). Whats everyones opinion?

What are you an as_shole?

 

[chocomorsel]

Consigliere, you are the true ass hole.
Was that really necessary? You are one miserable dude and I guess you want everyone else to be as well.

 

[pgg]

Keep it civil.

 

[urge]

, but im more willing to take OR call than OB

Don't understand how you like OB only during daytime.

There is nothing going on in OB during the day. Perhaps what you mean to say is that you like doing nothing all day?

Same with OR call at night. There is nothing going on.

 

[Monty Python]

Don't understand how you like OB only during daytime.

There is nothing going on in OB during the day. Perhaps what you mean to say is that you like doing nothing all day?

Same with OR call at night. There is nothing going on.

Would essentially agree, except we average 2-4 elective scheduled c/section each week, and 1-2 epidurals daily during business hours. Our c/section OR is on the labor deck, separate from the main OR suite two floors down, and is covered by the OB duty person. We ran some numbers last month, and about 95% of our after-hours work is L&D with little OR call-back.

 

[Mman]

OB is one of the most varied experiences in the anesthesia world and is completely hospital dependent. What you experience doing OB at a small community hospital is worlds apart from a busy women's hospital. Some places deliver 5,000-20,000 babies a year. That's 100-400 per week. Start doing the math with things like a 30% c-section rate or 75% epidural rate and you can get really busy. We are fortunate to be in the 3,000-4,000 delivery per year range. I'm not sure I could take any more. My personal record during 12 daylight hours is 11 epidurals and 8 c-sections and that is way more than enough for my taste.

 

[chocomorsel]

Mman, how is it possible for one person to do 11 epidurals and 8 csections in a 12 hour period? Were you supervising some epidurals and sections?

 

[Mman]

Mman, how is it possible for one person to do 11 epidurals and 8 csections in a 12 hour period? Were you supervising some epidurals and sections?

ACT model. I place all the spinals and epidurals, but I'm not helping snap pictures in the room for 30 minutes while they close.

 

[chocomorsel]

That is still a lot. I have not been able to make it into a room and out in less than 25 minutes when doing an epidural. The paperwork alone while sticking around to make sure it's working takes a good 10-15 minutes. Even in a fast straightforward skinny patient. Maybe I am just slow.

 

[Mman]

my average room time for an epidural is about 8-10 minutes including consent. I don't stick around for 15 minutes to make sure it works. I know it'll work. On the rare chance it isn't, I come back. I put in orders and document the note after I leave the room. I can type faster when not being asked questions, though on the EMR my epidural note is prefilled with almost everything so I can type that note in about 15 seconds.

 

[Libertas]

I do a lot of shifts at a busy women's hospital. In room time for an epidural is 10-20 minutes....mostly the limiting factors are getting a nurse into the room and positioning the patient. If we had more help like some of the private hospitals it would definitely speed things up! I don't stay too long for an epidural (leave room, document outside, check back in a bit) but if I place a cse I am more cautious watching the tracing for tachysystole.

 

[chocomorsel]

my average room time for an epidural is about 8-10 minutes including consent. I don't stick around for 15 minutes to make sure it works. I know it'll work. On the rare chance it isn't, I come back. I put in orders and document the note after I leave the room. I can type faster when not being asked questions, though on the EMR my epidural note is prefilled with almost everything so I can type that note in about 15 seconds.

Ok, yes, I am sure any one proficient in epidurals doesn't have many failed ones. I stick around to make sure that the patient is comfortable and happy with their pain, not that they will be comfortable in an hour. I want them as comfortable as possible before I leave and most times I have the time. So I stay in the room and document as I wait since our documents are on paper anyway. Talking to pt for a quick hx and exam, getting them positioned and doing the procedure takes about 15 minutes. If I just went in and did the epidural without taking any kind of hx or positioning or doing paperwork, I could be out in 10 minutes if not a difficult placement. I am a little OCD though about hx and PE and paperwork so it takes me a while.

If I did that many in a 12 hour period, I would be ready to go quit. I realized too when doing OB that I hate when my patients are awake and talking to me. I don't like feeling obligated to go goo goo gah gah over baby and pretending to enjoy small talk with a stranger.

Glad I don't have to do OB anymore, and if I can help it will never do it again.

 

[pgg]

OB speed is ALL about having good nurses to handle everything except the consent and needle driving.

It's hard to be in and out in 20 min or less if you have to get your drugs, talk her into position, program the pump, etc.

Also, CSEs are faster than epidurals.

 

[Mman]

Ok, yes, I am sure any one proficient in epidurals doesn't have many failed ones. I stick around to make sure that the patient is comfortable and happy with their pain, not that they will be comfortable in an hour.

I'm not one for making small talk after the epidural is in. They are generally comfy within 5-10 minutes of me leaving the room. If they aren't happy in 15 minutes the nurses call me back. It certainly doesn't take an hour to get someone comfy with an epidural.

 

[chocomorsel]

Yup. I hate small talk too. Guess I certainly could trim the time but going in, doing business, and leaving.
Either way, do not miss OB at all.

 

[narcusprince]

Im about 10-20 minutes per epidural. Only issues coming in are ensuring a consent form has been signed and nursing getting the patient upright for placement. I do not enjoy ob here at least their is a higher level of stress walking in to the patients rooms.

 

[Consigliere]

Any experienced anesthesiologist will tell you that OB anesthesia is a special type of hell.