Best FM Residency for Women’s Health Interest - Lots of Qs

[Metamorphosis.DO]

First, thanks for reading this! I know it is long.

I am pretty set on FM. I love it to death. I also really love women‘s health. While I would love the added bonus of delivering babies, until I get closer to finishing medical school, I’m not sure if I want to dedicate so much of my time to OB And I don‘t want their lifestyle. I’d prefer mostly 8-5 with occasional emergencies.

I’ve always loved the physiology of female reproductive system and have 4 sisters so I generally enjoy working with women, particularly as patients, more than men but certainly don’t mind treating men. I am highly interested in general screenings and pelvic exams, birth control including IUD placements/removals, fertility problems, etc. I essentially want to do as much as I can including procedures and Refer to OB/GYN when sx is indicated such as hysterectomies.

I want the best training possible but am not impressed with the “women’s health“ fellowships available for FM docs. I similarly don’t want to live anywhere they are currently available.

1. where is the best residency for these types of opportunities? Or how can I identify them?
2. Is there anyone who thinks I would in fact need a women’s health fellowship?
3. If I end up not getting all the experience I was hoping for in my training at the end of my FM residency, is it possible to learn how to do more procedures after without a fellowship?
4. Are GYN procedures lucrative if done in high-ish volume? (not worried about making 7 figures.. just thought I’d ask as my debt will be pretty health coming out of school..)

While I‘m sure an OB fellowship would overlap with these interests, I don’t want to do that so much because again, the lifestyle in OB isn’t what I’m looking for. However, I’m still open to the possibility. With that, I have another question;

5. How lucrative/realistic is it to limit my pregnant patients at any given time in order to prevent schedule issues while still delivering some? For example, could I only accept a set number of newly pregnant patients at a time so that I only average say, 4 deliveries a month?
6. Could I exclude nulliparous or women in high-risk categories? (the former of the two seems a bit exaggerated or that it may display low confidence).

Again, I’d also be happy without the OB. I just think it would be a special bonus if I got to do it. More interested in the GYN aspect. Thoughts?

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[VA Hopeful Dr]

Its not too difficult to find FM residency programs that would get you adequately trained to do in-office GYN procedures - colopscopies, IUD placement, Nexplanon placement/removal, endometrial biopsy, that sort of thing. If you can manage all of those, most new procedures that come out shouldn't be too difficult to learn. The issue is getting enough volume in practice to make that work. Easy to do if you work in the right places - planned parenthood and FQHCs will likely need your skills. Outside of places like that, a big issue is going to be: are you a male or female? This makes a huge difference. When I finished I wanted to do all of these things. But, I'm a guy. Most of my female patients want a female doctor doing their GYN care.

It would take more doing but there are programs that get pretty good OB numbers if you decide you want to provide that service. But your malpractice costs skyrocket and the extra money isn't all that impressive.

 

[Make Or Break]

I don’t know if you’re male or female but your sdn pic makes you look like a psychopath asking about women’s health.

 

[FrustratedFamDoc]

If your sole interest is gyn, why not just do an OB/Gyn referal and be done with? It WILL give you the best training for what you desire. It sounds like you're trying to back door yourself in to doing womens' health, without doing a specific women's health residency. There are OB/GYNs that only do gyn if that is your interest. Especially as a new grad, you'll be expected to take call, nuking your 8-5 schedule desire.

With that said, there is a fertility fellowship for OB/GYN grads that may be up your alley.

 

[Metamorphosis.DO]

I don’t know if you’re male or female but your sdn pic makes you look like a psychopath asking about women’s health.

I’ll change it since you are made uncomfortable so easily.

 

[Metamorphosis.DO]

If your sole interest is gyn, why not just do an OB/Gyn referal and be done with? It WILL give you the best training for what you desire. It sounds like you're trying to back door yourself in to doing womens' health, without doing a specific women's health residency. There are OB/GYNs that only do gyn if that is your interest. Especially as a new grad, you'll be expected to take call, nuking your 8-5 schedule desire.

With that said, there is a fertility fellowship for OB/GYN grads that may be up your alley.

Nah, I don’t think you read my post. I don’t care to deliver children. It’s not my focus. while I prefer working with female heath related issues, I want to have pts of all ages and genders. Not just reproductive age women. And I want to do plenty of GYN procedures, including some infertility stuff where possible. I don’t think doing 4+3 years post-grad training to then essentially limit myself to ONLY fertility Is anything near what I want. And just doing OB/GYN and then only doing GYN is an option I suppose but what a horrible waste of so much of those 4 years of training where I could be learning more about primary care medicine.

in other words, I wasn’t asking for advise to do OB/GYN residency. Obviously that’s the best place to get GYN experience. But look at the title of the post.. I want to do FM Because I want that scope. I just want to have additional training in any and most everything that FM docs can do in the realm of GYN.

My family doc does a lot of derm stuff because he enjoys it and his residency taught him to do it. he now does accutane after getting more training years back and will also do treatment in office for scars. Didn’t do a derm residency, isn‘t doing mohs surgery either. But.. there is another family doc I know who did a derm fellowship After FM. I’m asking in similar fashion if I should do a fellowship or not and how limited id be?

 

[FrustratedFamDoc]

Literally every paragraph that you first wrote was asking about women's health.

Specifically what is it that makes you want to be a family doc? Understand that the foundation that 99% of us do is managing chronic disease with a sprinkling of the other stuff mixed in. If you do some of the 'other', realize that it will be in conjunction of managing whatever chronic illness that they also come to you with.

If you see yourself as a procedurilist, there are residencies better suited for that purpose. Choose which one best serves your intended pursuit. Don't try and shortcut proper training.

 

[Metamorphosis.DO]

Literally every paragraph that you first wrote was asking about women's health.

Specifically what is it that makes you want to be a family doc? Understand that the foundation that 99% of us do is managing chronic disease with a sprinkling of the other stuff mixed in. If you do some of the 'other', realize that it will be in conjunction of managing whatever chronic illness that they also come to you with.

If you see yourself as a procedurilist, there are residencies better suited for that purpose. Choose which one best serves your intended pursuit. Don't try and shortcut proper training.

Now I see the underlying reasoning for your previous comment. Again, I appreciate your candor and I’ll take that into consideration. Perhaps I need to revisit OB/GYN once more as I do see myself doing more procedures. not that there is anything wrong with chronic disease management.

 

[AMEHigh]

Literally every paragraph that you first wrote was asking about women's health.

Specifically what is it that makes you want to be a family doc? Understand that the foundation that 99% of us do is managing chronic disease with a sprinkling of the other stuff mixed in. If you do some of the 'other', realize that it will be in conjunction of managing whatever chronic illness that they also come to you with.

If you see yourself as a procedurilist, there are residencies better suited for that purpose. Choose which one best serves your intended pursuit. Don't try and shortcut proper training.

Ehh, I kind of disagree with this.
I "specialize" in reproductive health as a family med doc and I think our mindset is different than obgyn and I’m 100% glad I did not do ob/gyn residency. Obviously since I have this specialize I know dozens upon dozens of family med docs like me who focus more on repro health as well, so it’s not like it’s something totally rare.
Family med can really be what you make it and you absolutely do not have to do "typical" chronic diseases management only.

For the OP, you just need to search residency websites and social media to see what’s out there. Then, obviously when it comes time for interviews ask questions about the type of training you’re looking for. Since there are so many family med programs whenever people ask these type of questions it’s not like there’s 1 solid database with info. You can also go to aafp conferences as there are repro health meetings and you can meet with other residents and attendings.

As far as my day to day, the care i provide is mostly: prenatal care (don’t do deliveries), postpartum care, obviously contraceptive counseling and iud and nexplanon placement and removal (including difficult removals), colposcopy, endometrial biopsies, abortion care, miscarriage management, basic fertility work up and treatment, I&D, skin biopsies. I’m also trained in ultrasound for pregnancy dating and IUD localization. I will manage "basic" things like anxiety, depression, simple derm stuff, etc. But if you have an A1C of 9, I’m referring out to the persons pcp or finding them one.

I was hoping to get trained in vasectomies but that hasn’t happened yet. I know a few people that have trained as attendings so hopefully one day. I obviously also see boys/men and transgender patients.

As far as jobs go, there are plenty of jobs you could get such as student health, sexual health clinics/centers, family planning centers, public health departments, family med residencies where you teach all the repro health stuff, and the list goes on.

I’m so so glad I didn’t do obgyn. I have no desire to ever be in the OR again and no thank you to being on call or working a 24 hour shift.

 

[Metamorphosis.DO]

Ehh, I kind of disagree with this.
I "specialize" in reproductive health as a family med doc and I think our mindset is different than obgyn and I’m 100% glad I did not do ob/gyn residency. Obviously since I have this specialize I know dozens upon dozens of family med docs like me who focus more on repro health as well, so it’s not like it’s something totally rare.
Family med can really be what you make it and you absolutely do not have to do "typical" chronic diseases management only.

For the OP, you just need to search residency websites and social media to see what’s out there. Then, obviously when it comes time for interviews ask questions about the type of training you’re looking for. Since there are so many family med programs whenever people ask these type of questions it’s not like there’s 1 solid database with info. You can also go to aafp conferences as there are repro health meetings and you can meet with other residents and attendings.

As far as my day to day, the care i provide is mostly: prenatal care (don’t do deliveries), postpartum care, obviously contraceptive counseling and iud and nexplanon placement and removal (including difficult removals), colposcopy, endometrial biopsies, abortion care, miscarriage management, basic fertility work up and treatment, I&D, skin biopsies. I’m also trained in ultrasound for pregnancy dating and IUD localization. I will manage "basic" things like anxiety, depression, simple derm stuff, etc. But if you have an A1C of 9, I’m referring out to the persons pcp or finding them one.

I was hoping to get trained in vasectomies but that hasn’t happened yet. I know a few people that have trained as attendings so hopefully one day. I obviously also see boys/men and transgender patients.

As far as jobs go, there are plenty of jobs you could get such as student health, sexual health clinics/centers, family planning centers, public health departments, family med residencies where you teach all the repro health stuff, and the list goes on.

I’m so so glad I didn’t do obgyn. I have no desire to ever be in the OR again and no thank you to being on call or working a 24 hour shift.

This is what i was looking for. Not a confirmation bias, just didn’t think all my thinking was fantasy land. I appreciate the tips on finding what I’m looking for! I I’ll certainly start there.

Thoughts on being the “primary care doc” in a womens center that has general OB/GYNs, MFM, Fertility specialists, and a ton of midwives? I have found a place in the town my wife and I hope to settle in like this. Could I be a family doc in a place like that who does the long term, continuity of care general practice with more womens health stuff, until I have to hand them off for labor, after failed fertility treatments, for high risk prenatal care, or a hysterectomy is needed ? How many women see their OBGYN for true primary care stuff?

 

[AMEHigh]

This is what i was looking for. Not a confirmation bias, just didn’t think all my thinking was fantasy land. I appreciate the tips on finding what I’m looking for! I I’ll certainly start there.

Thoughts on being the “primary care doc” in a womens center that has general OB/GYNs, MFM, Fertility specialists, and a ton of midwives? I have found a place in the town my wife and I hope to settle in like this. Could I be a family doc in a place like that who does the long term, continuity of care general practice with more womens health stuff, until I have to hand them off for labor, after failed fertility treatments, for high risk prenatal care, or a hysterectomy is needed ? How many women see their OBGYN for true primary care stuff?

Yes, there’s def jobs like that where I live.