building a practice after residency?

[OBfan]

Hi,
I just wanted to understand how it all works. I was told by one of my attendings that after residency most obgyn's do a lot of OB in order to build thier practice. After some time(years) of doing many deliveries they can then focus on just practicing gyn.

My question is why do they have to do OB first? Do they make more money doing this? If so how much? Or are they building thier cliental?

Thanks,
OBfan

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[smileyj]

I worked for a gyn. for over a year prior to med. school. He practiced ob for 30 years before he finally decided to just concentrate on gyn. There were several reasons for his decision. First, the LONG HOURS....he was almost 60 and working 16-20 hour days with delivering at the hospital, rounding on patients, plus seeing patients in the office, not to mention scheduling surgery time for ablations, d&c's, hysteroscopy's, and hysterectomies (note: he was a single doctor in his own practice!!). Second, the age of his clientele was increasing, most were in peri-menopause/menopause. He was actually starting to see the daughters of his patients (ones he had delivered)!!! Third, the high rates of insurance in NY.

He decided 5 years ago to stop ob altogether. Did his revenue decrease? Absolutely not!!! He is a nationally known doctor in menopause and management and has a waiting list of hundreds!! He also is able to do more surgeries and bring in more money to his practice. His hours now are only about 10/day, almost half of what it was.

As to your question, i would guess that you could just do gyn, however when you are young and more motivated, ob seems more challenging.

 

[UCLAMAN]

As to your question, i would guess that you could just do gyn, however when you are young and more motivated, ob seems more challenging.

more challenging in terms of hours? i think it has nothing to do with any kind of challenge at all. it has everything to do with the normal life cycle of a woman.

i think the reason people are OB heavy when they first start is because thats how they get new patients. patients that are new to a practice are usually younger and of child-bearing age. patients who are older and have predominantly gyne issues are usually already established with an OB who had delivered their children when they were younger. so a young doc is not going to get a whole lot of the older gyne issue patients because those patients are already established with an OB/gyn. so when someone is building a new practice(ie they just graduated residency), they have a lot of younger patients(when i say young i mean 20's and 30's) because the majority of patients who need an new OB/gyn are going to be young. But as the practice ages...now, those women will age was well and will begin to have issues that have nothing to do with getting pregnant.

now obviously this is not a hard and fast rule...obviously a new OB/gyn will have his or her share of menopausal patients but that will be due to one of two main reasons...either that patient had issues with their previous OB/gyn...or their previous OB/gyn retired. but when someone is establishing a practice they will mainly be getting new, younger patients who prior to getting pregnant may have been getting their annual paps, breast exams, etc. at their internist's office and now need an OB/gyn for the pregnancy. following that pregnancy, that OB/gyn will probably take over that women's annual healthcare. so as the majority of your practice's clientele ages, you have less OB prenatal responsibilities that you can essentially phase it out of your practice if you wanted to get rid of the awful labor and delivery hours.

see...the nice thing about OB/gyn is that your patient population evolves with you. make sense? nothing to do with challenge in my opinion and everything to do with life cycles.

 

[smileyj]

UCLA...i think you took my opinion wrong. I wasn't saying more challenging in terms of hours....in general i was stating that OB is more challenging than gyn. Mainly because you are dealing with two patients not one. OB's also have a more "active" practice since they not only see patients in office, but must also attend to them in a hospital setting. I dont know of any gyn. that would see a menopausal women with low testosterone levels both in office and in the hospital. Most gyn. who treat older women do so in office, and will go to the hospital for surgery only. Also, from my opinion, gyn. is a little boring. You seem to see the same hormonal imbalances, vaginitis, uti, hot flashes, etc over and over again. Again, this is only from my opinion of the type of person I am, and the type of doctor i want to be.

I totally agree with everything you said though. A majority of your patients will be of child-bearing age, and as they move on through life, your practice will change. I believe that is what i was implying in my answer to the OP. Overall, starting as an OB will give you a greater opportunity to increase your patient and practice size.

 

[UCLAMAN]

UCLA...i think you took my opinion wrong.

no. i knew you really weren't referring to hours...but i just don't see OB as "more challenging"...i see it as different. thats why i was wondering what sort of challenges you were referring to(i was being facetious when i posed the hours question). having to go back and forth from LnD to office often...well thats a scheduling challenge not a medical one. if anything i think that there may be greater ethical challenges and i think decisions must be made at a much quicker pace but i do not necessarily think its more challenging. but you are certainly entitled to your opinion. now, if you are talking MFM-type cases...well yeah thats a different story. i would agree with you there because managing the pregnancy of a mother with marfan's syndrome isn't necessarily cut and dry.

one could also argue the same thing for OB(as you have for gyne)... that its "boring"...i mean gees...vaginal delivery after vaginal delivery, then c-section, then pre-eclampsia after pre-eclampsia, PPROM after PPROM, shoulder dystocia after shoulder dystocia, same stuff over and over...i mean...the idea being...no matter what field of medicine ya go into...you will see the same thing again and again and again.

ultimately, whether one thinks OB is more challenging than gyne or not....i still think that "challenge" has nothing to do with why newly minted OB/gyns do more OB stuff earlier in their career.