Can I realistically focus on women’s health in FM?

[dranthropology]

I’m an MS4 who is really torn between OBGYN and Family Medicine. I love the excitement of OB but I really want Family life balance and FM seems to be a better fit.

I want to know if its possible to still focus on women’s health in a non- rural setting. I don’t need to be in a major city but would like to be at least close to one. I also don’t need to do deliveries- I would be happy to do in office gyn procedures and prenatal care.

What do you think? Is this a realistic option? Do jobs like this exist Or am I fooling myself?

Would also appreciate any insight from anyone in FM or Obgyn.

Thanks in advance!

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[jm192]

Question 1: Are you a woman? I honestly think that matters.
Women are more comfortable with women. It's different when you're the GYN doctor. But if you're looking to do a lot of GYN things--in a non-rural setting--it probably helps to be female.

The question you likely should be asking--can you do OB/GYN and then not do deliveries? And I'm pretty sure the answer is yes. That may be something to look into with those guys. I would imagine however it's less appealing to employers. It may be the sort of thing that you do call/deliveries for so many years and then fade into outpatient only.

 

[deleted87716]

I love the excitement of OB

I assume you mean that sleep-deprived high that you sometimes get when you're catching babies at three AM...? Trust me, that s*t will pass, 'specially once you're in your forties.

I really want Family life balance and FM seems to be a better fit.

Well, duh.

I want to know if its possible to still focus on women’s health in a non- rural setting...I would be happy to do in office gyn procedures and prenatal care.

Doing Pap smears and telling women to stop drinking when they're pregnant isn't the most exciting thing I do, but...to each their own.

 

[dranthropology]

Question 1: Are you a woman? I honestly think that matters.
Women are more comfortable with women. It's different when you're the GYN doctor. But if you're looking to do a lot of GYN things--in a non-rural setting--it probably helps to be female.

The question you likely should be asking--can you do OB/GYN and then not do deliveries? And I'm pretty sure the answer is yes. That may be something to look into with those guys. I would imagine however it's less appealing to employers. It may be the sort of thing that you do call/deliveries for so many years and then fade into outpatient only.

Thanks for your reply!

I am female.

I considered obgyn and then not doing deliveries but I can’t imagine going through the hell of an obgyn residency when I’m going to be trained in a lot of gyn procedures in fm anyway.

 

[deleted87716]

I can’t imagine going through the hell of an obgyn residency when I’m going to be trained in a lot of gyn procedures in fm anyway.

The only gyn procedures we learned were Paps, colposcopy, endometrial biopsy, and IUD placement. All I do any more are Paps.

 

[VA Hopeful Dr]

The only gyn procedures we learned were Paps, colposcopy, endometrial biopsy, and IUD placement. All I do any more are Paps.

There's a part of me that still would like to do colpos and IUD placement.

Then there's the part of me that could see 2 patients in the time either of those takes and make more money not doing them.

 

[deleted87716]

There's a part of me that still would like to do colpos and IUD placement.

Then there's the part of me that could see 2 patients in the time either of those takes and make more money not doing them.

Both of my partners (female) do IUDs. None of us do colposcopy (not enough volume).

 

[VA Hopeful Dr]

Both of my partners (female) do IUDs. None of us do colposcopy (not enough volume).

Interestingly, it pays more to remove them than to place them

 

[deleted87716]

Interestingly, it pays more to remove them than to place them

Huh. I could probably do that...

 

[VA Hopeful Dr]

Huh. I could probably do that...

I used to get referrals to the urgent care from local family docs to remove IUDs for their patients. It was weird because 99% of the time its insanely easy and takes literally 20 seconds.

 

[FrustratedFamDoc]

Sure you can focus on women's health as a fam doc but don't expect too much business unless you have something that you can offer that is uniquely better than the other OB/GYNs in town. If they're seeing you, they will want you to deliver their kiddo, and be able to manage anything that goes not quite right. All of that is pretty difficult to do on an outpatient fam doc schedule.

 

[AMEHigh]

It depends on exactly what you want to do. I plan to do a fellowship in family planning. I'll get a lot of training in LARC placement, 1st and early 2nd tri abortions and minor procedures like colposcopy. I have a lot of family med mentors who have had no trouble getting jobs and practice women's health in that capacity at places like planned parenthood and other clinics. I have no desire to do OB and am happy going the route I'm going to practice women's health and still have the full spectrum family med training.

 

[Dr G Oogle]

It depends on exactly what you want to do. I plan to do a fellowship in family planning. I'll get a lot of training in LARC placement, 1st and early 2nd tri abortions and minor procedures like colposcopy. I have a lot of family med mentors who have had no trouble getting jobs and practice women's health in that capacity at places like planned parenthood and other clinics. I have no desire to do OB and am happy going the route I'm going to practice women's health and still have the full spectrum family med training.

I’m finished an obgyn residency and I can honestly say that other than surgical stuff and non-high risk OB an FM could easily have a focus on women’s health. There’s a huge shortage of physicians that provide this sort of care in both urban and certainly rural settings. Also 50% of your patients are women and would be quite delighted if they could come to you for gyn care. I say this because in my urogyn fellowship we provided some general gyn care like screening, paps and annuals etc and patients love it but would argue that an FM is much better equipped for things like that than a urogyn. I don’t think that colpo is one thing that you could do but I also don’t think most obgyns should be doing it, it is not taught well in most residency and the stakes are fairly high. As far as OB you could certainly manage people prenatal and have someone else deliver them either an OB or FM or even a CNM partner as long as the patient has met the delivering provider. This type of arrangement happens frequently in OB practices for lifestyle concerns. Also it is feasibly to have an outpatient only practice in OBgyn but you’d probably have to join an academic or large private group. There are also practices where you only do 25-50 deliveries a year which is pretty manageable. If you do the FM route you can also look into women’s health fellowships.

Bottom line is that there are options through both fields you just have to figure out which route is best for you.

 

[TorMed]

The University of Toronto has a one year women’s health fellowship for people who have completed an FM residency. There may be funding issues if you aren’t Canadian but they would definitely recognize your FM residency in the US. There is a large hospital in Toronto dedicated to women’s health so you would probably get great training.

 

[Atlas Shrugged]

I’m finished an obgyn residency and I can honestly say that other than surgical stuff and non-high risk OB an FM could easily have a focus on women’s health. There’s a huge shortage of physicians that provide this sort of care in both urban and certainly rural settings. Also 50% of your patients are women and would be quite delighted if they could come to you for gyn care. I say this because in my urogyn fellowship we provided some general gyn care like screening, paps and annuals etc and patients love it but would argue that an FM is much better equipped for things like that than a urogyn. I don’t think that colpo is one thing that you could do but I also don’t think most obgyns should be doing it, it is not taught well in most residency and the stakes are fairly high. As far as OB you could certainly manage people prenatal and have someone else deliver them either an OB or FM or even a CNM partner as long as the patient has met the delivering provider. This type of arrangement happens frequently in OB practices for lifestyle concerns. Also it is feasibly to have an outpatient only practice in OBgyn but you’d probably have to join an academic or large private group. There are also practices where you only do 25-50 deliveries a year which is pretty manageable. If you do the FM route you can also look into women’s health fellowships.

Bottom line is that there are options through both fields you just have to figure out which route is best for you.

Can you expand on the colposcopy thing?


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[Dr G Oogle]

Can you expand on the colposcopy thing?


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Colposcopy, like anything, requires a fair bit of volume both to learn and maintain skills. If you are not at a training program that has a large volume of this and you take advantage of that volume you will not learn it correctly. Similarly, if you do not perform it regularly in practice you will lose the ability to recognize more subtle findings that may represent significant dysplasia or malignancy.

 

[smq123]

I used to get referrals to the urgent care from local family docs to remove IUDs for their patients. It was weird because 99% of the time its insanely easy and takes literally 20 seconds.

Urgent cares don't have ring forceps?

 

[VA Hopeful Dr]

Urgent cares don't have ring forceps?

They do. I was working at the Urgent Care and the family doctors would send me their patients to take out the iuds.

 

[deleted87716]

They do. I was working at the Urgent Care and the family doctors would send me their patients to take out the iuds.

To be honest, if one of my patients needed her IUD removed, I'd probably send her to one of my partners who puts them in. Sure, most of the time, they pop right out. However, I believe in Murphy's Law...

 

[VA Hopeful Dr]

To be honest, if one of my patients needed her IUD removed, I'd probably send her to one of my partners who puts them in. Sure, most of the time, they pop right out. However, I believe in Murphy's Law...

And it didn't bother me. Super easy and the patients were very grateful.

 

[Xorthos]

Man I'd rather remove them all day than put them in. 10 times easier....and I just get an awful feeling every time I have to clamp the cervix when placing them.

It hurts me to my soul, and I don't even have a cervix.

 

[Atlas Shrugged]

You don’t have to use a tenaculum every single time. The attending that taught me only used it in about 1/5 patients.


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