Cesarean Sections and Family Medicine

[sqeeks]

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Alright fam. So I am on my OBGYN rotation right now and I absolutely LOVE c-Secs. ABSOLUTELY love them. The problem is I am not a huge fan of anything else in the specialty. Gyn work/procedures are fine but nothing I want my living to be made out of in the future. I am still in love with Family Medicine as my specialty of choice. I want to be able to practice full scope and I have always planned on living in a more rural location so I have planned on doing a decent amount of OB. Now that I know I love OB (I do love all of the prenatal care as well and I already knew I loved vag births because I have had 4 kids of my own already) and c-secs I would really like to practice this in the future. I was looking into some OB fellowships to help with c-sec proficiency and there arre a number of programs but I noticed that there is no ACGME accreditation for ANY FM OB fellowships. So I was curious if anyone had any experience personally or second hand of how this would work.
I have ready that if you find an OB heavy residency you can usually graduate with around 40-50 c-secs where you are the primary surgeon just from residency. In my opinion I would rather have around a couple hundred before I would feel proficient enough to practice and operate on my own. Most OB fellowships seem to have that number for their fellows before they graduate but my concern is if the fellowship is not accredited then will hospitals give you rights to perform cesareans at all after you complete the program?
Any input is appreciated. I'm really hoping I can make this work. Right now it seems like the dream situation for me.

 

[InternistDO]

My understanding from doing my own research is that hospitals that have FM doctors doing deliveries will credential them based on doing a certain amount (I think around 100) of c sections in residency/fellowship. Some residency programs may have enough OBGYN focus to allow for residents to hit 100 in residency, other programs may not, which would require the women's health fellowship to hit those numbers. Again, this is just from what I researched myself, I don't have any firsthand experience.

I know for a fact there are jobs out there on AAFP CareerLink that are looking for FM docs who do outpatient medicine + deliveries (and outpatient + inpatient + emergency + deliveries, if you're rural enough).

 

[HipsterLorax]

It all comes down to getting credentialled which is dependent on the hospital/system you're trying to get a job at. The minimum is usually 30-50 primaries which is doable at certain residencies, but no one would fault you for wanting more experience and doing a fellowship. It's easier if there have been family docs before you that do c-sections, otherwise it might be difficult to convince the hospital to give you credentials. In many cases, people seeking credentials will be proctored on a certain number of procedures by someone on the credentialling committee to make sure their skills are up to par.

 

[sqeeks]

Awesome. Thanks guys/gals. 🙂

 

[WantToBeFamMed]

There are some Family Med programs that specifically consider C/S training one of their focuses and strengths, Via Christi in Wichita, Kansas comes to mind as one that I've met a couple graduates of. Many that are just "OB heavy" though might just mean the typical residents are getting 100-200 vaginal deliveries and 50-100 C/S first assists, but not typically really getting trained to be the primary surgeon. Many of those will have the occasional residents with specific interest in getting C/S training though who take the extra initiative and puts in extra hours coming to C/S's when not on the L&D floor, and a culture where the physicians and OB/Gyn's are willing to take in the FM resident and train them to do their own C/S's as long as the resident is willing to put in the extra work. In this way my former program had an occasional residents previously graduate prepared to C/S's coming out of their 3 years, since then the OB/Gyn's have begun having up to 1 resident per class stay on for a 4th year as "fellow-type" role for focus on heavy L&D time and tons of C/S experience at all scheduled C/S and many of the urgent unexpected ones as well. There's also always the option of the formal fellowships. Ask when you interview at these "OB heavy" residencies, "Are there any current residents or recent graduates that you know of being trained to be ready do their own C/S's when they leave here? What kind of numbers do they graduate with as primary surgeon?" etc

 

[betamale]

Alright fam. So I am on my OBGYN rotation right now and I absolutely LOVE c-Secs. ABSOLUTELY love them. The problem is I am not a huge fan of anything else in the specialty. Gyn work/procedures are fine but nothing I want my living to be made out of in the future. I am still in love with Family Medicine as my specialty of choice. I want to be able to practice full scope and I have always planned on living in a more rural location so I have planned on doing a decent amount of OB. Now that I know I love OB (I do love all of the prenatal care as well and I already knew I loved vag births because I have had 4 kids of my own already) and c-secs I would really like to practice this in the future. I was looking into some OB fellowships to help with c-sec proficiency and there arre a number of programs but I noticed that there is no ACGME accreditation for ANY FM OB fellowships. So I was curious if anyone had any experience personally or second hand of how this would work.
I have ready that if you find an OB heavy residency you can usually graduate with around 40-50 c-secs where you are the primary surgeon just from residency. In my opinion I would rather have around a couple hundred before I would feel proficient enough to practice and operate on my own. Most OB fellowships seem to have that number for their fellows before they graduate but my concern is if the fellowship is not accredited then will hospitals give you rights to perform cesareans at all after you complete the program?
Any input is appreciated. I'm really hoping I can make this work. Right now it seems like the dream situation for me.

Unfortunately, none of those fellowships are accredited. They give you clinical experience and a certificate but they are not ACGME. They will give you C section numbers so you can credentialed like one of our faculty members, however, we had one who did not do the fellowship but still got credentialed because of his prior experience in Residency and private practice.

I heard you can make $350-400 doing FM + OB especially in Texas. But learn Espanol first

ABPS offers a Family Medicine Obstetrics board-certified but certain states may bar you from advertising yourself as board certified in Obstetrics since it is not an ABMS certification. It may, however, be favorable to credentialing committee to have that. The biggest threat for you will be big corporate groups who are introducing inpatient laborists staffed by OBGYNs. The laborist group may end up forcing you out of the OB call list and decrease your future C section numbers because the ED may end up steering non-assigned OB patients to whoever those inpatient laborists contract with. Saw this happen at a couple of hospitals.

 

[SLC]

My first job wanted me to do Obstetrics, but requires all Obstetrics providers to be credentialed in cesarean deliveries. The hospital I’m working out of only has FM providers and a Gen-Surg, no OB’s at all.

I’m not going to graduate with the requisite numbers, and I’m not really certain I’d be interested anyway. But the hospital offered to proctor me until I have enough numbers to get credentials if I’m interested. We’ll see...

 

[cabinbuilder]

Alright fam. So I am on my OBGYN rotation right now and I absolutely LOVE c-Secs. ABSOLUTELY love them. The problem is I am not a huge fan of anything else in the specialty. Gyn work/procedures are fine but nothing I want my living to be made out of in the future. I am still in love with Family Medicine as my specialty of choice. I want to be able to practice full scope and I have always planned on living in a more rural location so I have planned on doing a decent amount of OB. Now that I know I love OB (I do love all of the prenatal care as well and I already knew I loved vag births because I have had 4 kids of my own already) and c-secs I would really like to practice this in the future. I was looking into some OB fellowships to help with c-sec proficiency and there arre a number of programs but I noticed that there is no ACGME accreditation for ANY FM OB fellowships. So I was curious if anyone had any experience personally or second hand of how this would work.
I have ready that if you find an OB heavy residency you can usually graduate with around 40-50 c-secs where you are the primary surgeon just from residency. In my opinion I would rather have around a couple hundred before I would feel proficient enough to practice and operate on my own. Most OB fellowships seem to have that number for their fellows before they graduate but my concern is if the fellowship is not accredited then will hospitals give you rights to perform cesareans at all after you complete the program?
Any input is appreciated. I'm really hoping I can make this work. Right now it seems like the dream situation for me.

Its going to come down whether you can get credentialed and whether there is going to be an Ob-Gyn group who is willing to be your back up. It only takes one bad case to turn the tables and you will definitely need the specialist on your side to help you. In a lot of places that is easier said than done. Don't be surprised if its an uphill battle.

 

[JustPlainBill]

Or you could do what one of the attendings at UT Tyler FM did -- he did an FM residency followed immediately by an OB residency at JPS -- and then went to UT Tyler FM residency and taught the residents enough to get certified for C Sections --- In this instance, you don't want to just "get by" -- since if things go bad, you'll be judged to the standard of "What should a board certified ob/gyn have known/done", "well, they're FM with 100 C Sections in residency" --- and you mentioned being on a Ob/Gyn rotation -- resident or MS3 student? 2 different ballgames....

 

[sqeeks]

Or you could do what one of the attendings at UT Tyler FM did -- he did an FM residency followed immediately by an OB residency at JPS -- and then went to UT Tyler FM residency and taught the residents enough to get certified for C Sections --- In this instance, you don't want to just "get by" -- since if things go bad, you'll be judged to the standard of "What should a board certified ob/gyn have known/done", "well, they're FM with 100 C Sections in residency" --- and you mentioned being on a Ob/Gyn rotation -- resident or MS3 student? 2 different ballgames....

MS3. That makes a lot of sense thank you. Yeah I have seen a few old posts along the lines of "you get enough training in residency to do c sections if you want" but honestly from what little I have seen id be terrified to perform c secs after only 3 years of residency that includes general medicine and pediatrics as well.

 

[JustPlainBill]

MS3. That makes a lot of sense thank you. Yeah I have seen a few old posts along the lines of "you get enough training in residency to do c sections if you want" but honestly from what little I have seen id be terrified to perform c secs after only 3 years of residency that includes general medicine and pediatrics as well.

And do yourself a favor -- don't lock into any one area of medicine until you've finished up MS3. Be really open minded about where you like to spend your days, what kind of lifestyle you want, etc. and recognize the days of one doc doing it all are long, long gone....

 

[sqeeks]

And do yourself a favor -- don't lock into any one area of medicine until you've finished up MS3. Be really open minded about where you like to spend your days, what kind of lifestyle you want, etc. and recognize the days of one doc doing it all are long, long gone....

I appreciate your input.

 

[topraman]

Definitely possible to do, even without fellowship (minimum number tends to be about 50) but certainly with a fellowship it's easier and, at least on the West Coast, it will open up many urban hospitals, particularly if they have an FM training program.

My friend a year ahead of me in residency got privileged right after graduation last year (we're a 3 year program) at a large hospital in Oakland CA for his community clinic continuity patients they take call for. They watched his skills with initial proctoring and yes there is a back-up OB available. It also helps that we assisted their main GYN-Onc who would come to do cases at our county hospital and he could vouch for his skills.

So my other piece of advice is that surgical cross training matters. Do open urology cases to get better with bladder complications, do abdominal hysterectomies to get better with pelvic anatomy for bad extensions and practice for the eventual c-hys. Skills are not just about c-section numbers alone even if you never plan to do the other procedures. Finally OB acuity is critical, you want to be able to make the right call in the first place so a place where FM residents manage high-risk prenatal and intra-partum care and are comfortable with operative vaginal delivery is necessary to learn when to operate in the first place. Fellowship will give you that as well, residency may not even if you're exposed to the OR in some fashion.

 

[sqeeks]

Definitely possible to do, even without fellowship (minimum number tends to be about 50) but certainly with a fellowship it's easier and, at least on the West Coast, it will open up many urban hospitals, particularly if they have an FM training program.

My friend a year ahead of me in residency got privileged right after graduation last year (we're a 3 year program) at a large hospital in Oakland CA for his community clinic continuity patients they take call for. They watched his skills with initial proctoring and yes there is a back-up OB available. It also helps that we assisted their main GYN-Onc who would come to do cases at our county hospital and he could vouch for his skills.

So my other piece of advice is that surgical cross training matters. Do open urology cases to get better with bladder complications, do abdominal hysterectomies to get better with pelvic anatomy for bad extensions and practice for the eventual c-hys. Skills are not just about c-section numbers alone even if you never plan to do the other procedures. Finally OB acuity is critical, you want to be able to make the right call in the first place so a place where FM residents manage high-risk prenatal and intra-partum care and are comfortable with operative vaginal delivery is necessary to learn when to operate in the first place. Fellowship will give you that as well, residency may not even if you're exposed to the OR in some fashion.

Thank you so much for this!

Does anyone know/have any info on UNM (New Mexico) and their 2 year Maternal Child and Reproductive Health Fellowship? I am pretty impressed with what I see on paper and would love to do something similar.

 

[Ericslv]

Just a few thoughts. If you don't like the other ob/gyn things you may get real tired of c-sections when you are on your own. It's a different world when you a** is on the line rather than the attending. Sometimes as a resident some procedures are real cool especially if they are surgical and new but get old. If you want to make 350 to 400K consider other things like cosmetics. Spend some time getting some business skills that will take you much further than a non-accredited fellowship. Those business skill are transferable. C-sections and ob can get real old when you are 50 years old and have to get up at 3 am to do a C-section. Then there is malpractice cost associated with ob. Also, there really is no way to do c-sections and not do other things associated with ob and if you can do c-sections you can most likely do almost any other office procedure associated with gyn. You won't be able to do surgical gyn. I know a few docs after residency that did deliveries and then just got tired of it. Tired of politics, the hours, malpractice costs and the pay did not make up for that. That's why they didn't go into ob/gyn in the first place.

 

[sqeeks]

Just a few thoughts. If you don't like the other ob/gyn things you may get real tired of c-sections when you are on your own. It's a different world when you a** is on the line rather than the attending. Sometimes as a resident some procedures are real cool especially if they are surgical and new but get old. If you want to make 350 to 400K consider other things like cosmetics. Spend some time getting some business skills that will take you much further than a non-accredited fellowship. Those business skill are transferable. C-sections and ob can get real old when you are 50 years old and have to get up at 3 am to do a C-section. Then there is malpractice cost associated with ob. Also, there really is no way to do c-sections and not do other things associated with ob and if you can do c-sections you can most likely do almost any other office procedure associated with gyn. You won't be able to do surgical gyn. I know a few docs after residency that did deliveries and then just got tired of it. Tired of politics, the hours, malpractice costs and the pay did not make up for that. That's why they didn't go into ob/gyn in the first place.

Thank you that is good advice.

 

[Ericslv]

Thank you that is good advice.

You are very welcome.