Deciding between Family Practice and Ob-Gyn.

[Ypo.]

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Unfortunately my FP rotation experience was not good. I have always been drawn to family practice for many reasons (I think they are among the most "practical" doctors, can see patients of all ages, genders, cradle to grave, can do a little of everything, continuity of care). My mother is a family doc who also moonlights in the ER. She used to deliver babies but quit because she wasn't getting enough experience to keep her skills up and because the malpractice was too high.

My family practice rotation was 7 weeks of outpatient shadowing/minimal patient responsibility and 1 week of inpatient. Ironically, the only time I actually got to follow up with a patient was during my week of inpatient care. That was also the only week I enjoyed (I loved working up the problems, seeing whether I was right or not, and seeing how the patient responded to treatment). The 7 weeks I had of outpatient care they had me with so many different doctors and residents that I could never follow up on any of the patients I saw. Plus very often I didn't get do much because as we all know, it takes a day or two for people to become comfortable with a medical student.

It's really weird because in the first half of med school I was the president of the family practice interest group and was one of those people dead set on FP. Now I am seriously considering doing something else. In addition, although I have always been leery of specializing, what I have seen of family practice is that it is not all that diverse either, but instead ends up specializing in mostly HTN, diabetes, high cholesterol, colds, where anything more complicated (and interesting) gets referred to specialists. I'm really enjoying OB/Gyn, but it's very strange considering only seeing women/specializing in a part of the body. However, I really, really hated my FP rotation and I love my OB rotation. I am one of those people who enjoys seeing an occasional child or two, but I really don't feel the need to see a lot of them, so perhaps I wouldn't mind giving it up.

So the question starts to be; can I rely on my rotation experience to decide? Do I love OB/Gyn enough to give up the idea of treating men, young children? I have to admit it is a little funny to pass the baby to the nurse and say "see ya!"


I have the highest respect for FP, so please don't get me wrong. Also, I don't want this thread to turn into a big argument, just a discussion of facts. Thanks.

 

[MeowMix]

Please do not make this important decision based only on a crappy MS3 FM rotation and a good Ob rotation.

Find yourself a good, challenging, and varied FM MS4 experience with lots of responsibility (ask around and find out how other students at your school have done this). Find an equally good Ob/Gyn (do not forget, you will do plenty of gyn) MS4 rotation.

You can be an FM doc and do tons of OB, C-sections, women's care, and also care for babies and guys, with less of the stuff you don't like.

If you want both in residency, with plenty of latitude in practice, consider the UC Davis 4-yr FM/OB program. You get boarded in FM only, but you get a ton of OB experience including operative training.

 

[sophiejane]

I think you just had a bad experience, if you re-read your post you will see most of your complaints are very rotation-specific. In my clinic as a first year resident, I have diagnosed and managed some interesting and challenging cases, and more so in the hospital. I have seen a lot of variation in what gets referred, depending on faculty and their comfort level. Some of that is medico-legal.

On the other hand, keep an open mind. Like the previous poster suggested, do an FM rotation at a good unopposed program where they do it all. If you still don't feel the love, do OB. There are plenty of us FPs who want to do OB in their practice, so one less won't kill us. 🙂

 

[Ypo.]

Please do not make this important decision based only on a crappy MS3 FM rotation and a good Ob rotation.

Find yourself a good, challenging, and varied FM MS4 experience with lots of responsibility (ask around and find out how other students at your school have done this). Find an equally good Ob/Gyn (do not forget, you will do plenty of gyn) MS4 rotation.

You can be an FM doc and do tons of OB, C-sections, women's care, and also care for babies and guys, with less of the stuff you don't like.

If you want both in residency, with plenty of latitude in practice, consider the UC Davis 4-yr FM/OB program. You get boarded in FM only, but you get a ton of OB experience including operative training.

Thanks, that is good advice. As much as I do think the FM rotation was organized poorly, I also know that many of the bread and butter FM stuff was not that interesting to me; really it has always been the patient themselves I find interesting.

I think you are right; I will have to do another OB-Gyn rotation early. I will be doing a FM rotation in Honduras in the summer. I will be going with doctors who I am friends with, so I'm sure it is going to be a wonderful experience. I have a pretty good idea what family practice is like. But I can't ignore the feeling that every day I am in OB/gyn I feel interested and excited, whereas in family practice (even when I saw patients on my own) I didn't get that same feeling. Maybe it is different when you have been seeing those patients for a long time, but there is no way of knowing that until it happens.

The other things I have been thinking about FM are; sure you get training in Ob/gyn, but I see the FP residents here and they are way less comfortable with delivering than the OB residents. My mother quit delivering babies because she wasn't getting enough experience and because the malpractice insurance was too high. The very last baby she delivered, the cord was wrapped around the infant's neck 3 times, the FHT dropped way low, and it was rushed to emergency section (which was done by an OB doctor). Like Sophie Jane was saying in another thread, you have to be realistic; sure you can get all this great training, but keeping up those skills when you are competing with doctors who specialize in that alone (peds, OB, psych, dermatology) and getting hospital priviledges (for c-sections for example) is another thing altogether. I don't think that the 5 months of pediatrics I can get in FP residency compares to the 3 years that pediatricians get. I'm starting to feel that I don't want to take care of pregnant women unless I can completely take care of all their problems; pawning them off to an OB-Gyn doc (who is unfamiliar with them) when the going gets rough or during an emergency sucks.

I guess I'm just coming to the realization that as much as FP has always appealed to me because they are "a little bit of everything", the truth is that in this day and age, you can't do it all, and if you try to, you just end up being less skilled at it than someone who focuses on that alone.

 

[sophiejane]

I'm starting to feel that I don't want to take care of pregnant women unless I can completely take care of all their problems; pawning them off to an OB-Gyn doc (who is unfamiliar with them) when the going gets rough or during an emergency sucks.

I guess I'm just coming to the realization that as much as FP has always appealed to me because they are "a little bit of everything", the truth is that in this day and age, you can't do it all, and if you try to, you just end up being less skilled at it than someone who focuses on that alone.

I think what I have come to realize about FM is that it is not being able to "do everything" the way a specialist would. Of course that's impossible. But what we can do is provide excellent longitudinal care for the entire family for 90% of what ails them. The other 10% we refer. We are specialists in routine problems in ALL systems of the body, and that to me is what medicine is about. You, on the other hand, already seem to have the heart of a specialist, and that's great, as well. You should probably go with that, or be unhappy.

Most deliveries are routine, as are most c-sections. I plan to be trained in both (likely will do a one year fellowship if I find a job where the OB volume would support me doing deliveries). Of course there will be a small percentage that go wrong, and I will need help. I don't have much of an ego left at this point anyway, so that's not a problem for me. 🙂

The reason I don't have a problem asking for help is because I'm not trained to take out gall bladders and do heart surgery. But I can deliver babies, and then (and this is the best part, the part that is so cool that it keeps me getting up in the middle of the night to do continuity deliveries), I get to take care of the baby AND the mom from then on (not to mention grandma and dad and Uncle Joe, etc). How great is that. Actually, I know how great it is because I've gotten to do it 4 times this year, and it's one of the most satisfying things I've ever done.

I DO think FPs who do OB MUST be trained in surgical obstetrics. You can't just do SVDs, and pawn off the emergency sections to whomever is on call. If I can't find a practice where I do enough of both, I won't do OB. But it the meantime, I'm having a blast getting the training to do them.

 

[AwesomO]

I DO think FPs who do OB MUST be trained in surgical obstetrics. You can't just do SVDs, and pawn off the emergency sections to whomever is on call. If I can't find a practice where I do enough of both, I won't do OB. But it the meantime, I'm having a blast getting the training to do them.

I concur with that. That was actually a pretty big deal for me on the interview trail this year. I wanted to be sure that I would be in there 1st assisting for any of my continuity patients. I've always believed that if a FP was going to do OB he or she should be able to provide all the services that may be required. I'm not sure if I'll be doing OB or not but if I do win up doing it I definitely want to be able to provide not just sections but tubals and hysterectomies if need be.

 

[smq123]

But I can't ignore the feeling that every day I am in OB/gyn I feel interested and excited, whereas in family practice (even when I saw patients on my own) I didn't get that same feeling.

It sounds like you love OB - which is a great field. (I'm a third year who is also interested in OB/gyn.) Do you love gyn though? Can you at least tolerate it? I think that some of the ob/gyn residents who ultimately drop out of residency find out that they truly loved ONLY OB, or ONLY gyn - but not both. Are you willing to undergo 2 years of gyn, gyn onc, and urogyn? I think that these are important things to consider.

I'm starting to feel that I don't want to take care of pregnant women unless I can completely take care of all their problems; pawning them off to an OB-Gyn doc (who is unfamiliar with them) when the going gets rough or during an emergency sucks.

I totally sympathize. But I think the thing is - with OB/gyn, you also might need to "pawn off" your patients to other services in other cases.

For instance, if you're doing an emergency c-section and you accidentally pierce the bladder/ureter (apparently, not that uncommon!), then you will need to "pawn off" your patients to a urologist, since ob/gyns (aside from the gyn onc people) are not trained in surgical bladder repair.

If you're doing a hysterectomy or LOA, and you pierce the colon (again, a fairly common occurrence), you'll need to call in a general surgeon - obviously, general ob/gyns are not trained in bowel surgery.

If you're taking care of a pregnant woman, and you realize that she has some rare autoimmune disease (such as NAIT), or some kind of crazy thrombocytopenia, you'll have to "pawn off" your patient to an MFM - a general ob/gyn is generally not experienced enough to deal with these kinds of complicated pregnancies.

My point is, taking complete control of your patient's care is not possible in either specialty - the chance that you'll always be sharing ownership with another doctor is quite high.

Good luck! It's a tough decision, I know.

 

[sophiejane]

I totally sympathize. But I think the thing is - with OB/gyn, you also might need to "pawn off" your patients to other services in other cases. .

Exactly. You took the words out of my mouth. Specialists pawn off patients all the time, evidenced by the fact that surgeons somehow appear to forget how to manage hypertension and diabetes in the hospital somewhere along the lines. It's not really that hard, but they don't do it every day, so they'd rather get a hospitalist to deal with those issues.

No one can know everything or do everything, and FM has never assumed to be the specialty that "does it all". What we do is preventive care and routine or non-emergent ambulatory care for most chronic and acute complaints of adults, infants, and children. Within that is a tremendous variation in scope of practice and threshhold for referring.

As an OB/Gyn, you won't likely be treating your pt's hypertension, depression, sore throats, etc. So even you won't be able to take care of everything.

 

[Frijolero]

I can echo the above sentiments regarding having a bad rotation. One of my biggest fears of 3rd year was that I would end up choosing or ignoring a specialty based on a particularly good or bad rotation. I didn't really enjoy my 3rd year FM rotation either, but did a sweet sub-I early in 4th year that cemented my decision. I liked OB as well but in the end decided I would be able to do far more OB as an FP than I could FM as an OB. Good luck!

Btw sophie, what are you doing on the business end of a scope? You got FAP or something?

 

[Ypo.]

It sounds like you love OB - which is a great field. (I'm a third year who is also interested in OB/gyn.) Do you love gyn though? Can you at least tolerate it? I think that some of the ob/gyn residents who ultimately drop out of residency find out that they truly loved ONLY OB, or ONLY gyn - but not both. Are you willing to undergo 2 years of gyn, gyn onc, and urogyn? I think that these are important things to consider.

So far, yes I am enjoying the Gyn part. Today I saw a laparoscopic robotic hysterectomy with the Da Vinci. I assisted in a TAH and left oophorectomy where we removed a teratoma that was like something straight out of Robbins(complete with hair, fat and a tooth!).

I love the surgery part of it. And most of the surgery is not dismal (patients are not dying). I haven't done the onc part yet, but I don't think I'll mind dealing with it for a few years, although I can't guarantee I'll be doing a lot of it when I practice.

I also haven't had the ambulatory part yet, so I can't comment on that.

But I can say that Ob-gyn is compatible with my desire to do primary care, plus it adds the excitement of surgery. I also volunteer internationally and am determined to do something that is needed and useful in that arena, so OB fits the bill for that. Last year I went to Honduras and there was a poor old lady with a prolapsed uterus that fell out everytime she stood up. We didn't have a pessary there so we couldn't do anything about it. I don't know if any of the FPs we had with us felt comfortable with inserting pessaries??

What makes me nervous about going into OB is that I don't know how I feel about giving up the idea of caring for men and children. And the schedule of course.

I totally sympathize. But I think the thing is - with OB/gyn, you also might need to "pawn off" your patients to other services in other cases.

For instance, if you're doing an emergency c-section and you accidentally pierce the bladder/ureter (apparently, not that uncommon!), then you will need to "pawn off" your patients to a urologist, since ob/gyns (aside from the gyn onc people) are not trained in surgical bladder repair.

If you're doing a hysterectomy or LOA, and you pierce the colon (again, a fairly common occurrence), you'll need to call in a general surgeon - obviously, general ob/gyns are not trained in bowel surgery.

If you're taking care of a pregnant woman, and you realize that she has some rare autoimmune disease (such as NAIT), or some kind of crazy thrombocytopenia, you'll have to "pawn off" your patient to an MFM - a general ob/gyn is generally not experienced enough to deal with these kinds of complicated pregnancies.

My point is, taking complete control of your patient's care is not possible in either specialty - the chance that you'll always be sharing ownership with another doctor is quite high.

Good luck! It's a tough decision, I know.

True, true, true. Especially in today's age of lawsuits and advanced technology. We can't practice like docs did 50 years ago.

The surgery pt I had today (with the teratoma) was transferred to cardiology because she woke up with chest pain.

But I was hoping if I make efforts to moonlight or work in an urgent care, that I can keep up some FP skills as well. I have heard of some OB-gyn docs doing so. What do you think?

I guess it's a debate within myself of generalist versus specialist. Narrow versus broad. I've always been the type to be afraid of going narrow for fear of getting bored later. But I find OB exciting in a way that FP never did, so it's hard to say.


Are you a 4th year, Smq? Let me know how you decide!

 

[Ypo.]

As an OB/Gyn, you won't likely be treating your pt's hypertension, depression, sore throats, etc. So even you won't be able to take care of everything.

The attendings I have talked to here say that they actually do quite a bit of primary care for their patients. Some of their patients only see them. So they end up taking care of those problems as well. I think it comes down more to preference; some OB-gyn docs would rather not take care of those problems at all.

I know for certain that OB-gyn docs routinely take care of their patient's diabetes, HTN and depression because I've seen it over and over again here.

 

[Doowai]

I think what I have come to realize about FM is that it is not being able to "do everything" the way a specialist would. Of course that's impossible. But what we can do is provide excellent longitudinal care for the entire family for 90% of what ails them. The other 10% we refer. .

I picked which residencies I wanted the most by how many procedures they taught : cardiac stress testing, colonoscopy, vasectomy, EGD. I am not sure I would ever do them if there was a specialist doing them within 60 miles, which there probably is. But I wanted training in them, and procedures do bring in the money.

I turned down a FP prematch offer, that had many great things (near family, great pay, low stress, low crime) and teaches basically primary care. Took a prematch offer in a residency in a high crime area, good pay, far from family, high stress) that teaches alot of procedures.

What chance do you see that an FP will do any of these procedures or do you think learning procedures as a FP is just a waste?

 

[sophiejane]

But I was hoping if I make efforts to moonlight or work in an urgent care, that I can keep up some FP skills as well. I have heard of some OB-gyn docs doing so. What do you think?

I'd be surprised if you could pull this off, but if people are actually doing it, ask them how they are working that into their regular day job and call schedule.

I think you are talking yourself into believing there is more primary care in OB/Gyn than there actually is. What I see in real life is PAs and NPs doing the well woman exams and primary care related stuff so the docs can do more deliveries and surgeries. Remember, you are in academic medicine right now, and the private world is a very different place.

I'm not sure I'd want my OB/Gyn being my PCP if I had diabetes and hypertension. It's time consuming and I don't know of many OB/Gyns who have the time to deal with chronic illness like that unless she is pregnant as well.

It's early yet. You will figure it out. I went back and forth between OB/Gyn and FM, was being recruited by an OB/Gyn program after doing sub-I there, and I was tempted. But I'm really glad I chose what I chose now, and I think in the end, you will be too, if you give it a lot of careful, introspective thought.

 

[smq123]

Are you a 4th year, Smq? Let me know how you decide!

Nope - still a third year. Trying to figure out ob/gyn vs. surgery...

I love the surgery part of it. And most of the surgery is not dismal (patients are not dying). I haven't done the onc part yet, but I don't think I'll mind dealing with it for a few years, although I can't guarantee I'll be doing a lot of it when I practice.

Onc probably won't be a big part of your practice, because it's really, really specialized and specific - it's a 3-4 year fellowship after residency. General ob/gyns don't do a lot of gyn onc, just because it is so specific. They do culposcopy and LEEPs, but anything more invasive (pelvic node dissection, pelvic mass removal, ovarian cancer, cervical cancer) gets referred to gyn onc, even in private practice. OB/gyn residency doesn't train you to adequately care for gyn cancer patients on your own without additional training.

Last year I went to Honduras and there was a poor old lady with a prolapsed uterus that fell out everytime she stood up. We didn't have a pessary there so we couldn't do anything about it. I don't know if any of the FPs we had with us felt comfortable with inserting pessaries??

An FP with a lot of gyn and ob experience might be okay with inserting pessaries. I don't think it takes all that much experience.

But I can say that Ob-gyn is compatible with my desire to do primary care, plus it adds the excitement of surgery.

But I was hoping if I make efforts to moonlight or work in an urgent care, that I can keep up some FP skills as well. I have heard of some OB-gyn docs doing so. What do you think?

I guess it's a debate within myself of generalist versus specialist. Narrow versus broad. I've always been the type to be afraid of going narrow for fear of getting bored later.

I think that the advantage of OB/gyn is that it allows you the option of choosing either primary care or surgery. But I think that its proponents unintentionally mislead you, because they make it seem like you can do both. You can...but I don't know how well you can practice both at the same time. And some OB/gyn programs definitely tend to focus at one over the other.

Being good in the OR requires experience - a decent general surgeon has at least 4 years in the OR. (Closer to 5 at community programs.) Some OB/gyn residency programs give you, over all, ONE year in the OR. Is that enough? Sure, 2 years of outpatient clinic experience is probably enough to turn you into a competent outpatient physician (it's close to what a family med or peds resident gets), but is one year of surgical experience enough to make you confident enough to incorporate gyn surgery in your everyday practice?

Whether or not you can moonlight to keep up some FP skills is debateable. Moonlighting in an ob/gyn or general surgery residency is absolutely forbidden. Moonlighting as an attending is physically and emotionally difficult - the hours are bad enough as it is!

But I can say that Ob-gyn is compatible with my desire to do primary care, plus it adds the excitement of surgery.

Surgery IS exciting - but I think the question is whether or not you like it enough to do it for a while. I think an EM resident, on another thread, said that he loved scrubbing in and gowning up. He would have done surgery if the cases weren't so long...and the personalities not so difficult...and the hours not so crappy...and the reimbursements were better...

If you love the OR, and would be miserable without it, then maybe OB/gyn isn't a bad option for you. But if you're finding the OR exciting only because it's new, novel, and you've never experienced anything like it before, then maybe it's not time to rule out Fam Med yet.

This is getting off-topic, but have you considered other surgical subspecialties? Ophtho does a better job of combining outpatient care and surgery than Ob/gyn does - outpatient eye clinics attract a very diverse patient population who have very specific needs. (And there is a HUGE need for good ophtho care in third world countries - just look at Unite for Sight.) Urology combines outpatient care and surgery, although their focus now is on minimally invasive stuff. ENT also has a big outpatient component, and a HUGE surgical component -and allows you to take care of men, women, and children (eartubes, tonsils, adenoids, some onc stuff).

Good luck finding out what makes you happiest!

 

[MeowMix]

I don't know if any of the FPs we had with us felt comfortable with inserting pessaries??

Fitting and inserting a pessary is like fitting a damn diaphragm, for goodness' sake. It's a task capably performed by thousands of skilled nurses and FPs all over the world. You could learn the basic procedure in 15 minutes (we learned it at the AAFP conference in KC last summer). I've seen "poor old ladies with prolapsed uteruses" in US hospitals in major cities, and the ob/gyn residents didn't have any clue about how to insert a pessary either. I've also seen ob/gyn residents who could barely read an EKG and didn't have any idea how to manage the most basic primary care medical problems, because their academic programs focused so exclusively on ob/gyn.

Once you have the MD, you can create whatever kind of practice you like as an FP.

I think you've actually already made up your mind. We can keep helping you to confirm that decision, but you actually don't need it. Just don't get sucked in by the surgical glamor.

 

[Ypo.]

Fitting and inserting a pessary is like fitting a damn diaphragm, for goodness' sake. It's a task capably performed by thousands of skilled nurses and FPs all over the world. You could learn the basic procedure in 15 minutes (we learned it at the AAFP conference in KC last summer). I've seen "poor old ladies with prolapsed uteruses" in US hospitals in major cities, and the ob/gyn residents didn't have any clue about how to insert a pessary either. I've also seen ob/gyn residents who could barely read an EKG and didn't have any idea how to manage the most basic primary care medical problems, because their academic programs focused so exclusively on ob/gyn.

Like I said, it was simply the fact that we didn't have a pessary there, but I thought (?) i also remember that we did not have anyone with us comfortable inserting the pessaries. In my FP rotation, I never saw any of the FP attendings I work with insert one either. I'm sure like you say, it just depends on training. Anyways, the point I was trying to make is that Ob-Gyns can also provide much needed services (not necessarily inserting pessaries) in undeveloped countries, which is a personal requirement i have.

Once you have the MD, you can create whatever kind of practice you like as an FP.

Within the breadth of family practice, technically, yes you can create whatever practice you want, but, my experience in my FP rotation (shadowed around 20 attendings) did not exemplify that. Apart from sports medicine docs, and an attending who focused on geriatric medicine (why not just do IM??), and 1 FP who focused on OB (she was university hired) it seemed like 80% was diabetes, HTN, hypercholesterolemia, and sinusitis/URIs. My understanding is that if you truly want to do full spectrum FP, you may have to choose between living in a rural versus an urban area to practice OB, particularly if you plan on doing c-sections. In my hospital, there are 2 family practice attendings who regularly deliver babies, and they both work for the medical school.

I think you've actually already made up your mind. We can keep helping you to confirm that decision, but you actually don't need it. Just don't get sucked in by the surgical glamor.

No, I really haven't yet made up my mind at all, which was why I created this thread for the discussion of both specialties. 🙂

 

[Ypo.]

I think you are talking yourself into believing there is more primary care in OB/Gyn than there actually is. What I see in real life is PAs and NPs doing the well woman exams and primary care related stuff so the docs can do more deliveries and surgeries. Remember, you are in academic medicine right now, and the private world is a very different place.

Is this true even for community ob gyns? Our med school has community campuses that we split into for our third and 4th year; we work with community doctors who agree to take on students, so what I see is not so much academic medicine. I haven't done ambulatory Ob-gyn yet, but some community attendings I talked to the other day said they do quite a bit of primary care.

I'm not sure I'd want my OB/Gyn being my PCP if I had diabetes and hypertension. It's time consuming and I don't know of many OB/Gyns who have the time to deal with chronic illness like that unless she is pregnant as well.

Really? Maybe this is arrogant of me to assume, but I would think that most doctors are competent to take care of HTN, diabetes, assuming they try and keep up on the literature and treat enough of it each year. My impression was that docs avoid doing that if they aren't interested in it, or if the patient already has a PCP.

It's early yet. You will figure it out. I went back and forth between OB/Gyn and FM, was being recruited by an OB/Gyn program after doing sub-I there, and I was tempted. But I'm really glad I chose what I chose now, and I think in the end, you will be too, if you give it a lot of careful, introspective thought.

Thanks, Sophie. It's nice to hear from you, especially considering you struggled with the same decision.

 

[secretwave101]

MS-3 is the year of power. As much as we try to be un-influenced by those rotations, I believe they affect our specialization decisions more than any other time in our lives. I hated my MS3 OB rotation, and then found that I loved OB once in residency. I loved my MS3 surgery rotation so much that I did another month of it as MS4...and flat-out hated it.

Also, many OB's provide primary care for their patients, and many patients regard their OB as "their doctor". But don't be fooled into thinking that many of the OB's are happy about this. Some might actually like it, but most do it because they need to. In our community, there simply isn't enough primary care docs for all the patients.

There's no way to predict the future. You can't know if you're going to love or hate what you do. Frankly, I think most docs can be happy in most specialties. I agree that you should do at least one more FP rotation before you throw out the specialty if only so that you can tell yourself that you truly evaluated it in future years when you're tempted to be unhappy with whatever nonFP specialty you chose.

Keep in mind that you can do a TON of OB as an FP if that's what you want. You will get a bit of primary care as an OB, but not much unless you work to create that kind of practice for yourself.

 

[Doowai]

I think an EM resident, on another thread, said that he loved scrubbing in and gowning up.

I loved gowning up! Being dressed by another person. Standing around the table telling dirty jokes and funny stories. And the little machines in the surgery suite that go : bee bee boop. I love that noise. But anything longer than half an hour sucked - especially if you had to wear a lead vest.

 

[Doowai]

Sophie Jane and others, how likely do you think it is that a FP will actually be doing procedures in "real life" : colonoscopy, EGD, vasectomy, fetal ultrasound etc?

 

[skypilot]

I loved gowning up! Being dressed by another person. Standing around the table telling dirty jokes and funny stories. And the little machines in the surgery suite that go : bee bee boop. I love that noise. But anything longer than half an hour sucked - especially if you had to wear a lead vest.

I agree. Being gowned and gloved can start to suck when its 90 degrees and you've been holding the retractor for three hours and your nose starts to itch.

 

[sophiejane]

Sophie Jane and others, how likely do you think it is that a FP will actually be doing procedures in "real life" : colonoscopy, EGD, vasectomy, fetal ultrasound etc?

It's a reality in my state, it just depends on where you are and what the need is. I know quite a few folks doing OB, colonoscopy, US, colposcopy, derm procedures, etc. who are just out of training within the past few years. Most of the counties in TX are medically underserved, so you can basically throw a dart at a map of the state (unless it's a major urban area) and hit an area where you will likely have an opportunity to do whatever procedures you'd like. You might have to buy the equipment, or work something out with the local hospital, but I think it's quite plausible in most areas that are medically underserved.

BTW, I agree that surgery can be very sexy when you are a 3rd year and experiencing it for the first time. All the toys, the ritual of it, the drama, the POWER OF CURE! It wears off for most, but if it doesn't, you may be cursed with the sickness and actually have to consider a career in it. Ack. It also becomes less sexy when you deal with post-op infections, complications, adhesions, etc.

 

[thtswhatshesaid]

First time post here on SDN....I have read a lot of the posted debates, though, in my quest to figure out if FM or OB/GYN is right for me, and thought I'd resurrect this thread. I know that I want to do obstetrics -- I had a great time on L&D and was energized by the patient connection and hands-on aspects of it. I love the philosophy of continuity in FM and will definitely would want to be c-sectioned trained with an ob fellowship year after FM if I go that route (or go to a ob heavy program, or both). I have been pretty dead set on that for a while, but lately I have been torn between FM and OB/GYN. I was not a huge fan of the gyn side during my rotation, but I am worried about trying to practice operative obstetics without more OR experience. And the respect issue (fps getting much less that ob/gyns) is starting to get to me more than it should. I suppose I could put up with the gyn surg/gyn onc during residency...and I always generally enjoyed the OR when I was actually doing something and not just standing there.....that being said I would definitely miss taking care of kids if I do OB/GYN! I hated handing off the baby after a delivery. Also never seeing men again! That seems so odd to me.

I ultimately want to work with an underserved population and stay involved in public health, but I can do that from either speciatly. I see FM as having more of an underserved committment, though, which draws me to it and makes me feel like I will fit into the culture better.

I feel like I would be happy in either specialty but will have times where I miss aspects of the other. Will this ever get clearer for me?? I am an M3 and am trying to get a good family rotation organized for early next year....it doesn't help that my school does not give FM any respect and I get negative responses whenever I say I am strongly considering it....

Anyone else still trying to figure this out??

 

[MeowMix]

This will get clearer as you do fourth-year rotations. I found I wanted to continue working with kids, to do all aspects of women's health, and to work with men. I did not want to lose the ability to diagnose and treat basic medical problems. I also realized that I personally would contribute more to medicine by working directly with patients, rather than by being a surgeon, because of my particular skills.

In the olden days before the 80-hr work week, it was possible to get adequate C/s training in a regular FM residency. My conclusion after interview season is that you really can't do that any more unless you are in a very special program with a huge emphasis on operative obstetrics, a liberal interpretation of the 80-hr work week, and you are going to give up some other aspect of your FM training in order to do that.

Consider the combined FM/OB program at UC Davis. This is a 4-yr program and I thought it was fantastic (but the geography didn't work out for me long-term). Top-notch OB training - you are essentially an OB resident when you are not an FM resident.

 

[sophiejane]

I struggled too. In fact, I still struggle. My heart starts beating faster when I walk through the doors to L&D or the OR. I love sections. I love SVDs. I kind of love Gyn but less so.

But.....I also really like the rest of my job. The challenge of the sick hospital patient and the continuity in clinic. Sick kids, well kids, old people, young parents.

All of it challenges me and keeps me going.

I just have to trust I will find my niche in real life, and get to do most, if not all, of the things I love.

If I can't do OB, I will have done a whole lot in residency and had a blast doing it. 🙂

 

[hilseb]

I am having this struggle, too. I started med school thinking I would do FP with OB. But, I hear from everyone that it is hard, that I will only be able to do OB if I live in a rural setting. I took the advice of an instructor, who is an FP, to look closer at Ob/Gyn. I talk and read obsessively about obstetrics.

Well, a year later an I am an M2 and will be president of the Ob/Gyn interest club. I spent the day with an Ob associated with the residency I want to apply to, and she suggested I look into FP! She said FPs do deliver their own patients at Jackson, which is the biggest public hospital in Miami, the teaching hospital for U Miami. Miami is about as big city as it gets.

Ugh. I am so torn. I am interested in continuity of care. I like cardio and endocrinology. I LOVE obstetrics. I am not so sure I will be that into gyn surgery, or gyn onc.

I love the idea of the UC Davis program, but my family really wants to stay in South Florida. (I have a husband and kids). If I do FP here, it will be with limited OB. I could try to moonlight in OB. There is no OB residency anywhere down here except at Jackson. They also have an OB fellowship for FP. But, will I be able to deliver at any hospitals? Will I be able to find a practice to keep me sharp enough to handle operative complications? Will I have to live in a rural setting my whole life? Will academic medicine be out of the question?

 

[Miami_med]

I am having this struggle, too. I started med school thinking I would do FP with OB. But, I hear from everyone that it is hard, that I will only be able to do OB if I live in a rural setting. I took the advice of an instructor, who is an FP, to look closer at Ob/Gyn. I talk and read obsessively about obstetrics.

Well, a year later an I am an M2 and will be president of the Ob/Gyn interest club. I spent the day with an Ob associated with the residency I want to apply to, and she suggested I look into FP! She said FPs do deliver their own patients at Jackson, which is the biggest public hospital in Miami, the teaching hospital for U Miami. Miami is about as big city as it gets.

Ugh. I am so torn. I am interested in continuity of care. I like cardio and endocrinology. I LOVE obstetrics. I am not so sure I will be that into gyn surgery, or gyn onc.

I love the idea of the UC Davis program, but my family really wants to stay in South Florida. (I have a husband and kids). If I do FP here, it will be with limited OB. I could try to moonlight in OB. There is no OB residency anywhere down here except at Jackson. They also have an OB fellowship for FP. But, will I be able to deliver at any hospitals? Will I be able to find a practice to keep me sharp enough to handle operative complications? Will I have to live in a rural setting my whole life? Will academic medicine be out of the question?

It is highly unlikely that you will deliver patients in Miami as an FP. Even OBGYNs are dropping OB in droves to practice only GYN in Miami as no one can get insurance.

#1)I'd think long and hard about the implications of trying to practice OB in this city through any discipline, because everyone really is out to get you. The only insured entity practicing OB in Miami is the UM group at Jackson.

#2)While FM residents do sometimes deliver patients at Jackson, I've seen zero FP attendings or private practicioners engage in this practice in S. Fla.

I don't know how much operative experience you'd actually get in OB down here as an FP resident.

 

[sophiejane]

It is highly unlikely that you will deliver patients in Miami as an FP. Even OBGYNs are dropping OB in droves to practice only GYN in Miami as no one can get insurance.

#1)I'd think long and hard about the implications of trying to practice OB in this city through any discipline, because everyone really is out to get you. The only insured entity practicing OB in Miami is the UM group at Jackson.

#2)While FM residents do sometimes deliver patients at Jackson, I've seen zero FP attendings or private practicioners engage in this practice in S. Fla.

I don't know how much operative experience you'd actually get in OB down here as an FP resident.

THis is happening all over the country, but I do agree Florida (and south Texas) are two of the worst places for malpractice.

It's very disturbing. I guess when all the &*%($(& lawyers who are getting rich off suing OBs start showing up to L&D with their pregnant wives and nobody will touch them, maybe then we will start seeing some changes....?

 

[Miami_med]

THis is happening all over the country, but I do agree Florida (and south Texas) are two of the worst places for malpractice.

It's very disturbing. I guess when all the &*%($(& lawyers who are getting rich off suing OBs start showing up to L&D with their pregnant wives and nobody will touch them, maybe then we will start seeing some changes....?

Since practicing OB is actually financially deleterious down here, with almost a negative pay for each baby delivered (with the liability surpassing the potential income), and we still actually have OB, I sincerely doubt it. I have to admit that it would be fun to live in a pre-EMTALA world. A Mrs. Gonzalez, I see that you are in labor. I would be happy to deliver your baby, but you previously sued me as the prosecuting attorney, and as you seem to believe that I am incompetent it would probably be better if you just went and used the tree outside.

 

[sophiejane]

Since practicing OB is actually financially deleterious down here, with almost a negative pay for each baby delivered (with the liability surpassing the potential income), and we still actually have OB, I sincerely doubt it. I have to admit that it would be fun to live in a pre-EMTALA world. A Mrs. Gonzalez, I see that you are in labor. I would be happy to deliver your baby, but you previously sued me as the prosecuting attorney, and as you seem to believe that I am incompetent it would probably be better if you just went and used the tree outside.

I guess what I meant was that when OBs can no longer afford to deliver babies, there will be a shortage in that area, and people will be delivering in the ER. A la EMTALA. Say bye-bye birthing suite and doula, say hello PA or DNP, gurney, and demerol, if you're lucky.

 

[lowbudget]

A Mrs. Gonzalez, I see that you are in labor. I would be happy to deliver your baby, but you previously sued me as the prosecuting attorney, and as you seem to believe that I am incompetent it would probably be better if you just went and used the tree outside.

Um... right. I'm sorry but it's our hospital's standard policy that the uninsured who own Louis Vuitton bags, snort top-shelf cocaine on weekends, and jet-set fill out this 15 page certification of financial need. Hey, listen. I know your brain's herniating. Well, ok then, if you're not a satisfied "customer", why won't you just drive that Escalade to the nearest hospital 70 miles on the other side of that mountain?

(Love. It.)

 

[smq123]

I am having this struggle, too. I started med school thinking I would do FP with OB. But, I hear from everyone that it is hard, that I will only be able to do OB if I live in a rural setting. I took the advice of an instructor, who is an FP, to look closer at Ob/Gyn. I talk and read obsessively about obstetrics.

Well, a year later an I am an M2 and will be president of the Ob/Gyn interest club. I spent the day with an Ob associated with the residency I want to apply to, and she suggested I look into FP! She said FPs do deliver their own patients at Jackson, which is the biggest public hospital in Miami, the teaching hospital for U Miami. Miami is about as big city as it gets.

Ugh. I am so torn. I am interested in continuity of care. I like cardio and endocrinology. I LOVE obstetrics. I am not so sure I will be that into gyn surgery, or gyn onc.

I love the idea of the UC Davis program, but my family really wants to stay in South Florida. (I have a husband and kids). If I do FP here, it will be with limited OB. I could try to moonlight in OB. There is no OB residency anywhere down here except at Jackson. They also have an OB fellowship for FP. But, will I be able to deliver at any hospitals? Will I be able to find a practice to keep me sharp enough to handle operative complications? Will I have to live in a rural setting my whole life? Will academic medicine be out of the question?

If you're an MS2....it's still too early to be worrying about this.

Go through your rotations. See what you like. Some people end up hating OB/gyn because they find that delivering babies is not nearly as much fun in real life as they anticipated. Some people really, really, really cannot stand the GYN part of the specialty, and hate being in the OR.

And see how you feel about the outpatient clinic (which is a huge part of family med). Do you like seeing a huge variety of patients? Do you mind having a patient with thyroid disease come in right after a patient coming in for a heart medication check? Do you like taking care of kids? Do you like taking care of elderly men?

You've got some time to figure it out. Good luck. 🙂

 

[Leukocyte]

And see how you feel about the outpatient clinic (which is a huge part of family med).

Ironicly, the OP clinic is what I hate the most about FM residency. I dread the 2 half-days that I have office hours on. We see patients every 10 minutes! Like cattle. Sometimes we are double booked for some of the 10 minute slots. The patient volume is huge, it is sickening. Not to mention that we have to take care of phone masseges, and re-fills that keep pilling up on my desk. Them I have to stay until 9pm to dictate all the charts. Horrible.

I am now in OB rotation, and I love it. Very focused specialty. The OB OP clinic is nothing like the FM OP clinic.

I am the "surgical type" anyways, and I have been having thoughts lately about switching residencies to OB/GYN. I like FM because of the variety, but the busy OP clinic is really taking a huge toll on me. I might be in the wrong specialty.🙁

 

[deleted87716]

Ironicly, the OP clinic is what I hate the most about FM residency.

That sounds like a pretty poorly-run residency clinic. There's certainly no reason that you'd have to work like that in private practice unless you wanted to.

In contrast, my program had a very well-run FM clinic, but the OB clinic (run by the OB residency program) was a true "cattle call."

This is definitely the sort of thing you want to explore when you're interviewing, because there's a lot of program-dependent variability.

 

[igcgnerd]

Does anyone have more info on the davis fm/ob program? I'm really interested in hearing from anyone who has some close personal knowledge of the program.

 

[dr0277341283141]

I didn't read all the posts above, but retrospectively I would have done Ob/Gyn.

I once had a patient whom I diagnosed with HELP syndrome. She thinks I walk on water now. I love the Ob service. They are healthy women, sometimes nuts like any patient but outcomes are awesome. And they seem to understand that you're going overboard because it's a baby.

 

[lowbudget]

It goes both ways. For every 5 steps above water, there're 5 below water. The real question in OB is: is there someone pushing your head even further below water?

 

[sophiejane]

And they seem to understand that you're going overboard because it's a baby.

Good outcomes are expected.

Bad outcomes are tragic and heartbreaking and will get you sued, whether you did anything wrong or not.

 

[hippiedoc13]

Does anyone have more info on the davis fm/ob program? I'm really interested in hearing from anyone who has some close personal knowledge of the program.

It's a very small program (1 per year I think), so the chances of encountering someone around here who has "close personal knowledge" of the program is pretty slim. I interviewed at Davis FM but not for the FM/OB program. I met a couple of the residents and they seemed super nice and approachable. I think your best bet is to look up their email addresses on the Davis FM residency site and contact them directly with your questions about the program.

 

[secretwave101]

Agreed. Best to get that kind of knowledge by rotating there if possible, or visiting.

 

[jenmardo]

i am currently in my 3rd year of FP residency, and planning to apply to OB/GYN next year.

First of all, I struggled with the decision on which specialty to go into. I eventually chose FP because of the variety, lifestyle, continuity of care. My FP program has very decent volume of OB, and we do operative obstetrics and tubals.
So, I am interviewing for jobs, and to my disappointment, people think its absolutely nuts I want to do OB as an FP. My husband and I prefer a metropolitan area, which does not smile friendly on FP/OB. I understand there are exceptions, and the academic avenue is there, but CRAP! I didnt work this hard to be an urban referral doc, which is what we are expected to be in the city.

If you truly love ambulatory medicine, and/or are willing to go rural or semi rural, then FP is AWESOME.

Its a tough decision. There is no wrong answer. I am going to stay double boarded.

 

[earthgirl101]

jenmardo--wow, your input is really valuable and appreciated. It seems like so many struggle with this decision (FP/OB) that there should be a better option out there. I've heard of so many who've switched residencies, both ways. I'm curious, what region of the country were you applying for jobs? I've heard its more FP/OB friendly out west...I personally would really like to get c-section privelages if I did FP and a fellowship...did you look into that option at all? Are you interested in gyn surgery at all? Feel free to PM if you want to carry on the conversation in private. I really appreciate anything input you can offer 🙂