Do family practitioners still deliver babies?

Discussion in 'Family Medicine' started by hilseb, Apr 12, 2007.

  1. hilseb

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    I get such mixed answers to this question. I have heard there is a 3 yr residency that is FM with OB. This is what I want to do. I want to deliver low risk pregnancies and do family medicine in some underserved or remote area, maybe even open a birth center. Are there any family medicine practitioners out there who still deliver babies? Will I be able to deliver babies without a 6 yr OB/Gyn residency? Will I be able to have rights at a hospital, or do you think I will be restricted to out of hospital birth?
     
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  3. sophiejane

    sophiejane Exhausted
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    THere have been a few threads on this topic in the past--you might find them on a search. But since this is my pet topic ;) I will oblige.

    Yes. Not as many as there used to be, but they exist, primarily in areas that are underserved--though there are FPs who do OB in urban areas.

    First, OBGyn residency is only 4 years, so if you really want OB to be your primary focus, you might consider that.

    Whether or not you can do deliveries as an FP depends on whether or not you are able to find a job for an FP with OB, or if you go solo, if you can get the patients to support such a practice. They are definitely out there, but you have to be pretty mobile and willing to relocate to another state or region, unless you already live in a state with a large underserved population.

    But, yes, if you complete a 3 year FM residency and get plenty of OB experience, you may get hospital priviliges. The requirements differ widely--anywhere from 100-200 deliveries seems to be the target. Obviously, the more the better. Also, many will recommend a one-year OB fellowship regardless of how many deliveries you get in residency. You might also consider that this will essentially be a 4 year residency, so if you look at it that way, you might as well just do OBGyn. I didn't choose that option because I want to do full-scope primary care as well.

    Someone correct me if I'm wrong, but I don't think MDs and DOs can do out of hospital deliveries, such as home or birthing center (if that's what you are referring to).

    If by "low risk", you mean you will refer older moms (>35), diabetics, multiples, and moms with complicating medical issues to an OBGyn, that makes sense, of course. But remember that sometimes an uncomplicated pregnancy becomes complicated at delivery. You cannot expect to do only vaginal deliveries if you are going to work in a remote area where you are the only provider, or where there are only FPs. Choose your residency wisely, and make sure you can get at least 100 c-sections during the three years (this number is not scientific, and may be more than is required by hospitals, but it's my personal goal for my own sense of security!). You may have to work for them, and stay longer hours or take more call, but it can be done at the right program.

    As for opening a birthing center not associated with a hospital and without an OR, I have no idea about that. I have a feeling there may be some legal hurdles that might prevent an MD or DO doing this, but I'm not sure.

    Best of luck to you.
     
  4. ny skindoc

    ny skindoc Senior Member
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    You need to be aware of the economics of a FP paying malpractice for OB..this is going to be very expensive and a high overhead item for a FP if you are on your own and doing genearl FP as well..Your post suggests that OB is a very strong interest
    especially in terms of a birthing center.I agree you will be best served by completeing a 4year OBGYN residency.Your skills will be at a much higher level.You will not have to worry about hospital privileges.There is no telling what the future of FPs doing OB will be.
    If you do OB in an undersereved area you may not have the luxury of sending out all high risk mothers and may need to manage many of them yourself.
     
  5. sophiejane

    sophiejane Exhausted
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    There are hospitals in rural areas that will subsidize your malpractice so that you pay what you'd pay for an FP and they cover the additional amount for OB. If not, you have to do about 4-5 deliveries a month to cover your additional malpractice insurance. In places with a true need, this is not difficult to do.

    My experience has been that people who tell you it can't be done economically don't have any actual experience as an FP doing OB,they are just towing the party line.

    What they don't tell you is that when you do the delivery, you get all the prenatal visits and you get to take care of both baby and mom afterwards...all those well child checks, well woman exams, plus sick visits. And they bring you the rest of the family (dad, grandpa, etc.) if you are good. The FPs who do OB tell me this is where the financial reward comes, not from the actual delivery.

    As for being more skilled after doing an OBGyn residency, that may be true in surgical skills, which you wouldn't use as an FP anyway. There are FM programs that graduate docs whose delivery numbers are very similar to those graduating from OBGyn residencies. At my program, it is not uncommon for someone who puts in some extra hours and call doing OB to get 300-400 deliveries and 100+ sections.
     
  6. Apollyon

    Apollyon Screw the GST
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    The big, urban, university hospital that I work at (among 3 other suburban ED's), which has an active FM program and an Ob/Gyn residency, recently distributed a letter from Ob encouraging us to refer low-risk and prior C-section pregnant patients to FM. Granted, the urban area is surrounded by rural/poverty, but it truly qualifies as urban.
     
  7. Marigold

    Marigold Kid Doctor
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    SJ, isn't it nice to be able to say "my program"??? :D
     
  8. sophiejane

    sophiejane Exhausted
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    :D Hee hee. Yes, it is.
     
  9. hilseb

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    Thanks for all the info!
     
  10. Tn Family MD

    Tn Family MD Junior Member
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    I certainly plan on doing OB in my practice. In fact, I plan on it being a very large part of my practice and I fully expect it to help contribute positively to the financial aspect of my practice. If you look into it, the numbers that most people will try to tell you are a bit misleading. Maybe that is not the case in every state due to varying malpractice rates, but I can tell you in my state you don't really have to perform very many deliveries annually to make it a financially sound business plan. And I have a businees degree with accounting emphasis, so I know how to analyze the financial aspects of a business and determine if it is a sound business plan. I plan on doing an OB fellowship and doing even moderate to high risk pregnancies. Probably the amount and type of stuff I will refer out won't need to go to an ordinary Ob/Gyn doc but rather to an MFM fellowship trained doc. I tend to be pretty opposite from what most others in my residency program feel about doing OB, though. I do fear it is a dying aspect of FM that will eventually wither and disappear. I don't think that will have much impact on me as a physician, though, because I am already getting that training that I need.
     
  11. lowbudget

    lowbudget Senior Member
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    If you're thinking of doing FP with OB, you may want to consider actually being faculty at an FP program. STFM publishes these self-propagating articles that programs with FP doing OB have better role modeling and increase the likelihood of residents practicing OB in the future. Your malpractice is covered, obviously. Thumbing through the want ads, they can't seem to give away these positions. In talking to my non-fellowship FP faculty who did OB in private practice before coming to my program, they said they kept a good relationship with their OB/Gyn colleagues and would consult the on call OB if they needed help and it would be no big deal. Of course, "good relationship" means more than just playing nicely and referring appropriately. Sounds like it also meant knowing what you're doing. It would be nice to be able to go to a C section without needing to call OB (or in some places, general surgery) which is why people fellowship train, but it sounds like it's doable if you want to do it.
     
  12. hilseb

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    I would love to be faculty somewhere. I like teaching.

    When does a fellowship take place? After the residency? Is it a paid position? Would it interfere with a National Health Corp scholarship?
     
  13. iatrosB

    iatrosB trying not to kill anyone
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    Fellowship is after residency (usually one year for OB).

    It is a paid position, but only slightly higher than residency (say $2,000-4,000 more), so it's still not very much.

    NHSC will not let you do the fellowship until after you serve your comittment.
     
  14. cooldreams

    cooldreams American Mensa Member :)
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    after res?? whaaaat??? what about frodo and the fellowship of the ring?? he did no residency... sheesh.... :laugh:
     
  15. DoctorMom78

    DoctorMom78 Sky Glory
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    I also want to go into FM w/ OB. I hope to go to UT for their FM residency and then do the OB fellowship there. I talked to a physician recruiter for a hospital in the area and they said that they would absolutely hire an FM/OB because it is like getting two doctors for the price of one. I think that there is definitely still a place for us, but it is only in rural areas.:) :luck:
     
  16. hilseb

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    Yes, I live in a very non rural area, South Florida. I want to live in a rural area / underserved community.

    I see you are class of 2011 also. How did you find out about the specific residencies already?
     
  17. sophiejane

    sophiejane Exhausted
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    It's a bit on the early side for 2011-ers, but if you want to get a head start, you can try the FRIEDA database or the AAFP:

    http://www.ama-assn.org/vapp/freida/srch/

    http://www.aafp.org/residencies/

    Or for DOs, the osteopathic site:
    http://opportunities.osteopathic.org/

    I've said it before, but I will say it again: rotate at or visit as many programs as you can. The interview day is not enough to make a decision that can affect your future in such a big way. Read everything you can on their websites, use SDN, and go to all the residency fairs you can.
     
  18. DoctorMom78

    DoctorMom78 Sky Glory
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    I am a total control freak and need to have a plan. So, I have actually already contacted UT to find out what I need to do to get into their program.:D :thumbup: There is a lot of information online if you want to check it out.
     
  19. DoctorMom78

    DoctorMom78 Sky Glory
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    Thank you!:)
     
  20. Doula-2-OB

    Doula-2-OB Going in from the outside
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    We have a few FP in my community who do catch babies, but only a few. The rest of the baby catchers are OBs and a couple of homebirth midwives - no CNM privileges at our hospital unfortunately. I am also interested in either OB/GYN or FP with OB.
     
  21. buglady

    buglady We need more cowbell
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    I don't know if you'd consider a military route, but many military programs can provide a ton of experience with delivering babies.

    The military FP programs, and I can only speak for the Navy, expect their FP residents to do a lot of OB. Where I will be doing my residency, we are the only residents in the hospital, thus, we're the residents on the Labor and Delivery floor and 1st assists when c-sections are performed. We're supervised mostly by FP's, but also OB-Gyn's and midwives.

    When I was doing one of my 4th year rotations at another Navy hospital on a Marine base, I was floored by what the residents were managing....they were extremely comfortable managing preeclampsia, gestational diabetes, etc. And so many mommies were having babies...that place was crowded!

    I expect to catch a lot of babies in the next 3 years!
     
  22. hilseb

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    Buglady, I love the cowbell.

    The military uses midwives? How interesting! CNMs, I assume.

    No, I am not really interested in a military route, but I am interested in National Health Service Corp.
     

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