family medicine obstetrics

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ilovelamp2

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Just wanted to spread the word about the new board certification for family medicine obstetrics.....
http://www.abpsus.org/certification/family_medicine_obstetric/index.html

As an FM R1 interested in doing an ob fellowship in a few years, I was very excited to see there is starting to be official certification available. It seems that having such a stamp of approval will only serve to help those who want to pursue surgical obstetrics as a family physician.

What are everyone's thoughts on this?

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do you think more FP's will practice now that it's official? I really considered ob/gyn, but am more holistic and "crunchy granola" in approaching pregnancy and L&D- I wonder if FP route could create more of a bridge between the ob/gyn surgeon mentality and the home-birth midwife approach. I know in the southeast, where I live, there are absolutely NO midwifes practicing in our hospitals... I feel like most people are still very conservative bc of the risk of malpractice. I just wonder if this is going to change anything. Still not a lot of programs, though. Is this mainly so that FP's can provide care in rural settings where there aren't obs?
 
i thought once you finish an fp residency you are allowed to practice obstetrics? is a fellowship necessary? sorry if this seems ignorant...
 
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Just wanted to spread the word about the new board certification for family medicine obstetrics.....
http://www.abpsus.org/certification/family_medicine_obstetric/index.html

What are everyone's thoughts on this?

I've never heard of this "American Board of Physician Specialties" until now. After reviewing the website, this "Board" seems to be created to make some money off of people's desire for certification.

From their website: "Though certification does not guarantee the competence of individuals, the affiliated Boards of Certification of the American Board of Physician Specialties (ABPS), attests that certified members have met minimum education and experience requirements for various certification levels."

I'd be wary of such 'certificates' since they're not really Board certification. Until the American Academy of Family Physicians and American College of Osteopathic Family Physicians certify FM docs with certificates of added qualifications or something similar, the certification you'd get from this so-called American Board of Physician Specialties is probably not worth the paper it's printed on.

Am I wrong? Perhaps someone can chime in on this ABPS, but this is the first time I've ever heard of this group.
 
You can certainly practice obstetrics as an FP - although a lot depends on the area you're practicing in (devoid of OBs helps). Sometimes FPs get a little extra training in high risk OB including doing C-sections. This extra documentation appears to be geared toward those folks.
 
The American Board of Physician Specialties is a legitimate but controversial attempt at a third force in multispecialty board certification. It was originally founded to certify early D.O.s who did allopathic residencies and at the time fell between the requirements of the ABMS and AOBMS. It is probably best known today for its Board of Certification in Emergency Medicine (BCEM), which continues to offer a practice pathway to its EM board certification for physicians residency-trained in other specialties. This is accepted in some contexts but clearly not accepted in many contexts that demand ABMS or AOBMS certification, and seems to be almost the entire reason the ABPS is controversial.

Physicians interested in announcing they are board certified should check requirements of any states in which they are licensed or practice. last I've seen, ABPS is approved for this purpose by state authorities in Florida, for instance, but disapproved in New York and North Carolina, again for example.

Highly credible people serve on the ABFMO (or ABOFMO) board. The Chair is Daniel M. Avery, Chair of OB/GYN at University of Alabama College of Community Health Sciences. Vice-Chair is Mark Loafman of Northwestern University. Members include Wm. MacMillan Rodney of PSOT fame.
 
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Interesting. Thanks chartero.
 
family docs can practice OB anywhere they chose. its 100% within our scope of practice. one caveat, most hospitals wont grant you surgery priveleges for section unless you have decent #'s. but if you want to do vaginal births, the sky is the limit. if u need to get your section #'s up, do some electives somewhere they will let u get lots of sections. it doesnt require a fellowship.
for routine OB, my program requires 30 deliveries and 10 continuity. i am pretty sure thats acgme #.
my program sends us offsite to get our deliveries so we dont have to compete with OB at our own hospital. it works out well. i have gotten my 40 in 3 weeks, its nice being the only resident.
that being said, personally i have seen enough of that area to last me a lifetime. lol, but if its your thing go for it!

ps: an obgyn reading this will think we are stepping on their toes. but think about this..
in most programs, obgyns dont do sections (as lead surgeon) until 4th year.
if you are a family doc and do a 4th year fellowship in obgyn, you would be in essentially the same boat.
 
ps: an obgyn reading this will think we are stepping on their toes. but think about this..
in most programs, obgyns dont do sections (as lead surgeon) until 4th year.
if you are a family doc and do a 4th year fellowship in obgyn, you would be in essentially the same boat.

I'm in an OB/GYN residency, and I absolutely don't think family practice doing deliveries/sections is stepping on toes. Most family docs who plan on doing OB are doing such in an unopposed/rural area, and it's a great way to provide continuity with all your patients.

I will, however, correct you on your statement about sections. In most programs, you start doing primary sections as 1st/2nd years as primary surgeon, NOT fourth year. At my program, we start being primary surgeon on primary sections starting in December of intern year. Repeat sections go to either the 3rd/4th year, or the 2nd year if they've had enough primary surgeon sections. Considering the fact that by the end of 2nd year, most of us will have had >100 sections, (with likely over 350 by the end of 4th year), I can honestly say you WON'T be in the same boat.
 
I'm in an OB/GYN residency, and I absolutely don't think family practice doing deliveries/sections is stepping on toes. Most family docs who plan on doing OB are doing such in an unopposed/rural area, and it's a great way to provide continuity with all your patients.

I will, however, correct you on your statement about sections. In most programs, you start doing primary sections as 1st/2nd years as primary surgeon, NOT fourth year. At my program, we start being primary surgeon on primary sections starting in December of intern year. Repeat sections go to either the 3rd/4th year, or the 2nd year if they've had enough primary surgeon sections. Considering the fact that by the end of 2nd year, most of us will have had >100 sections, (with likely over 350 by the end of 4th year), I can honestly say you WON'T be in the same boat.

Agreed. As a former Ob resident, I know this to be the case. However, if you as a FP doc do an OB fellowship, you will spend 9-12 months on labor and delivery, which depending on the program, will be roughly equivalent to the amount of time that an Ob/Gyn resident spends on L&D spread out over the course of their 4 years. In a good fellowship, an FP fellow should get at least 100 c/s and maybe up to 250-300 depending. So not quite equivalent, but perhaps good enough.
 
thanks for the clarification :) i only know 2 obgyn residents (in 2 other programs) and they dont lead until 4th year, same as my program. so thats 3 i knew of. but what they seem to have in common is low ob#'s so that could explain it.
i wrongly assumed it applied to "most" programs.
 
Why would an FP want to practice OB, considering the high risk, unless they're rural?
 
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Continuity of care.

Hah, no offense, but you'll think that the first time you get sued. There's a reason nobody wants to get into OBGYN. You're braver than I am. I wouldn't touch OB without being an OB.
 
Why would an FP want to practice OB, considering the high risk, unless they're rural?

Why would an FP want to practice ob? Well, maybe consider that they may really enjoy practicing obstetrics, a skill set that they worked hard to obtain. Or maybe that they feel like they have something unique to offer a pregnant patient (continuity of care probably being the most important).
I find the above question really frustrating because in its essence it paints ob as something that is generally unpleasant to do. I realize it is not every family physician's thing, but I don't think it should be a stretch for anyone to imagine why an FP would include OB in their practice.
 
As a former Ob resident, I know this to be the case. However, if you as a FP doc do an OB fellowship, you will spend 9-12 months on labor and delivery, which depending on the program, will be roughly equivalent to the amount of time that an Ob/Gyn resident spends on L&D spread out over the course of their 4 years.

Wow, seems as though my program is different. :) We aren't a big program (4 residents a year) but have 20 months total of OB over the four years. I think the implementation of night float is the cause of this.

But still, I agree, if you spend a full year on L&D, you'll get a LOT of experience.
 
Hah, no offense, but you'll think that the first time you get sued. There's a reason nobody wants to get into OBGYN. You're braver than I am. I wouldn't touch OB without being an OB.

Not so sure. It's not as sue-happy as it seems, and like any other skill set, if you're good at what you do, there is less to worry about. I know many skilled FP OB practitioners who love the continuity of care they provide for their patients. I know people have some bad experiences with OB, but trust me, we aren't all bad. :)
 
Why would an FP want to practice ob? Well, maybe consider that they may really enjoy practicing obstetrics, a skill set that they worked hard to obtain. Or maybe that they feel like they have something unique to offer a pregnant patient (continuity of care probably being the most important).
I find the above question really frustrating because in its essence it paints ob as something that is generally unpleasant to do. I realize it is not every family physician's thing, but I don't think it should be a stretch for anyone to imagine why an FP would include OB in their practice.

I don't think it's unpleasant, as I'm considering being an OBGYN. I'm also considering being an FP. If I were an FP, I wouldn't want to practice OB because of the liability issues. That's all I was saying. An FP is well within their rights to practice OB, I was just stating my own preference.
 
Why would an FP want to practice OB, considering the high risk, unless they're rural?

Doing OB and FP is very natural. I think that more OBs should partner with FPs. It is a very natural partnership. I did one year of OB, switched to FP for the medicine part and would like to do a fellowship when I am done with FP. Some FPs have a surgeon's heart. I think it is very fulfilling to do both. I do not get why ACGME does not recognise the strength of this combination. There should be more OB/FP combined programs.
 
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Why would an FP want to practice OB, considering the high risk, unless they're rural?

Some family physicians have a surgeon's heart. I know because I am one of them. I love surgery, when I am in the OR I feel completely fulfilled, like I have arrived home. I did one year of OB, what I found however completely lacking was the fact that inspite of the fact that OB's do a lot of primary care, our outpatient clinic was more for managing pregnancies. Primary care was non existent. I switched to family medicine and I think doing both OB and family medicine is the more natural way to go. It is unfortunate that there are hardly any combined OB/FP programs left. The one at Riverside in which was and excellent program was stopped 2 or so years ago.
In my current program, I have managed many pregnancies but I am also learning primary care. The 2 are not mutually exclusive.
Remember doctors get sued for bad bedside manner more than medical errors!
 
Some family physicians have a surgeon's heart. I know because I am one of them. I love surgery, when I am in the OR I feel completely fulfilled, like I have arrived home. I did one year of OB, what I found however completely lacking was the fact that inspite of the fact that OB's do a lot of primary care, our outpatient clinic was more for managing pregnancies. Primary care was non existent. I switched to family medicine and I think doing both OB and family medicine is the more natural way to go. It is unfortunate that there are hardly any combined OB/FP programs left. The one at Riverside in which was and excellent program was stopped 2 or so years ago.
In my current program, I have managed many pregnancies but I am also learning primary care. The 2 are not mutually exclusive.
Remember doctors get sued for bad bedside manner more than medical errors!

I'm doing the same. I'm about to finish my intern year of ob/gyn and moving to fp in july. I plan on doing both in practice after residency with or without a FPOB fellowship depending on what my case numbers look like.
 
Quasi necro bump.

Does anyone foresee a family physician having difficulty getting c section privileges if they have done 150 c sections as primary surgeon under a boarded OBGYN?
 
There's also a town of 6,000 15 minutes away with general surgery but no labor and delivery. Maybe they would love to have a family doc offering L&D services?
 
So how are you going to convince those 5 OBs to let you deliver babies in that hospital?

As for the other one, if its that close I bet you anything they're happy to just ship those down the road.
 
Some small hospitals require another physician to be an assistant at c sections.


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So five OB's wouldn't want help?
 
So five OB's wouldn't want help?
They might, though that would also cut into their income. Why would they want to share with you when they could hire another OB into their group? Plus, they would be the ones to bail you out if you get into trouble.
 
An FP can't really cover an OB from a call point of view so they might not be interested. Plus FPs in my location don't seem to be aware of when they are over their heads so an OB might be leery of the effect on their malpractice if consulted too late to prevent a bad outcome.


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Is it possible to do private practice FM and have privileges at a hospital for c sections if you just want to deliver you're own patients without joining an OBGYN group?
 
Is it possible to do private practice FM and have privileges at a hospital for c sections if you just want to deliver you're own patients without joining an OBGYN group?
Yes, but the OBs will likely fight giving you privileges unless you can give them a reason not to
 
Hmmmm, "Dear hospital, please give me privileges or my group of 10 family physicians will send all of our referrals to the competing hospital." It has potential...
 
Do the other ten have csection privileges?


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Hmmmm, "Dear hospital, please give me privileges or my group of 10 family physicians will send all of our referrals to the competing hospital." It has potential...

Unlikely that your group would agree to that


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Why didn't you join a group of FPs that do OB?


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In some communities.


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I think the best thing you can do, if interested in FM - OB is to be with FM-OB docs in the community and ask them:
1) what is your setup
2.) how hard is it to break into their location to do the same

It's a hard road to be GOOD at OB and it would be disappointing to put the work and sacrifice in, and not be able to practice as you were trained to do, in a location that you wish to live in.
 
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Yea, I don't want to take OB call every night during residency and then find out that my skills are inevitably going to be wasted when I could have been moonlighting and building up a useful skill like rural EM. There are family medicine residencies in my state that have FM faculty doing surgical OB. Maybe that's an option.
 
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