Family medicine or OB

[Mindyaown]

Hello all,

I am very interested in OB/Gyn however I am not very interested in the in-patient part of it all. I see myself working more out patient and am interested in caring for pregnant women/ deliveries. Do you guys think BCFMO is the way to go for this? I know rural family medicine docs do a lot of women's health but i'm not sure I want to live in a rural setting for the rest of my career.

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[AMEHigh]

I’m FM in a very large city and there are FM’s that do OB. If you want to work in academics that’s pretty easy to find. Where I work there are 3 FMs that do deliveries, the rest of us just do pre and postnatal care. I was browsing jobs yesterday and saw a couple of posts in my city looking for FM-OB. Although I don’t do deliveries doing pre and postnatal care is actually one of the things I love love about FM, it’s the true family med model. Get to really know your patient, then take care of the baby afterwards, help mom get contraception if she wants it (iud, nexplanon, etc). If she experiences a miscarriage you can manage it and don’t have to refer to someone else. So clearly I’m an advocate

Of course the job options will be less than if you just do general family med but it’s still definitely an option in non-rural areas and you really can shape a FM job how you want it.

 

[Sardonix]

Hello all,

I am very interested in OB/Gyn however I am not very interested in the in-patient part of it all. I see myself working more out patient and am interested in caring for pregnant women/ deliveries. Do you guys think BCFMO is the way to go for this? I know rural family medicine docs do a lot of women's health but i'm not sure I want to live in a rural setting for the rest of my career.

There's a lot to unpack here.

First of all, here's The List if you haven't seen it yet. For interests in OB and women's health, this is required reading for you:

September 2019 – advancedfamilymedicine

1 post published by sstringfield during September 2019

advancedfamilymedicine.wordpress.com

Notice that while rural is definitely in that document multiple times, it's not at all a necessity. Plenty of FM-OB fellowships and OB intensive FM residencies are in large cities.

It's understandable that in the US's increasingly cautious and compartmentalized healthcare system that people would assume FM docs only truly get to choose what they want to do out in the sticks. Even though I am going to one of the rural programs listed above, I can also safely say that is not the case. AMEHigh's post is a great example of that.

You want pre/post natal care? Easy peasy. You want to do deliveries? So long as you keep your numbers up and show active interest in doing it, I can't see that being too difficult. You want to do C-sections? Well now chances are that you MAY need a fellowship to do that unless you really do want to live in a rural setting.

It all comes down to what you want and how committed you are to obtaining those wants. Going rural will indeed make that easier, but it needs to be emphasized that's not the only option. Heck, what even is rural? If your definition of rural is anything outside of LA, NY, SF, Chicago, or a city center of +1million, then your options are narrow. If you are willing to negotiate and can imagine living in a place that isn't a small town but also isn't a large city, your options are vast.

Or you could say, screw it, this is too many semantics, and just gun straight for OB if that's what you really wish.

 

[AnatomyGrey12]

You want to do C-sections? Well now chances are that you MAY need a fellowship to do that unless you really do want to live in a rural setting.

I go to a school with a lot of FM faculty, and a lot of faculty that deliver, and I don't know any FM doc that does c-sections without an OB fellowship. Even in the complete boonies it's the general surgeon in town that usually does the cutting. I wouldn't expect to do c-sections as an FM doc anywhere without a fellowship and even then it's fairly rare.

 

[Sardonix]

I go to a school with a lot of FM faculty, and a lot of faculty that deliver, and I don't know any FM doc that does c-sections without an OB fellowship. Even in the complete boonies it's the general surgeon in town that usually does the cutting. I wouldn't expect to do c-sections as an FM doc anywhere without a fellowship and even then it's fairly rare.

Good addition. I was kinda murky on how that all worked out in practice.

 

[SLC]

I go to a school with a lot of FM faculty, and a lot of faculty that deliver, and I don't know any FM doc that does c-sections without an OB fellowship. Even in the complete boonies it's the general surgeon in town that usually does the cutting. I wouldn't expect to do c-sections as an FM doc anywhere without a fellowship and even then it's fairly rare.

Out here where I am (your home state if I’m not mistaken) only two of us FM docs affiliated with my hospital aren’t credentialed for c-sections. Nobody did an OB fellowship. They’ve even offered to train me, but I have no interest.

 

[Sardonix]

Out here where I am (your home state if I’m not mistaken) only two of us FM docs affiliated with my hospital aren’t credentialed for c-sections. Nobody did an OB fellowship. They’ve even offered to train me, but I have no interest.

I was hoping you'd chime in on this conversation too.

 

[AnatomyGrey12]

Out here where I am (your home state if I’m not mistaken) only two of us FM docs affiliated with my hospital aren’t credentialed for c-sections. Nobody did an OB fellowship. They’ve even offered to train me, but I have no interest.

Interesting. Maybe it's just where I go to school then.

 

[Dr. Death]

Hello all,

I am very interested in OB/Gyn however I am not very interested in the in-patient part of it all. I see myself working more out patient and am interested in caring for pregnant women/ deliveries. Do you guys think BCFMO is the way to go for this? I know rural family medicine docs do a lot of women's health but i'm not sure I want to live in a rural setting for the rest of my career.

What do you mean by "in-patient" part of OB? Are you talking about like hysterectomies where they stay overnight?