Surgeryislife

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Hello everyone! I’m a second year FM resident.
My main interests include, OB, peds, Derm, inpatient medicine, and possibly some EM. My ideal job would be inpatient medicine and inpatient OB coverage but I realize in order to do OB as a FM doc I’ll have to do some clinic too, though I don’t think I could tolerate more than 50% clinic. Does this seem realistic?
I’m guessing the jobs that match my above description will be in rural areas. I’m worried that working in a rural area will make it hard to keep numbers up for vaginal deliveries and repairs, c-sections, d&cs, colposcopies, etc. Is that true or do people find they’re able to maintain skills just fine working in rural areas?
Any guidance would be greatly appreciated.
Btw—planning to do an OB fellowship after residency so any recommendations for programs would also be appreciated. Again, definitely want to do some inpatient medicine in my future as well not just clinic.
 

AMEHigh

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If you work at a place with FM residency you can still do OB and inpatient. Yes it’s a dying bread but it’s still out there. I’m most familiar with places in the northeast. My coworkers do this and I live in a very large city. I’m not sure what break down you consider more than 50% clinic, but my colleagues typically do 2-3 half day sessions of outpatient care.

Working for the Indian Health Service would also give you this option but yes all of the people I know that work for IHS it is rather rural. But they do inpatient and OB. Not sure the breakdown of clinic hours. If you don’t want to be in academics at a FM residency this is a good option and you can do an elective with the IHS.

I do a lot of the procedures you mention above minus deliveries, but I can’t comment on keeping your skills up in rural areas since like I said I live in a very large city. I’m a part of a large network of family med docs that do similar care as me which is essentially "women’s health" and as far as I’m aware they have kept their skills up.
 
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AMEHigh

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Adding- I met 2 people last year that already had jobs lined up and were both going to be doing OB and inpatient in private practice. The jobs were in Wisconsin and NC, but not in super rural areas, more like decent sized towns.
 
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Blue Dog

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The number of FPs doing maternity care is declining. Most of the jobs will be rural, and I suggest choosing your residency accordingly. An OB fellowship can't hurt.

FWIW, the people who are still doing OB tend to love it. Dr. John Cullen, the immediate past president of the AAFP, is a good case in point (he practices in Valdez, AK).

 
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hallowmann

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You can still do OB and inpatient in FM, but if you really want some flexibility in shaping your schedule and keeping yourself out of clinic, then you should probably do it at an FM residency program as OB and inpatient faculty. That way you can do deliveries, work as much clinic as you like, and other time can be spent in research or procedure clinic. Of 3 graduates from the FM program at my institution, two are doing OB at residency programs and one is doing inpatient.

Also, I sure hope you are planning on a fellowship if you're hoping to do C-sections and be credentialed to do them independently. I don't know where you are training, but there aren't a lot of residency programs that have sufficient training in sections to be doing it enough to get credentialed.
 

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I don't get the whole "hate clinic" (but - presumably - like catching babies) thing. I mean, a woman spends 9 months of her gestation in clinic (which is where any medical decision-making aside from resuscitation would take place) and a few hours (typically) delivering her baby. If all you want to do is hang out in L&D and catch babies, you might as well be a midwife.
 
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VA Hopeful Dr

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I don't get the whole "hate clinic" (but - presumably - like catching babies) thing. I mean, a woman spends 9 months of her gestation in clinic (which is where any medical decision-making aside from resuscitation would take place) and a few hours (typically) delivering her baby. If all you want to do is hang out in L&D and catch babies, you might as well be a midwife.
I know laborists are a thing but even most OBs think that sounds miserable
 

hallowmann

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I don't get the whole "hate clinic" (but - presumably - like catching babies) thing. I mean, a woman spends 9 months of her gestation in clinic (which is where any medical decision-making aside from resuscitation would take place) and a few hours (typically) delivering her baby. If all you want to do is hang out in L&D and catch babies, you might as well be a midwife.

I suspect that "Surgeryislife" didn't end up in FM because they love clinic.
 
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