FPMRS fellow AMA

[Dr G Oogle]

Hi guys,
I'm a fellow in FPMRS and long time lurker first time poster

I thought I'd liven up this part of the forum with an AMA.

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[Rangers247]

Hi Dr G Oogle! Thanks for your post. I will be an intern starting in June. Couple of questions for you:

1. How competitive is the FPMRS field currently? I am interested in the FPMRS field, but I will be training at a program that does not have the fellowship.

2. What is the job outlook after completion of the fellowship? Is the market undersaturated? In terms of compensation, what ballpark range are you looking at after fellowship?

Thanks for your AMA. Really appreciate it.

 

[Dr G Oogle]

Hi Dr G Oogle! Thanks for your post. I will be an intern starting in June. Couple of questions for you:

1. How competitive is the FPMRS field currently? I am interested in the FPMRS field, but I will be training at a program that does not have the fellowship.

2. What is the job outlook after completion of the fellowship? Is the market undersaturated? In terms of compensation, what ballpark range are you looking at after fellowship?

Thanks for your AMA. Really appreciate it.

Hi rangers congrats on the match

1. FPMRS is becoming more and more competitive the match rate fluctuates between 70 and 80% for US grads, it is not as competitive as oncology but recently has been more competitive than REI. However, we are currently reviewing apps for the July 2018 and virtually every competitive applicant has at least one first or second author publication or at the very least an oral presentation. The most important things for getting into fellowship are 1) who you know-> most successful applicants will have their home program faculty call people they know in other specialties, as long as you have a urogynecologist at your program he or she can call on your behalf, because the field is so small odds are they know many people at places that do have fellowships, also non-FPMRS faculty often trained with or know people who went into the field
2) research research research, it does not necessarily have to be urogyn but at least gyn related unless you have a really great idea for an OB project and you are the major driving force behind it, or you were initially considering Mfm or general OB. all fellowships have a research requirement which will be the thesis you defend during specialty oral boards and the majority of fellowships have an "unofficial" research requirement where they expect you to publish regularly so they want to see that you are capable of that

Basically what you need to do is make your interest known early and start formulating a research plan. As a general rule fpmrs faculty are very chill and friendly and will be more than happy to help you. If you decide that it's not for you and want to do another specialty all that effort can carry over to whatever you field you want to go into

2. Job outlook is excellent especially in private practice, there many parts of the country that do not have a urogynecologist within driving distance for patients some in desirable parts of the country, there are only 40+ fellowship spots so that many new surgeons are coming out each year (which is not much) also many big practices (academic especially but also private) are moving towards urogyn taking over a lot of benign gyn surgery, so it doesn't take that long to build up a surgical practice, also at many places urology practices will higher gyn trained urogyns. Salary is tough, median is around 325k , however in private practice it can be much higher and in academics it can be much lower somewhere in the between $150-200k (if this low it is usually at very research centeric places and people want to be there for academic reasons)

Hope that helps

 

[finnasvaret]

Hey Dr. Google,

I am a medical student, so I will be asking basic questions.

1. What kinds of patients and procedures do you do usually? Can you describe an average day in your fellowship? What are your expectations for the future - private, academic, or even a mix of both (if that's possible)?

2. Things you wish you've done in medical school? residency?

Thanks 🙂

 

[Dr G Oogle]

Hey Dr. Google,

I am a medical student, so I will be asking basic questions.

1. What kinds of patients and procedures do you do usually? Can you describe an average day in your fellowship? What are your expectations for the future - private, academic, or even a mix of both (if that's possible)?

2. Things you wish you've done in medical school? residency?

Thanks 🙂

1. Fellowships are broken up in to 2 years clinic and 1 research. In my fellowship our research is broken up into 4 months research/8 month clinical. When I'm on service I spend 3-4 days in the OR usually doing 2-3 major surgeries with a few minor procedure in between. The other days I am in clinic with 1/2 day of my own clinic, supervised by an attending and 1/2 day performing and interpreting urodynamics.
OR starts at 715 everyday and goes until 4 or 5 pm, rarely it goes later than that. I'll round with the resident between 6 and 630 before the OR and make sure patients are ready for discharge.
A full day of clinic starts at 8 or 9 and goes until 5 pm, we usually see between 30-40 patients in a full day, 75% follow up and 25% new patients.

Here are the breakdown of cases: prolapse: robotic sacrocolpopexy, laparoscopic sacrocolopopexy, laparoscopic or vaginal uterosacral ligament suspension, abdominal sacrocolpopexy or uterosacral suspension; hysterectomy by any approach; anterior and posterior compartment repair, colpocleisis, sacrospinous ligament fixation

Incontinence: midurethal slings, pubovaginal slings, sacral neuromodulation, bladder Botox injection, suprapubic catheters, bladder neck closure

Urologic procedures: ureteral reimplants, ureter reimplantation, ureteral stents

Pelvic pain: pelvic floor Botox

As a fellow you are the primary surgeon with variable levels of attending involvement, I've been lucky with my fellowship choice because we get a lot of surgical autonomy without feeling like we are being unsafe and unsupported.

The majority of patients we see are over 40 but we see younger patients also, usually for pain issues.

My plan is to be 100% academic, but there are a lot more jobs in private practice , in general there will be a great need for fpmrs for many many years to come

There is a mix of that also: some of the best fpmrs fellowships and by extension jobs are in community hospitals with residency training programs.

 

[Dr G Oogle]

2. Things you wish you've done in medical school? residency?

Thanks 🙂

Forgot to answer this part.

I'm going to assume this is referring to optimizing your chances of entering the field (if I am wrong please clarify)

First there are 2 ways to get in to FPMRS urology or obgyn so I would make up my mind about which yield you are most interested in. The fellowship training is more or less the same and coming from either field you will have to pick up new surgical techniques (for instance I am gyn trained and have to learn ureteral surgery and doing urinary diversions and coming from urology one would have to learn all different modes of hysterectomy and vaginal surgery in general). Also if urology is much more surgery heavy in residency which is 5-6 years (depends if a research year is included) and obgyn is 4 years but you spend about half the time doing obstetrics which is not entirely transferable to Urogynecology, though doing complicated perineal repairs is quite helpful when learning posterior colporrhaphy and perineorrhaphy.

So the main thing is to figure out which route you want to take, and if you like the base field (urology or obgyn) because fellowship placement is not guaranteed, personally I like a lot of general gyn like abnormal bleeding and fibroids more than general urology like prostates and kidney stones, and would prefer a job where I did more non-fpmrs gyn surgery vs non-fpmrs urologic surgery.

 

[finnasvaret]

Thanks for the very detailed responses, that is really helpful.

 

[Dr G Oogle]

Thanks for the very detailed responses, that is really helpful.

Glad to help

 

[Iris42]

Hi there ! Does the core program (Urology vs OBGYN) of a FPMRS fellowship program affect the chances of matching for urology residents? There are many more programs with OB GYN as core compared with Urology.
Thanks.

 

[Dr G Oogle]

Hi there ! Does the core program (Urology vs OBGYN) of a FPMRS fellowship program affect the chances of matching for urology residents? There are many more programs with OB GYN as core compared with Urology.
Thanks.

For the integrated programs (that interview both urology and OB/gyn) in my experience, both interviewing at most of these programs and matching at one, there is a pretty high preference for urology over gyn applicants, all other things being equal. In general it is easier for a urologist to match into an fpmrs fellowshing than a gynecologist, since fewer urologists apply and there are also some unaccredited urology fellowships which are completed and many departments especially in PP will be very happy if anyone will take over female urology duties.

There is some difference in training though: integrated and gyn based programs focus heavily on vaginal surgery and (obviously hysterectomy)

And most urology only based program have a very heavy influence of neurourology which includes taking care of neurogenic bladder, they seem to do a lot more neuromodulation, and also do a lot of bladder reconstruction and augmentation; many but not all do not have a significant vaginal surgery component and often will defer hysterectomy to the gynecologists, though in these cases the fellow will at least rotate with gyn to get hyst exposure for a few months

So yes, even though there are more obgyn spots for FPMRS, overall urologists will have an easier time of getting FPMRS training, though not necessarily from an ACGME accredited fellowship

If you really want to do FPMRS and are deciding between uro and gyn, I’d recommend urology, because you get more surgical training upfront including FPMRS procedures, and many urologists can at least do some FPMRS procedures without completing a fellowship. If you are considering other sub specialties in obgyn or can’t stand the idea of taking care of prostates for 5 years then do obgyn. For what it’s worth the FPMRS salary is significantly higher if you’re highered by a urology group/Department compared to an obgyn Department

 

[anonperson]

Hi there ! Does the core program (Urology vs OBGYN) of a FPMRS fellowship program affect the chances of matching for urology residents? There are many more programs with OB GYN as core compared with Urology.
Thanks.

I'm not sure if they're is a benefit to being urology vs OB GYN for the purposes of matching.

There is a downside of being urology trained regarding fellowship choices. Although programs that have an OB-GYN core will interview urologists most will require they do a 3 year fellowship so the call schedules etc are not thrown off. That's 5 years of residency and 3 years of fellowship which probably isn't worth it from a cost benefit perspective. Many of my urologist colleagues complained about this on the interview trail.

It's only the urology core programs that will allow for a 2 year fellowship for sure.

Also being FPMRS trained as a urologist won't necessarily translate to a significantly higher salary. General urologists have very quick highly reimbursed procedures in general.

If you're deciding between OBGYN and urology, I would lean heavily towards urology. Better lifestyle, much higher pay, in very high demand across the country. Starting salaries even in competitive places like Southern California are easily $300K+.

 

[Iris42]

Thank you so much for the advice !
Are the step scores weighed most heavily when applying for the fellowship, or is it the publications, LoR, networking, etc ?

 

[anonperson]

Thank you so much for the advice !
Are the step scores weighed most heavily when applying for the fellowship, or is it the publications, LoR, networking, etc ?

Factors used by program directors to select obstetrics and gynecology fellows. - PubMed - NCBI

This has been looked at in a prior study. You should be able to get the paper through your school log in.

Program reputation /pedigree and the attendings who write your letter matter a lot.