FPs practicing OB/GYN

[Mara]

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Hi all,
I'm interested in Ob/Gyn, but frightened by the rough residency, the crazy life after residency, and simply not interested in gyn/onc. So, I'm thinking about FM followed by an ob/gyn fellowship.

Does anyone know anything about FPs practicing ob/gyn? Competency post fellowship? Salary? Lifestyle?

Thanks!

 

[minime]

I wanted to do the same thing, but due to malpractice these days it is nearly impossible for an FP to clear any money after malpractice insurance unless they do a LOT of deliveries (where I'm at appx. 125/yr.) which is a hard thing to do as an FP.

On another note-having seen many FP residents and attendings do OB it has been my observation (and only my observation) that their skills and clinical decision making is far inferior and when that difficult case comes in it ends up being a disaster for them.

Just look at the traing that an FP recieves compared to an OBGYN. OB's are primary surgeon's on 300-400 C-sections, 400 or so deliveries and the rest of the time are doing surgery. FP's do a few months of OB where they are second in line and just don't get the surgical training needed.

Just my two cents.

 

[PACtoDOC]

I wanted to do the same thing, but due to malpractice these days it is nearly impossible for an FP to clear any money after malpractice insurance unless they do a LOT of deliveries (where I'm at appx. 125/yr.) which is a hard thing to do as an FP.

On another note-having seen many FP residents and attendings do OB it has been my observation (and only my observation) that their skills and clinical decision making is far inferior and when that difficult case comes in it ends up being a disaster for them.

Just look at the traing that an FP recieves compared to an OBGYN. OB's are primary surgeon's on 300-400 C-sections, 400 or so deliveries and the rest of the time are doing surgery. FP's do a few months of OB where they are second in line and just don't get the surgical training needed.

Just my two cents.

You are living in a fantasy land if you think all OBGYN programs prepare their grads to this degree. Simply head over to FREIDA and read each programs average number of prcedures for each particular procedure. You will see that there are many programs that only give a resident around 20 vag/hysts, <100 c-sections, and sometimes less than the required number of particular gyn surgeries. In many unopposed FP programs, these residents can even surpass some of these numbers because of one on one training and zero competition.

Where I am, an FP only has to do 50 deliveries to pay their malpractice. And there are plenty of federally underserved rural locations that will pay your malpractice to do OB there.

 

[minime]

I'm actually applying to OBGYN this year. These numbers are about the average for OBGYN residencies and are not listed on FREIDA. They are listed on APG😵rg which requires a password. I've never seen the number of C sections under 250, TAH's under 100. The only program that I looked at that had less than 30 Vag. hysts was on probation and is probably going to lose it's accreditation. Obgyn residents do nothing but OBGYN for 4 years with the exception of a few months of primary care.

I'm not saying that FPs can't do OB. I guess in the last month I've seen a few things go wrong because an FP tried to follow high risk patients too long and the mothers and babies suffered-I'm kind of irritated at them right now. The American College of FPs only recommends that FPs do only uncomplicated vaginal deliveries. I know that there are still a few rural areas that FPs are doing OB, but these are becoming fewer and fewer....

Personally, I really respect FPs. They know more medicine and are more versatile than any other specialty. My second child was actually delivered by an FP whose group is no longer doing FP. I'm not saying there is no place for FPs in OB, I'm just saying that it's becoming less and less these days-which is unfortunate.

 

[PACtoDOC]

Yes I have a password on APGO, and I have seen plenty with poor numbers. Do you have not have a password so you can see for yourself? There is no reason a qualified FP can't do C-sections if serving in a place where there are no OB's even remotely close. Sure, I don't think it is the best idea to have FP's doing sections in big cities, which is why it does not occur. But rural Americans should be the ones who get to decide if they have to either drive 200 miles to the big city or get delivered where they are close to home with their FP. I mean lets be a bit serious for a moment. Anyone who has done both their surgery rotation and OBGYN rotation can tell you that they would prefer to have a general surgeon doing the section if it could be arranged!! Surgeons have a meticulous technique while OBGYN's sit there like they are carving a Turkey with a dull kitchen knife!! A section is just not that hard after you have done 50 of them. There are certain things you must do, but it certainly aint like doing a Whipple or something. Obviously 50 must make one competent because it seems to be the magic number that allows a physician of any kind to gain priviledges.

 

[gwyn779]

Just look at the traing that an FP recieves compared to an OBGYN. OB's are primary surgeon's on 300-400 C-sections, 400 or so deliveries and the rest of the time are doing surgery. FP's do a few months of OB where they are second in line and just don't get the surgical training needed.

Just my two cents.

There are plenty of programs where FP residents are first in line and can easily get >200 deliveries. There are fewer programs that provide enough numbers for c-sections, but they exist. It's not that uncommon for people really interested in OB to use their elective time to go do c-sections at a high volume place. Plus, that's what the fellowships are for. Sure, take an average FP residency and they're not going to have adequate training for people to do sections, but they WILL train good low-risk OB docs.

So, for someone who's interested, there are enough opportunities to get high-risk training and end up very competent, but obviously most FPs who do OB will stick to low-risk.

 

[CambieMD]

I wanted to do the same thing, but due to malpractice these days it is nearly impossible for an FP to clear any money after malpractice insurance unless they do a LOT of deliveries (where I'm at appx. 125/yr.) which is a hard thing to do as an FP.

On another note-having seen many FP residents and attendings do OB it has been my observation (and only my observation) that their skills and clinical decision making is far inferior and when that difficult case comes in it ends up being a disaster for them.

Just look at the training that an FP recieves compared to an OBGYN. OB's are primary surgeon's on 300-400 C-sections, 400 or so deliveries and the rest of the time are doing surgery. FP's do a few months of OB where they are second in line and just don't get the surgical training needed.

Just my two cents.

I have to agree with minimie. OB is a land mine right now. OB is not something that is done on the side. There is way too much at stake. It is a pipe dream to think that you will deliver babies as an FP doc. What happens if something goes wrong. The training does not prepare you to practice the full spectrum of OB care. It is nice to argue things in the safety of a forum. When you get out there and you have to deal with malpractice and coverage issues you have to face reality. I am hard pressed to think that an FP would be qualified to deliver babies upon the completion of their residency.

I just can't see an FP having enough volume to support a thriving OB practice.
Coverage would probably be a problem. An OB/GYN may not want to take over after things go bad. They would most likely get sued too if there was a poor outcome.

You can try to refute my statements but I know that I am right.

CambieMD

 

[PACtoDOC]

I have to agree with minimie. OB is a land mine right now. OB is not something that is done on the side. There is way too much at stake. It is a pipe dream to think that you will deliver babies as an FP doc. What happens if something goes wrong. The training does not prepare you to practice the full spectrum of OB care. It is nice to argue things in the safety of a forum. When you get out there and you have to deal with malpractice and coverage issues you have to face reality. I am hard pressed to think that an FP would be qualified to deliver babies upon the completion of their residency.

I just can't see an FP having enough volume to support a thriving OB practice.
Coverage would probably be a problem. An OB/GYN may not want to take over after things go bad. They would most likely get sued too if there was a poor outcome.



CambieMD

It never ceases to amaze me that you think you have all the answers. This time you are WRONG, like it or not. There are literally THOUSANDS of FP's nationwide delivering babies routinely in their practice. Do you call that a pipe dream? Over half of the FP residencies in the state of Wisconsin for instance prepare their grads for OB practice. Most of these programs have between 85-100% of their grads currently still doing OB with their practice. If you know you are so right, my guess is that you score rather poorly on exams where you choose the correct answer based on your "know" reasoning. You are just plain wrong. FYI, there are 50 states in the US, and practice dynamics are very different in each. Perhaps you should have tried looking around before you bailed on the profession just because you couldn't handle it in your neck of the woods.

 

[iatrosB]

It never ceases to amaze me that you think you have all the answers. This time you are WRONG, like it or not. There are literally THOUSANDS of FP's nationwide delivering babies routinely in their practice. Do you call that a pipe dream? Over half of the FP residencies in the state of Wisconsin for instance prepare their grads for OB practice. Most of these programs have between 85-100% of their grads currently still doing OB with their practice. If you know you are so right, my guess is that you score rather poorly on exams where you choose the correct answer based on your "know" reasoning. You are just plain wrong. FYI, there are 50 states in the US, and practice dynamics are very different in each. Perhaps you should have tried looking around before you bailed on the profession just because you couldn't handle it in your neck of the woods.

On that note (the constructive note, not the attack note), several of the FP residencies here in Missouri have special OB tracks that you can take implying the possibility of delivering as a FP doc. Also, I know quite a few FP docs here in Missouri that deliver, but also a lot who have bailed on it. I don't know what this contributes to the thread but whatever.

 

[BayesianDoc]

Aside from rural practice, is it feasible for an FP to manage most prenatal care then refer out to an OB to handle the delivery. Would OBs care that they were not the ones managing prenatal care or would they be happy that they were only doing deliveries thus yielding more $$? Obviously it probably depends on location, the OB, and um the location.

 

[deleted6669]

midlevels can and do manage prenatal care unless the pt is high risk. it just isn't that difficult. most community womens health ctrs are staffed by pa's/np's/midwives. just look at planned parenthood, etc.

in my neck of the woods(pacific nothwest) the fp docs have to avg 4 vag deliveries/month to keep hospital priviledges.many still do this for increased compensation although some opt out just to avoid extra call.

 

[doc05]

Aside from rural practice, is it feasible for an FP to manage most prenatal care then refer out to an OB to handle the delivery. Would OBs care that they were not the ones managing prenatal care or would they be happy that they were only doing deliveries thus yielding more $$? Obviously it probably depends on location, the OB, and um the location.

bad idea. there are liability issues with prenatal care, not just the delivery. I doubt any ob would want to deal with the hassles of delivery (on-call hours, poor compensation, liability), if they couldn't bill for prenatal visits, ultrasounds, etc. if you want ob, choose ob.

 

[lowbudget]

The way to think about this is to ask yourself whether you're willing to sacrifice other aspects of FP to specialize in OB/Gyn in order to gain better practice environment (less privileging hassles, urban/suburban environment). If you're unwilling to sacrifice other aspects of FP, then you have to ask yourself whether you'll be ok with a more restricted practice, such as doing only prenatal care or low risk OB or rural FP or having to fight OB/Gyn for privileges, etc.

Find the trade-off that's right for you. AAFP does have a position on the role of FP in Obstetrics and so you might want to read through it to get a sense of what mainstream FPs expect/are doing so that you don't go into residency thinking you'll come out being able to do everything everywhere. Make sure to check out the link for C-section in FM.

http://www.aafp.org/x6949.xml