gyn vs onco gyn

[priapoconstante]

O.K. I understand that gyn-onco is a subspecialist who only cares about oncological gynecological problems.
My question is: as a ob/gyn, can you treat that kind of diseases, or you need to send them to the gyn-oncologist?
I mean, where would be the end of treatment by gynecologist and the begining of treatment by gyn-onco?
on the other hand, is it similar with gynecologist who make 2 more years in urinary incontinence? I mean, as a gynecologist, can you treat a problem of urinary incontinence or rectocele without doing another 1 or 2 years of fellowship in that field?

Thanks for the answers.

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[sacrament]

on the other hand, is it similar with gynecologist who make 2 more years in urinary incontinence? I mean, as a gynecologist, can you treat a problem of urinary incontinence or rectocele without doing another 1 or 2 years of fellowship in that field?

I don't know, but as soon as you find out, you should then find a psychiatrist and explore the reasons why in the name of God this is a career interest.

No, just kidding, rectoceles are awesome. Best thing ever.

 

[doc05]

O.K. I understand that gyn-onco is a subspecialist who only cares about oncological gynecological problems.
My question is: as a ob/gyn, can you treat that kind of diseases, or you need to send them to the gyn-oncologist?
I mean, where would be the end of treatment by gynecologist and the begining of treatment by gyn-onco?
on the other hand, is it similar with gynecologist who make 2 more years in urinary incontinence? I mean, as a gynecologist, can you treat a problem of urinary incontinence or rectocele without doing another 1 or 2 years of fellowship in that field?

Thanks for the answers.

not really. ob-gyns get very limited surgical training during residency; hence most have reputations of technical incompetence. In order to do demanding cases, a fellowship should be done. Of course, a female urologist could do the same thing.

 

[NYC Girl]

So for a serious answer, not inclusive of a smiling hand-drawn "male" symbol...

General OB/Gyn's do not normally manage oncologic cases - you will do some gyn onc rotations during residency, but onc is a very technically difficult field, including wide lymph node dissections, bowel resections, etc. I mean, ovarian cancer with extensive peritoneal studding is a horror and requires extreme surgical skill. Also, you will obviously need a specialist's knowledge of chemotherapy and radiation therapy in addition to surgical management.

However, general gynecologists routinely perform surgical repairs for incontinence/pelvic organ prolapse (including all your good rectoceles, cystoceles, etc. etc.) Here's where you can do some interesting repairs, slings, TVT's etc. This is bread and butter gyn, though obviously more complex surgeries will require urogyn specialty training.

 

[priapoconstante]

O.K. Let's say you have the experience from another country, and just need the title of ob/gyn to practice in the U.S. If you ever perform a major oncologic surgery because you know how to do it, and you've done it before, and have the previous experience of doing it in another country, would there be any problem with the American Board of OB/GYN?
What I'm trying to assess is the limitations someone would have in the practice of OB/GYN in the U.S., and the legal implications that it has. I mean, what if someone comes with a lot of experience in gyn-onco acquired in another country? If that person gets into a 4-year OB/GYN program and gets the title, theoretically even if he or she doesn't get enough surgical experience in the program, there'd be no problem 'cause after all, that person already has it, right? But, as a OB/GYN doctor in the US you're obviously vulnerable to legal problems. In that case, what would be the position of the doctor if ever get sued because of a complication? And what'd be the position of the Board of OB/GYN, if that doctor is certified only in general ob/gyn?

 

[priapoconstante]

I don't know, but as soon as you find out, you should then find a psychiatrist and explore the reasons why in the name of God this is a career interest.

Actually, you're right, and I agree with you. But I'm forced to enter into that program, 'cause that's the nearest specialty to mine (urology). So, since it's almost imposible for a IMG to enter into Urology, the best I can do is to get into a field wich would let me at least practice something I've already been to: urinary incontinence, cistocele, etc.

 

[NYC Girl]

I'm a little confused - in your country of origin, do urologists rountinely manage gynecologic malignancies? Is this not the realm of, well, gynecologists?

If you are truly concerned about liability issues in terms of accreditation, I think the bigger issue would be whether you would be able to actually develop a surgical oncologic practice. From my experience (granted, limited to large academic centers in major cities), gyn onc is the exclusive realm of those who have completed a formal fellowship. Gyn onc is not an enormous field, and given the low demand for gyn onc, I doubt you would be able to build a practice with board certification in general OB/Gyn only. Perhaps this is different for rural areas, and if this is so perhaps someone with more knowledge of this could pipe in.

Also, standards of management may be different in the U.S. than in your country, and in terms of malpractice, you *would* be held to the standards of practice of the U.S. Exceptionally risky to jump into a surgical practice with the sickest possible patients, based only upon experience built in another country!!! (baaaaad idea)

Also, as I've mentioned already, gynecologists routinely perform surgical treatments of incontinence - if your background is in urology, you can most certainly build a general gynecologic practice with an emphasis in uro-gyn types of surgery, without doing a fellowship. Uro-gyn is not a boarded fellowship anyway, so this is done all the time. Compared with oncology, incontinence and POP are much more common, so the potential patient base is greater, and you would not need to complete a fellowship.

And hey - you don't have to get into the pissing matches RE: "are gynecologists real surgeons" crap. Gynecologists get plenty of surgical training for the procedures that we perform. Your experience will also depend on your attitude and the purposefulness with which you select a residency program - surgery was highly important to me, so I ranked programs with more surgical training time highest.

Also, some advice - if you maintain and publicize the attitude that "I was forced to go into OB/Gyn because it was easier to get into than the field which I would actually prefer to be in" I don't think it will go over very well. People who choose OB/Gyn do so because they love the field - because of its surgical as well as primary care opportunities, interest in reproductive health/women's health, etc. And when programs pick applicants for residencies, I imagine that they will select those folks who demonstrate genuine commitment to the field. Your background in urology will help you, but if you're actually going to go into gynecology, you're going to have to at least pretend to be interested in *women's* urologic issues or people will have some questions

 

[priapoconstante]

NYC girl:

I really want to thank you for your answer.
I actually love OB/GYN, and as a matter of fact, I wanted to enter to that program in my country, but because of some circumstances, I didn't. So, when I got to the US and realize about the situation with urology, well, then it came to my mind OB/GYN. There are some things in the specialty that I don't want to get involved with, and when I finish my residency I will try to focus only in some aspects of the specialty. That's why I'm so interested on gynecologic aspects instead of obstetric aspects, although I also like obstetrics, but as you know, obstetrics is the most liable.
As an urologist, in my country, we used to do major surgical procedures, wich included total abdominal hysterectomy and ooforectomy as part of radical cystectomy, and also we had to do pelvic and cavo-aorto lymphadenectomy in the same procedure, so as you can see, practically you can call that a radical hysterectomy, wich would be one of the procedures gyn-onco may do. So as you can see, that wouldn't be that much new for me. But anyway, since you say it's really more often to get involve with incontinence problems, then I'll focus on that matter instead of trying to get a heart attack doing the gyn-onco surgeries.
I really appreciate your time.

 

[NYC Girl]

No problem! I'm really impressed with the type of surgical experience that you have - it's unfortunate that you wouldn't be able to make use of that experience, but I think you'll definitely be a step ahead of the average resident given your background. And again, I'm not sure what the status quo is in rural practice - I know for other surgical fields, the more rural the area, the less formal board certification truly matters in terms of practice (for instance, I did a surgery rotation in upstate NY, where general surgeons did a lot more specialized surgeries without formal fellowship training than they'd be able to do in New York city)

 

[JShupe]

A female urologist could certainly NOT do the same thing as a Gyn Onc. Gynecology Oncologists deal with all types of cancer of the female reproductive tract. Not only are they in charge of doing pretty extensive surgeries on these patients (ever seen a 6 hour pelvic exhaneration) but they also manage their chemotherapy treatment as well. No urologist I know can do that. Also a gyn onc can handle any urological case that a urologist can; of course as long as it is a female. There is a reason why Gyn Onc is the most competitive subspecialty after OBGYN and why the US has only 35 spots.

 

[priapoconstante]

Also a gyn onc can handle any urological case that a urologist can; of course as long as it is a female. There is a reason why Gyn Onc is the most competitive subspecialty after OBGYN and why the US has only 35 spots.

I'm not sure about that. I have not seen any gyn onc doing a radical cystectomy. However, I have seen urologists doing hysterosalpingooforectomies as part of radical cystectomies in women. On the other hand, is the gyn onc capable of doing neovesical reconstructions, or neobladder surgeries? I'm asking because I don't know the extent of training they receive.

 

[bkrone1]

I agree with NYC Girl's comments.

A general OB/GYN should never knowingly operate on advanced GYN malignancies...this is negligence. However, general OB/GYN's can and should operate on all pre-malignant conditions of the vulva, cervix, and uterus.

Most OB/GYN programs, including mine at the University of Kentucky, do rotations with GYN-Onc. I feel that our residents would feel comfortable completing staging (lymph node sampling, omental sampling, peritoneal washings/biopsies, etc.) if we they were to unexpectantly encounter a GYN-malignancy during a surgery that was for benign condition. We would atleast realize that staging should be performed and call for assistance if needed.

Uro-gyn procedures for incontinence, prolapse, cystocele, etc. are performed by many general ob/gyn's across the country. I think each program around the US have varying degrees of training in these procedures.

I doubt any general ob/gyn's have training for radical bladder surgery however, the GYN-onc surgeons at the University of Kentucky do perform reconstructive bladder surgery, bladder repairs, and ureteral repairs since these type of injuries and surgeries are encountered frequently with severe GYN malignancies.

Good luck with your career in the US.

 

[tweetledee]

Does anyone know what the lifestyle is like for female gyn oncologists (i.e. can you have a family, hours, etc?), % women in the field, and how competitive it is to obtain a gyn onc fellowship after residency?

Thanks!

 

[bkrone1]

Does anyone know what the lifestyle is like for female gyn oncologists (i.e. can you have a family, hours, etc?), % women in the field, and how competitive it is to obtain a gyn onc fellowship after residency?

Thanks!

Just from observing my Gyn/Onc attendings, it seems as though they have pretty good schedules. I'm not sure if academic vs. private gyn/onc hrs, but I would assume that an academic carreer would have better hrs, or course b/c much of the daily work is performed by residents. The attendings at our institution are on call, but of course it is from home and they only have to come in for emergency surgeries at night.

Fellowship, however, is a whole different ballgame. At my institution, the Onc fellowshipe is very time consuming. The first year is a research year with limited clinical duties, the second year fellow basically runs the service. They are on home call every night and 2/4 weekends. The third year fellow does a lot of clinic and runs some research protocols and is involved in surgeries. I hope this helps.