Help choosing a specialty

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brekina12

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M3 about to apply for electives for next year. I still have no idea what I am going to do and would love some unbiased insight!
I absolutely LOVED OBGYN. It was by far my favorite rotation (and I am on my last rotation). I loved the patient population, the procedures, and I seriously love the OR. I really like the balance of clinic/procedures/OR. However, the single most important thing for me is lifestyle. I am a parent to two young kids (and want more!) and I would like to actually see them grow up. Even if I can make it work as an attending, kids are only little for so long and I hate the idea of missing so much of these early years with my kids being in such an intense residency. I am older than pretty much all of my peers so I don't really want to be in training forever so I don't really want to do a fellowship. Unfortunately, OBGYN doesn't seem too compatible with this so I am trying to find something similar that is more family friendly. Right now, I am considering maybe FM or EM? Here is my list of pros/cons so far.

FM
Pros
-I know some residencies can be very OB and procedure heavy, which I would love, but it seems like you have to be willing to be rural. While I really like the idea of doing rural FM and delivering babies and then being their doctor, I would like my kids to be able to have a decent education and opportunities and I don't know how much OB and procedures I would actually be doing if I lived in a medium-sized city.
Cons
-I absolutely do not want to ever email a patient in my off time. Having an inbox sounds like my definition of hell.
-Paperwork/insurance
-I find annual well visits pretty boring

EM
Pros
-Shift work sounds nice. My husband has great benefits so I don't need to worry about them and I really like the idea of doing locums and only working a few days a week until my kids are older. EM seems like one of the best specialties for that sort of thing.
-Lots of procedures
-I was an EMT for 5 years and really enjoyed the pace
-No patients emailing me after hours
Cons
-Longevity. I am already on the older side and worry about if it is a job that I would still like when I'm 60+.
-I realize most of what you do is not actually dealing with emergencies and there is a lot of tedious non-emergencies and social work involved that I don't necessarily love the idea of dealing with.

I am also pretty average/below average academically. I haven't failed anything, but I am definitely in the bottom half of my class. I also haven't done a day of research in my life (though I don't mind taking a research year if necessary).
 
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I’m sure you know that you’re going to work hard in residency no matter what. While OBGYN hours are kinda trash (60-70/wk), FM is no cake walk either especially if you’re on the OB or other inpatient or surgical services; there are just fewer rotations like that. Attending life is really what you want to use to base your decision on, not the 3 or 4 years you’ll be in residency.

FM has a lot of in-basket tasks, though the outpatient hours can be very cush. You’ll also be seeing 30+ patients a day for the most part, many of whom will be annual well check.

OBGYN attending life is very flexible. If you can find a well-established practice you might have 1:5 or 1:6 call so lots of family time. You can join a hospital and do only L&D as a laborist, or you can try to tailor your hours to be outpatient only seeing both OB and GYN patients. There will still be in-basket tasks you need to follow up on, though I’m sure fewer than FM.

Sounds like to me you really should bite the bullet and do OBGYN because you’ll be happier as an attending at the end of it.
 
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I'm an OBGYN attending.
I had children in both medical school, residency and as an attending.
Residency was very difficult. Being on the road auditioning being away from family was extremely difficult.
Being an attending in a field you can truly see yourself with for the long haul is what it's really about and is what lasts.

In those one-year programs where you want to play OBGYN as a family doctor 1) you end up doing 4 years of residency anyway to 2) become generally insufficient to become a quality obstetrician and you're still not a gynecologist. You don't do the OR. Why spend 4 years to obtain mediocrity in the field in which proficiency is necessary? You can never be a true OBGYN able to get privileges as an OBGYN if you take the family medicine route. While to some degree it is to each their own, I would caution you to manage expectations if you find that an attractive option.
 
DocWinter said:
I'm an OBGYN attending.
I had children in both medical school, residency and as an attending.
Residency was very difficult. Being on the road auditioning being away from family was extremely difficult.
Being an attending in a field you can truly see yourself with for the long haul is what it's really about and is what lasts.

In those one-year programs where you want to play OBGYN as a family doctor 1) you end up doing 4 years of residency anyway to 2) become generally insufficient to become a quality obstetrician and you're still not a gynecologist. You don't do the OR. Why spend 4 years to obtain mediocrity in the field in which proficiency is necessary? You can never be a true OBGYN able to get privileges as an OBGYN if you take the family medicine route. While to some degree it is to each their own, I would caution you to manage expectations if you find that an attractive option.
Click to expand...
Very fair points. What is your lifestyle like now as an attending? Is it possible to work part time or do locums for a while? All of the OBGYNs I know work mon-Fri 8-6 and have call a couple times a week. I don’t mind taking call, but mon-Fri 8-5 plus call sounds terrible. I’d much rather do something like three 10-12 hour shifts plus call. I know there are hospitalist options, but I do like the GYN surgeries and I’d be worried about losing those skills if I did that and eventually wanted to switch back.
 
Lost in Translation said:
I’m sure you know that you’re going to work hard in residency no matter what. While OBGYN hours are kinda trash (60-70/wk), FM is no cake walk either especially if you’re on the OB or other inpatient or surgical services; there are just fewer rotations like that. Attending life is really what you want to use to base your decision on, not the 3 or 4 years you’ll be in residency.

FM has a lot of in-basket tasks, though the outpatient hours can be very cush. You’ll also be seeing 30+ patients a day for the most part, many of whom will be annual well check.

OBGYN attending life is very flexible. If you can find a well-established practice you might have 1:5 or 1:6 call so lots of family time. You can join a hospital and do only L&D as a laborist, or you can try to tailor your hours to be outpatient only seeing both OB and GYN patients. There will still be in-basket tasks you need to follow up on, though I’m sure fewer than FM.

Sounds like to me you really should bite the bullet and do OBGYN because you’ll be happier as an attending at the end of it.
Click to expand...
Thank you! You’re definitely right. I guess I didn’t think about how if I do lots of OB during FM training, I’d be working those crappy hours anyway only I wouldn’t come out at the end as an OBGYN. Every time I convince myself I’d be happy doing something else, OB comes creeping back in and I can’t stop regretting my “choice” to do something else. I just worry that it won’t be as easy as I think to find an attending job with a reasonable lifestyle.
 
DocWinter said:
I'm an OBGYN attending.
I had children in both medical school, residency and as an attending.
Residency was very difficult. Being on the road auditioning being away from family was extremely difficult.
Being an attending in a field you can truly see yourself with for the long haul is what it's really about and is what lasts.

In those one-year programs where you want to play OBGYN as a family doctor 1) you end up doing 4 years of residency anyway to 2) become generally insufficient to become a quality obstetrician and you're still not a gynecologist. You don't do the OR. Why spend 4 years to obtain mediocrity in the field in which proficiency is necessary? You can never be a true OBGYN able to get privileges as an OBGYN if you take the family medicine route. While to some degree it is to each their own, I would caution you to manage expectations if you find that an attractive option.
Click to expand...
At my school, the OBGYN residents/attendings wouldn’t even speak to the FM resident who is on OBGYN rotation despite being in the same call room. Think it was probably similar dynamic at the attending level
 
brekina12 said:
Very fair points. What is your lifestyle like now as an attending? Is it possible to work part time or do locums for a while? All of the OBGYNs I know work mon-Fri 8-6 and have call a couple times a week. I don’t mind taking call, but mon-Fri 8-5 plus call sounds terrible. I’d much rather do something like three 10-12 hour shifts plus call. I know there are hospitalist options, but I do like the GYN surgeries and I’d be worried about losing those skills if I did that and eventually wanted to switch back.
Click to expand...
I work more than most, because I choose to and I like the money. M-Th with half day Fri, but that doesn't account for after hours deliveries, rounding and starting at 0700 in the OR. I also really like what I do so it's not really "work"
You can do whatever you want when you graduate. No shortage of positions.

Yes you'll lose OR proficiency in time if you don't maintain volume. Maybe not ability, but proficiency.
 
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voxveritatisetlucis said:
At my school, the OBGYN residents/attendings wouldn’t even speak to the FM resident who is on OBGYN rotation despite being in the same call room. Think it was probably similar dynamic at the attending level
Click to expand...

Sounds like a maturity issue.
We had FM residence at my program too. Good relationship. But every single one of them said that they had never worked harder then when on rotation with us
 
This is pretty pathetic, NGL. Some people never grow up.

DocWinter said:
Sounds like a maturity issue.
We had FM residence at my program too. Good relationship. But every single one of them said that they had never worked harder then when on rotation with us
Click to expand...
Most of the time we would walk in and say good morning and the residents would just stare at us. Some decent ones but overall the nastiest group of people as a collective I’ve ever had to work with

General surgery residents work a lot harder at my school, but are much more friendly in my experience
 
voxveritatisetlucis said:
At my school, the OBGYN residents/attendings wouldn’t even speak to the FM resident who is on OBGYN rotation despite being in the same call room. Think it was probably similar dynamic at the attending level
Click to expand...

n=1

at my school they were very cordial, willing to help get interested FM residents into cases.
 
Lost in Translation said:
I’m sure you know that you’re going to work hard in residency no matter what. While OBGYN hours are kinda trash (60-70/wk), FM is no cake walk either especially if you’re on the OB or other inpatient or surgical services; there are just fewer rotations like that. Attending life is really what you want to use to base your decision on, not the 3 or 4 years you’ll be in residency.

FM has a lot of in-basket tasks, though the outpatient hours can be very cush. You’ll also be seeing 30+ patients a day for the most part, many of whom will be annual well check.

OBGYN attending life is very flexible. If you can find a well-established practice you might have 1:5 or 1:6 call so lots of family time. You can join a hospital and do only L&D as a laborist, or you can try to tailor your hours to be outpatient only seeing both OB and GYN patients. There will still be in-basket tasks you need to follow up on, though I’m sure fewer than FM.

Sounds like to me you really should bite the bullet and do OBGYN because you’ll be happier as an attending at the end of it.
Click to expand...
30+ patients per day?

That is not the standard. In my group of 40-50 FPs I bet there's only 6-8 doctors who routinely break 30 patients per day.
 
DocWinter said:
I'm an OBGYN attending.
I had children in both medical school, residency and as an attending.
Residency was very difficult. Being on the road auditioning being away from family was extremely difficult.
Being an attending in a field you can truly see yourself with for the long haul is what it's really about and is what lasts.

In those one-year programs where you want to play OBGYN as a family doctor 1) you end up doing 4 years of residency anyway to 2) become generally insufficient to become a quality obstetrician and you're still not a gynecologist. You don't do the OR. Why spend 4 years to obtain mediocrity in the field in which proficiency is necessary? You can never be a true OBGYN able to get privileges as an OBGYN if you take the family medicine route. While to some degree it is to each their own, I would caution you to manage expectations if you find that an attractive option.
Click to expand...
To me the only time it makes sense is if you're going very rural.
 
DocWinter said:
I'm an OBGYN attending.
I had children in both medical school, residency and as an attending.
Residency was very difficult. Being on the road auditioning being away from family was extremely difficult.
Being an attending in a field you can truly see yourself with for the long haul is what it's really about and is what lasts.

In those one-year programs where you want to play OBGYN as a family doctor 1) you end up doing 4 years of residency anyway to 2) become generally insufficient to become a quality obstetrician and you're still not a gynecologist. You don't do the OR. Why spend 4 years to obtain mediocrity in the field in which proficiency is necessary? You can never be a true OBGYN able to get privileges as an OBGYN if you take the family medicine route. While to some degree it is to each their own, I would caution you to manage expectations if you find that an attractive option.
Click to expand...
I was suggesting FM followed by outpatient Women’s Health—not OB. One of my dear friends had a long and happy career doing this.
 
I’m not an OB but did a surgical residency that I would argue was cushier than most of my friends in more lifestyle friendly fields. So much depends on program specifics and even within the program individual rotations can vary. I definitely had some late nights and rough calls, but I also had many days when I left the hospital around 3 or 4 and nearly all weekends were golden with Saturday and Sunday fully off. I think I worked 4 weekends as a chief - better than my call now!

I would encourage you to dig in a bit to various programs and see what’s out there in terms of call and rotation schedules. You may find it’s actually just a few weeks of crappy hours and otherwise pretty doable. Others may be pretty brutal all around. I just know I had a lot of FM and IM friends who worked a lot more than I did in residency. I have a friend here who just graduated OB residency and she was very active in the performing arts here locally during training, so clearly there was some flexibility there and she was able to have a full life outside the hospital.

Attending hours are much more flexible. In the end, a medical license allows you to turn time into money at a favorable rate. If you’re willing to accept less money you can have more time. If you’re fairly flexible on location and comp, you should be able to find something that meets your work-life balance needs in any field. If you must live in the Bay Area and need to make serious coin, you’ll be hard pressed to find a cushy gig in anything.
 
operaman said:
I’m not an OB but did a surgical residency that I would argue was cushier than most of my friends in more lifestyle friendly fields. So much depends on program specifics and even within the program individual rotations can vary. I definitely had some late nights and rough calls, but I also had many days when I left the hospital around 3 or 4 and nearly all weekends were golden with Saturday and Sunday fully off. I think I worked 4 weekends as a chief - better than my call now!

I would encourage you to dig in a bit to various programs and see what’s out there in terms of call and rotation schedules. You may find it’s actually just a few weeks of crappy hours and otherwise pretty doable. Others may be pretty brutal all around. I just know I had a lot of FM and IM friends who worked a lot more than I did in residency. I have a friend here who just graduated OB residency and she was very active in the performing arts here locally during training, so clearly there was some flexibility there and she was able to have a full life outside the hospital.

Attending hours are much more flexible. In the end, a medical license allows you to turn time into money at a favorable rate. If you’re willing to accept less money you can have more time. If you’re fairly flexible on location and comp, you should be able to find something that meets your work-life balance needs in any field. If you must live in the Bay Area and need to make serious coin, you’ll be hard pressed to find a cushy gig in anything.
Click to expand...
That's nuts.
Most weeks I would just report regular hours cuz doing the paperwork to report more than 80 became too much work.
 
I would poke around the EM forum if you haven't already. Granted SDN could (an probably very well does) represent biased views of the field, but as long as you take things with a grain of salt I think you could get an idea of what EM attending life is like and what practice options are available.
 
I loved OB/GYN also, my second favorite rotation. But I chose the field that is the MOST similar, but with a great lifestyle…ophthalmology. And I still love it.

It is indeed the most similar to OB/GYN. They both revolve around a single organ system/anatomical area, and you take care of ALL medical and surgical care for that system. Practically every other field bifurcates medical/surgical care (IM/GS, Neuro/Neurosurg, Cardio/Cardiac Surg, Nephro/Urology, etc). And there is a great balance of office and OR time.
 
voxveritatisetlucis said:
At my school, the OBGYN residents/attendings wouldn’t even speak to the FM resident who is on OBGYN rotation despite being in the same call room. Think it was probably similar dynamic at the attending level
Click to expand...
This probably isn't as dramatic as you make it sound.. the ob residents know each other well whereas the FM resident is probably just a rotator.
 
brekina12 said:
M3 about to apply for electives for next year. I still have no idea what I am going to do and would love some unbiased insight!
I absolutely LOVED OBGYN. It was by far my favorite rotation (and I am on my last rotation). I loved the patient population, the procedures, and I seriously love the OR. I really like the balance of clinic/procedures/OR. However, the single most important thing for me is lifestyle. I am a parent to two young kids (and want more!) and I would like to actually see them grow up. Even if I can make it work as an attending, kids are only little for so long and I hate the idea of missing so much of these early years with my kids being in such an intense residency. I am older than pretty much all of my peers so I don't really want to be in training forever so I don't really want to do a fellowship. Unfortunately, OBGYN doesn't seem too compatible with this so I am trying to find something similar that is more family friendly. Right now, I am considering maybe FM or EM? Here is my list of pros/cons so far.

FM
Pros
-I know some residencies can be very OB and procedure heavy, which I would love, but it seems like you have to be willing to be rural. While I really like the idea of doing rural FM and delivering babies and then being their doctor, I would like my kids to be able to have a decent education and opportunities and I don't know how much OB and procedures I would actually be doing if I lived in a medium-sized city.
Cons
-I absolutely do not want to ever email a patient in my off time. Having an inbox sounds like my definition of hell.
-Paperwork/insurance
-I find annual well visits pretty boring

EM
Pros
-Shift work sounds nice. My husband has great benefits so I don't need to worry about them and I really like the idea of doing locums and only working a few days a week until my kids are older. EM seems like one of the best specialties for that sort of thing.
-Lots of procedures
-I was an EMT for 5 years and really enjoyed the pace
-No patients emailing me after hours
Cons
-Longevity. I am already on the older side and worry about if it is a job that I would still like when I'm 60+.
-I realize most of what you do is not actually dealing with emergencies and there is a lot of tedious non-emergencies and social work involved that I don't necessarily love the idea of dealing with.

I am also pretty average/below average academically. I haven't failed anything, but I am definitely in the bottom half of my class. I also haven't done a day of research in my life (though I don't mind taking a research year if necessary).
Click to expand...
For a dual income family where a spouse is getting good reliable benefits there is absolutely no better field than EM if you are going part time/casual.

1) You can choose your own hours/shifts a month.
2) 1099.
3) No call.
4) Zero work outside of work.
5) One of the highest hourly rates especially if on 1099.
6) You can float between multiple hospitals and sometimes pick up bonus pay depending on how desperate. Had a colleague pick up 10 grand for a single shift once.
7) Most casual/part timers don’t work a lot of holidays and nights.

EM has definitely changed post covid and doing anything over 10-12 shifts a month really makes you question humanity. I think working 6-8 or so shifts a month would be a real good life. Just enough to keep things interesting but not enough to make things terrible.
 
Tenk said:
For a dual income family where a spouse is getting good reliable benefits there is absolutely no better field than EM if you are going part time/casual.

1) You can choose your own hours/shifts a month.
2) 1099.
3) No call.
4) Zero work outside of work.
5) One of the highest hourly rates especially if on 1099.
6) You can float between multiple hospitals and sometimes pick up bonus pay depending on how desperate. Had a colleague pick up 10 grand for a single shift once.
7) Most casual/part timers don’t work a lot of holidays and nights.

EM has definitely changed post covid and doing anything over 10-12 shifts a month really makes you question humanity. I think working 6-8 or so shifts a month would be a real good life. Just enough to keep things interesting but not enough to make things terrible.
Click to expand...
Yes but will the high rates remain once there is an excess of graduates as predicted in that paper?
 
Tenk said:
For a dual income family where a spouse is getting good reliable benefits there is absolutely no better field than EM if you are going part time/casual.

1) You can choose your own hours/shifts a month.
2) 1099.
3) No call.
4) Zero work outside of work.
5) One of the highest hourly rates especially if on 1099.
6) You can float between multiple hospitals and sometimes pick up bonus pay depending on how desperate. Had a colleague pick up 10 grand for a single shift once.
7) Most casual/part timers don’t work a lot of holidays and nights.

EM has definitely changed post covid and doing anything over 10-12 shifts a month really makes you question humanity. I think working 6-8 or so shifts a month would be a real good life. Just enough to keep things interesting but not enough to make things terrible.
Click to expand...
This is very true. There was mass people exodus from EM after COVID. But with change of scenario and extra income comparable to speciality fields, soon EM may again become field people will apply again . Disclaimer - I am doing really well and enjoying my intern year in Ophtho. Will not trade this for anything else. Love it.
 
Tenk said:
For a dual income family where a spouse is getting good reliable benefits there is absolutely no better field than EM if you are going part time/casual.

1) You can choose your own hours/shifts a month.
2) 1099.
3) No call.
4) Zero work outside of work.
5) One of the highest hourly rates especially if on 1099.
6) You can float between multiple hospitals and sometimes pick up bonus pay depending on how desperate. Had a colleague pick up 10 grand for a single shift once.
7) Most casual/part timers don’t work a lot of holidays and nights.

EM has definitely changed post covid and doing anything over 10-12 shifts a month really makes you question humanity. I think working 6-8 or so shifts a month would be a real good life. Just enough to keep things interesting but not enough to make things terrible.
Click to expand...
The job market and future of em are terrible given the deliberate overexpansion of residencies (mostly by HCA). Hospitals know they can treat em docs like crap because of the oversupply, which leads to physician burnout. I remember hearing that the average female em attending retires in her mid 40s.
 
Last edited:
brekina12 said:
M3 about to apply for electives for next year. I still have no idea what I am going to do and would love some unbiased insight!
I absolutely LOVED OBGYN. It was by far my favorite rotation (and I am on my last rotation). I loved the patient population, the procedures, and I seriously love the OR. I really like the balance of clinic/procedures/OR. However, the single most important thing for me is lifestyle. I am a parent to two young kids (and want more!) and I would like to actually see them grow up. Even if I can make it work as an attending, kids are only little for so long and I hate the idea of missing so much of these early years with my kids being in such an intense residency. I am older than pretty much all of my peers so I don't really want to be in training forever so I don't really want to do a fellowship. Unfortunately, OBGYN doesn't seem too compatible with this so I am trying to find something similar that is more family friendly. Right now, I am considering maybe FM or EM? Here is my list of pros/cons so far.

FM
Pros
-I know some residencies can be very OB and procedure heavy, which I would love, but it seems like you have to be willing to be rural. While I really like the idea of doing rural FM and delivering babies and then being their doctor, I would like my kids to be able to have a decent education and opportunities and I don't know how much OB and procedures I would actually be doing if I lived in a medium-sized city.
Cons
-I absolutely do not want to ever email a patient in my off time. Having an inbox sounds like my definition of hell.
-Paperwork/insurance
-I find annual well visits pretty boring

EM
Pros
-Shift work sounds nice. My husband has great benefits so I don't need to worry about them and I really like the idea of doing locums and only working a few days a week until my kids are older. EM seems like one of the best specialties for that sort of thing.
-Lots of procedures
-I was an EMT for 5 years and really enjoyed the pace
-No patients emailing me after hours
Cons
-Longevity. I am already on the older side and worry about if it is a job that I would still like when I'm 60+.
-I realize most of what you do is not actually dealing with emergencies and there is a lot of tedious non-emergencies and social work involved that I don't necessarily love the idea of dealing with.

I am also pretty average/below average academically. I haven't failed anything, but I am definitely in the bottom half of my class. I also haven't done a day of research in my life (though I don't mind taking a research year if necessary).
Click to expand...
Just keep in mind that much of the EM forum will tell you to pick something else. I have a great EM job and yet many people in my group are trying to build a way out.
 
TooMuchResearch said:
Just keep in mind that much of the EM forum will tell you to pick something else. I have a great EM job and yet many people in my group are trying to build a way out.
Click to expand...
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