Help me figure out my future:: Ob/Gyn vs. Gen Surg

[JamesPotterMS-3]

Step 1: 238

I've enjoyed both OB/Gyn and Gen Surg but don't know which to commit to and I am genuinely in need of some outside opinion. Instead of talking about what I enjoy about each field, I have written what I am concerned about each field in the hopes to see if these are concerns that are universal or just unique to my particular institution.

Ob/GYN:

• More interested in GynOnc or REI than actual Ob/Gyn; more into procedures.
• Understand that I need to get into a university program to have a shot at fellowships which shouldn't be a big problem but not a total "given" either, even if you are coming from a university program
• Malpractice insurance is crazy high. Salary is important to me. Some docs at my school pay 6 figures per year.
• Love the procedures and the mix of clinic time and OR time.
• Love working with moms and families. I really feel passionate about the field and feel like I can contribute a lot to the advancement to the field, especially GynOnc.

Gen Surg:

• It would be ideal to do gen surg and then a vascular surgery fellowship (with a year or so of minimally invasive surgery fellowship) as that's the field of surgery I am interested in but, again, I realize that this is challenging/nearly impossible coming out of a community program.
• I have no research and a mediocre step score. I'm also coming from a low tier, newer MD school and know I have a low chance at matching at a university program in the city my partner and I need to live in. The community programs I have looked at don't do too hot at placing grads into fellowships and I don't know how cool I am with doing gensurg stuff.
• Super concerned about salary. Most of my residents I worked with had similar concerns. Without a fellowship I'll be doing hernia repairs and basic GI stuff. I've heard the market isn't looking too good for general surgeons

Any advice would be greatly appreciated. Feel free to ask questions if you have any.

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[sinombre]

It seems like there is a whole lot of misinformation here about general surgery. I interviewed at plenty of community programs who had chiefs who had matched into/were heading into vascular, so claiming that is "nearly impossible" contradicts what I've seen (although admittedly this is anecdotal).

Also, going through arguably the most difficult residency for 5+ years with the sole intention of one particular subspecialty seems like a bad idea, especially because your interests will likely change over time (just like how most med students change their mind about specialties between MS1 and MS4). I picked general surgery because 1) I enjoyed general surgery as a med student, and 2) it is an insanely broad field with a million different subspecialty options.

Oh and your step 1 certainly won't keep academic programs out of reach for either field, if that's what you're interested in. I matched into an academic program with a lower score than you.

Edit: I am also a brand new intern going through orientation, so I basically have the perspective of a graduating med student. So take what I say with a grain of salt.

 

[aggie08]

Male here from a low tier US MD school.
Step 1: 238

I've enjoyed both OB/Gyn and Gen Surg but don't know which to commit to and I am genuinely in need of some outside opinion. Instead of talking about what I enjoy about each field, I have written what I am concerned about each field in the hopes to see if these are concerns that are universal or just unique to my particular institution.

Ob/GYN:

• More interested in GynOnc or REI than actual Ob/Gyn; more into procedures.
• Understand that I need to get into a university program to have a shot at fellowships which shouldn't be a big problem but not a total "given" either, even if you are coming from a university program
• Malpractice insurance is crazy high. Salary is important to me. Some docs at my school pay 6 figures per year.
• Love the procedures and the mix of clinic time and OR time.
• Love working with moms and families. I really feel passionate about the field and feel like I can contribute a lot to the advancement to the field, especially GynOnc.

Gen Surg:

• It would be ideal to do gen surg and then a vascular surgery fellowship (with a year or so of minimally invasive surgery fellowship) as that's the field of surgery I am interested in but, again, I realize that this is challenging/nearly impossible coming out of a community program.
• I have no research and a mediocre step score. I'm also coming from a low tier, newer MD school and know I have a low chance at matching at a university program in the city my partner and I need to live in. The community programs I have looked at don't do too hot at placing grads into fellowships and I don't know how cool I am with doing gensurg stuff.
• Super concerned about salary. Most of my residents I worked with had similar concerns. Without a fellowship I'll be doing hernia repairs and basic GI stuff. I've heard the market isn't looking too good for general surgeons

Any advice would be greatly appreciated. Feel free to ask questions if you have any.

Lots to consider here. Some of your ObGyn concerns have been addressed in the AMA thread we've got going: https://forums.studentdoctor.net/th...g-resident-married-w-kids-ask-me-anything-ama

Input from an ObGyn
- You can operate a LOT in ObGyn, but your skills have a clear limit and you need to be okay with knowing when to ask for help from your general surgery colleagues. I love operating and have a broad skill base, but I know my limits and there is absolutely nothing wrong with asking for input from others. That being said, we're self sufficient most of the time and having a good relationship with your gen surg colleagues will serve you incredibly well.
- I chose ObGyn *knowing* I'd do a fellowship because I wasn't totally sold on general practice. Way more detail in above thread, but I ended up really falling in love with the breadth of the generalist field and the flexibility of the practice styles I would have.
- Malpractice is high, but you can be lucrative in the field anyway - most ObGyns are not paying their own malpractice. If you really want to have your own private practice then you should be careful where you choose to practice (TORT. REFORM.). However, malpractice is crazy high partially due to obstetrics and if you specialize will be less intrusive.
- If you love working with moms and families then Ob is up your alley. You may find you don't want to sub-specialize, though - keep your mind open!
- Fellowships are quite competitive, around 1/3 who apply don't match at all...do not choose ObGyn if you'd be unhappy as a generalist.
- A love of moms/families, procedures, and mix of clinic and OR time should absolutely sell you on this field.

Regarding general surgery, also a very exciting field! Tons of options and lots of ways to direct the trajectory of your career. Will let the gen surgeons weigh in more.

Unless you want to be a millionaire your salary is going to be fine in either field (probably more in a surgery sub-specialty than ObGyn, tho). If you want to be a millionaire you chose the wrong field all together, though. In all honesty, salary concerns should prompt consideration of a broad number of practice styles and locations when you're finishing your training, but should not influence your specialty choice at all (particularly when choosing between these two fields).

Regarding sub-specializing from either field
- Getting into fellowship in any field is going to be hard, but NOT impossible, from a more community-type program.
- A lot of it is also up to how much effort you put into making yourself competitive and networking with people in the field you are interested in

 

[vm26]

It seems like there is a whole lot of misinformation here about general surgery. I interviewed at plenty of community programs who had chiefs who had matched into/were heading into vascular, so claiming that is "nearly impossible" contradicts what I've seen (although admittedly this is anecdotal).

Also, going through arguably the most difficult residency for 5+ years with the sole intention of one particular subspecialty seems like a bad idea, especially because your interests will likely change over time (just like how most med students change their mind about specialties between MS1 and MS4). I picked general surgery because 1) I enjoyed general surgery as a med student, and 2) it is an insanely broad field with a million different subspecialty options.

Oh and your step 1 certainly won't keep academic programs out of reach for either field, if that's what you're interested in. I matched into an academic program with a lower score than you.

Edit: I am also a brand new intern going through orientation, so I basically have the perspective of a graduating med student. So take what I say with a grain of salt.

Good point...from an outsider's perspective (who has read CTA run-offs, follow-up on endo-vascular AAA repair etc) vascular seems like a rough field, elderly/very sick patients...

 

[JamesPotterMS-3]

Oh and your step 1 certainly won't keep academic programs out of reach for either field, if that's what you're interested in. I matched into an academic program with a lower score than you.

Thank you. The problem is I am not very flexible on location because of my partner.
My own school's program is at a community hospital that hasn't graduated a full cohort yet and alumni rosters aren't easy to come by online so I am trying to figure out what some of these community programs are like.
I also recognize that salary for general surgery depends largely on location and your contract.

 

[JamesPotterMS-3]

- I chose ObGyn *knowing* I'd do a fellowship because I wasn't totally sold on general practice. Way more detail in above thread, but I ended up really falling in love with the breadth of the generalist field and the flexibility of the practice styles I would have.

First of all, thank you SO VERY MUCH for your input. It is incredibly, inexplicably valuable to have you chime in on this.
Secondly, the quote above ^^ is actually the big thing deterring me, ironically, from general surgery. Like I said, I believe I can be totally fine with delivering babies the rest of my careers (being a generalist OB) but I really, really, don't know if I can say the same for doing hernia repairs, appendectomies, and biopsies for the rest of my career (general surg stuff). I realize gs is much more broad than that but, due to partner's work, I'm looking at being in either Los Angeles, Boston, or Chicago where the scope of practice is crowded by specialists and sub-specialists.

 

[ortnakas]

If you were to end up not doing a fellowship for whatever reason, would you rather be in OBGYN or general surgery?

Edit: never mind, you answered this as I was typing my question

 

[aggie08]

First of all, thank you SO VERY MUCH for your input. It is incredibly, inexplicably valuable to have you chime in on this.
Secondly, the quote above ^^ is actually the big thing deterring me, ironically, from general surgery. Like I said, I believe I can be totally fine with delivering babies the rest of my careers (being a generalist OB) but I really, really, don't know if I can say the same for doing hernia repairs, appendectomies, and biopsies for the rest of my career (general surg stuff). I realize gs is much more broad than that but, due to partner's work, I'm looking at being in either Los Angeles, Boston, or Chicago where the scope of practice is crowded by specialists and sub-specialists.

Well, considering most of your Ob concerns are pretty easy to overcome and your gen surg one seems to be more of a risk, maybe you've got your answer. In Ob OR Gen Surg (or anything really) if you think you'd be unhappy has a generalist, you should not choose the field.

 

[JamesPotterMS-3]

Can any residents/attendings comment on the scope of practice of general surgeons in an urban setting?

 

[surgonc2017]

Sure, you seem to have some misconceptions about general surgery.

It's unlikely someone would do a vascular surgery fellowship and an MIS fellowship. Vascular surgery probably utilizes laparoscopic and robotic techniques less than any other field in surgery. Minimally invasive techniques in vascular are wires and catheters in an artery, not doing laparoscopic procedures. Minimally invasive surgeons tend to focus on laparoscopic hernia repairs, gastric bypass, foregut procedures etc. It wouldn't be impossible to do both, but there wouldn't be much utility in it. Vascular and MIS fellowship are both attainable from community programs. You do have a shot a academic gen surg programs as well, but with geographic restrictions that's more difficult.

Salary shouldn't be a huge concern in gen surg or a fellowship. Depending on your practice model you can do as well or better than OB.

General surgery practice in an urban setting is going to highly depend on the system you're practicing in. If you're at a trauma 1 center, you'll probably be doing a lot of in house trauma call and doing acute care surgery (gallbladders, appendixes, but pus, etc.). In an academic non-trauma setting you may still do ACS, but probably more elective things like hernias, Nissens, hellers,maybe breast cancers, colon, thyroid etc. depending on what specialists are available. To be fair though, the majority of gen surg residents (>80%) do a fellowship of some kind.

 

[Donald Juan]

Vascular surgery vs gyn onc?

 

[bannie22]

Lol.

Do ObGyn if you dont want to learn how to operate.
Do Gen Surg if you dont want to have kids.

 

[Entadus]

Lol.

Do ObGyn if you dont want to learn how to operate.
Do Gen Surg if you dont want to have kids.

Your post isn't helpful at all. Care to elaborate?

And what qualifies you to make these statements?

 

[bannie22]

Your post isn't helpful at all. Care to elaborate?

And what qualifies you to make these statements?

It is helpful.
Especially if you consider the inverse,
If you wanted kids, pick ObGyn
If you wanted operative skills, pick GS.

I'm just any other SDN member.

 

[Entadus]

It is helpful.
Especially if you consider the inverse,
If you wanted kids, pick ObGyn
If you wanted operative skills, pick GS.

I'm just any other SDN member.

In other words, not qualified at all. Got it. 😀

 

[Mad Jack]

Male here from a low tier US MD school.
Step 1: 238

I've enjoyed both OB/Gyn and Gen Surg but don't know which to commit to and I am genuinely in need of some outside opinion. Instead of talking about what I enjoy about each field, I have written what I am concerned about each field in the hopes to see if these are concerns that are universal or just unique to my particular institution.

Ob/GYN:

• More interested in GynOnc or REI than actual Ob/Gyn; more into procedures.
• Understand that I need to get into a university program to have a shot at fellowships which shouldn't be a big problem but not a total "given" either, even if you are coming from a university program
• Malpractice insurance is crazy high. Salary is important to me. Some docs at my school pay 6 figures per year.
• Love the procedures and the mix of clinic time and OR time.
• Love working with moms and families. I really feel passionate about the field and feel like I can contribute a lot to the advancement to the field, especially GynOnc.

Gen Surg:

• It would be ideal to do gen surg and then a vascular surgery fellowship (with a year or so of minimally invasive surgery fellowship) as that's the field of surgery I am interested in but, again, I realize that this is challenging/nearly impossible coming out of a community program.
• I have no research and a mediocre step score. I'm also coming from a low tier, newer MD school and know I have a low chance at matching at a university program in the city my partner and I need to live in. The community programs I have looked at don't do too hot at placing grads into fellowships and I don't know how cool I am with doing gensurg stuff.
• Super concerned about salary. Most of my residents I worked with had similar concerns. Without a fellowship I'll be doing hernia repairs and basic GI stuff. I've heard the market isn't looking too good for general surgeons

Any advice would be greatly appreciated. Feel free to ask questions if you have any.

Vascular is becoming less of an option as programs convert to integrated. As to the market for general surgeons, it's pretty good if you're geographically flexible.

 

[AcademicNeurosurgery]

Since you're "super concerned about salary", I'll say this: looking at base salaries for these two specialties is incredibly short-sighted. If you want financial security (who doesn't?), the following is what I've learned from satisfied attendings:

1. Do what you love.
2. Care about your patients.
3. Limit unnecessary spending.
4. Invest wisely.

In short, pick what you enjoy most. The rest will follow.

 

[ACSurgeon]

Vascular is becoming less of an option as programs convert to integrated. As to the market for general surgeons, it's pretty good if you're geographically flexible.

Plenty of vascular fellowships will remain for the next decade or so

 

[ACSurgeon]

It is helpful.
Especially if you consider the inverse,
If you wanted kids, pick ObGyn
If you wanted operative skills, pick GS.

I'm just any other SDN member.

My graduating chief class has almost as many kids as we do Chiefs.

My community general surgery practice job pays well, offers plenty of time off, and has plenty of variety (the kind I want anyways).

General surgeons can easily earn 350k, and even up to 450k starting out of residency. In an urban setting (not as large as Chicago LA).

 

[Mad Jack]

Plenty of vascular fellowships will remain for the next decade or so

But those fellowships are likely going to heat up as some of the spots are sniped off to become integrated programs. I mean, it's not like vascular is going to be impossible, but there's a chance OP won't land a position.

 

[Dr G Oogle]

Your post isn't helpful at all. Care to elaborate?

And what qualifies you to make these statements?

Let me elaborate on this because i grappled with a similar issue. To be fair there is a preception that obgyns are not "good surgeons" and I think some of it comes from csections watching people tear at tissue and then call in urology because of a bladder injury will give anyone that impression. But make no mistake an obgyn definitely prepares you surgically and maybe one of the more intensive laparoscopic surgery training programs and having closely worked with urology residents in fellowship I can honestly tell you that there is very little difference between really skilled residents in either field, there is much more variability in the lesser ranks.

However a general obgyn likely operates less than a generalist general surgeon, that has more to do with the nature of generalist practice which includes a lot of obstetrics and the national average amongst genral obgyns for annual number of hysterectomy is about 8. With 12 considered high volume. This likely varies if you join a practice that is far away from large metro areas with academic centers and subspecialists or you are the only game in town.

Low case volume isn't unique to obgyn, one of my mentors sits on the ROC and meets with other surgical specialties and it's pretty much universal, the problem wit obgyn though is that they train more surgeons per capital than other specialties to fill the real need of obstetric coverage. It is very likely in the future that most pelvic surgery will be done by oncology, urogyn and MIS trained surgeons unless you are in an area without those services and that residency training will evolve into something like the integrated vascular and integrated IR programs for gyn surgery (this was even brought up at this years annual meeting).

It's not likely that this training paradigm shift will occur before you start residency but will probably happen in the next 20 years.

So when you are making your decision you should take that into consideration.

 

[aggie08]

My graduating chief class has almost as many kids as we do Chiefs.

My community general surgery practice job pays well, offers plenty of time off, and has plenty of variety (the kind I want anyways).

General surgeons can easily earn 350k, and even up to 450k starting out of residency. In an urban setting (not as large as Chicago LA).

I'm Ob and agree with this completely - having children is so much more dependent on your PROGRAM and your PARTNER than it is your specialty.

Additionally, general surgery will usually have a higher earning potential than general Ob/Gyn. Why? Surgery reimburses relatively well (as compared to clinic medicine and definitely compared to obstetrics). Gen Surg has a larger surgical breadth and volume and, thus, more earning potential. Now, there are some Obs who are doing really well and some surgeons who are not, but I'd guess most surgery and surgery sub-specialties earn more than I will. No prob, my earning potential is more than comfortable and I love my field.

Let me elaborate on this because i grappled with a similar issue. To be fair there is a preception that obgyns are not "good surgeons" and I think some of it comes from csections watching people tear at tissue and then call in urology because of a bladder injury will give anyone that impression. But make no mistake an obgyn definitely prepares you surgically and maybe one of the more intensive laparoscopic surgery training programs and having closely worked with urology residents in fellowship I can honestly tell you that there is very little difference between really skilled residents in either field, there is much more variability in the lesser ranks.

However a general obgyn likely operates less than a generalist general surgeon, that has more to do with the nature of generalist practice which includes a lot of obstetrics and the national average amongst genral obgyns for annual number of hysterectomy is about 8. With 12 considered high volume. This likely varies if you join a practice that is far away from large metro areas with academic centers and subspecialists or you are the only game in town.

Low case volume isn't unique to obgyn, one of my mentors sits on the ROC and meets with other surgical specialties and it's pretty much universal, the problem wit obgyn though is that they train more surgeons per capital than other specialties to fill the real need of obstetric coverage. It is very likely in the future that most pelvic surgery will be done by oncology, urogyn and MIS trained surgeons unless you are in an area without those services and that residency training will evolve into something like the integrated vascular and integrated IR programs for gyn surgery (this was even brought up at this years annual meeting).

It's not likely that this training paradigm shift will occur before you start residency but will probably happen in the next 20 years.

So when you are making your decision you should take that into consideration.

Totally agree with this - I have excellent surgical training. That does not mean I don't need help sometimes. My lap training is far superior to some Ob programs and having very active oncologists and no oncology fellowships means we get extensive primary surgical experience in both open and difficult lap cases on Onc rotations. My skills will never compare to a general surgeon - they have a longer residencies and focus primarily on surgery - they don't deliver babies or take care of pregnancies, and they don't do nearly as much general medicine/primary care in the clinic...however my ability to operate in the pelvis and vaginally is very good and I am more than capable to do these cases. Again, I'd never imply I won't find something I need help with sometimes, which is why we maintain a good relationship with Urology and General Surgery...but to say no Gyn surgeons are good surgeons is ignorant. You're working with the wrong people in the wrong places if you think that.

 

[masaraksh]

Gen surg has blood, poop and bowel fluid. OBGYN has poop, urine, amniotic fluid, blood, bike, estrogen, dead babies, and vaginal discharge.

Radiology ultimately is the winner. There is a peaceful dark room, espresso, and gadolinium/iodinated contrast

 

[ACSurgeon]

I'm Ob and agree with this completely - having children is so much more dependent on your PROGRAM and your PARTNER than it is your specialty.

Additionally, general surgery will usually have a higher earning potential than general Ob/Gyn. Why? Surgery reimburses relatively well (as compared to clinic medicine and definitely compared to obstetrics). Gen Surg has a larger surgical breadth and volume and, thus, more earning potential. Now, there are some Obs who are doing really well and some surgeons who are not, but I'd guess most surgery and surgery sub-specialties earn more than I will. No prob, my earning potential is more than comfortable and I love my field.
.

After a certain income, it's just gravy. I'm sure OB/GYNs do well overall.

 

[Brahnold Bloodaxe]

After a certain income, it's just gravy.

Tell that to Jose's Landscaping😡. You think those hedgerows in my third mansion just trim themselves?

 

[SLC]

Step 1: 238
…I'm also coming from a low tier, newer MD school...

In another thread you're claiming to be "a DO going into general surgery"

I SWEAR if I hear the word "discrimination" thrown around one more time to describe the preference of MD over DOs by PDs, I'm going to lose it. God forbid, if I needed a brain tumor removed, would I pick the UCSF trained surgeon with a CV the size of a dictionary or the doc who received his training at a 150-bed community hospital? Would that be discrimination too? JESUS. And this is coming from a DO student going into surgery.

My main piece of advice is to learn/figure out which type of student you are before applying/going on interviews.

Your school faculty members should be able to help you out with this information if you require assistance 😀

 

[Brorthopedic]

RIP @JamesPotterMS-3