If you dont want your shirt sued off your back, do not go into OB/GYN

[sirus_virus]

http://calbears.findarticles.com/p/articles/mi_m0CYD/is_16_39/ai_n6179301
"ACOG survey: one in seven quit obstetrics from 1999 to 2003"

"Ob.gyns. have an average of 2.6 claims filed against them during their careers."

http://www.fightingdocs.com/information_trialLawyer.htm
"an OB-GYN in his family was forced to quit medicine because of the rising cost of malpractice insurance and now teaches math in the Philadelphia parochial school district."


BTW, as an OB/GYN you might have to maintain liability insurance even after you RETIRE, because some of them get sued 20 years later.

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[cgscribe]

That's really too bad. Anybody know of any movements at the state/nation level to levy lawsuits or make the process more doctor friendly? If so, feel free to PM me.

 

[Law2Doc]

BTW, as an OB/GYN you might have to maintain liability insurance even after you RETIRE, because some of them get sued 20 years later.

FWIW, ALL physicians ought to maintain liability insurance even after they retire, for some period of time. Only fools don't purchase tail coverage. It is not all that rare for complications to arise years later. Eg. A radiologist, pathologist, or internist can all be sued years later for having missed that cancer nodule at an early operable date.

 

[sirus_virus]

That's really too bad. Anybody know of any movements at the state/nation level to levy lawsuits or make the process more doctor friendly? If so, feel free to PM me.

I think the AMA has something going on but the parasites(lawyers) are working to block progress. I think premeds and medstudents need to abandon OB/GYN as a whole. There is no need to walk right into a sucker punch if you can avoid it.

 

[gujuDoc]

I think the AMA has something going on but the parasites(lawyers) are working to block progress. I think premeds and medstudents need to abandon OB/GYN as a whole. There is no need to walk right into a sucker punch if you can avoid it.

There is no question that Obstetrics/GYNec is one of the fields of medicine that has it worst in terms of malpractice because of its high risk nature and the fact that it is highly procedural.

However, there's always going to be a need for them just like any other field so if everyone automatically abandoned it then what do you expect that people will do when they need to see one?

There's no sense in making comments of that nature.

That said, a lot of reform does need to take place otherwise states like Fl. are going to lose a lot of OB/GYNs because of the laws working against them, and even if they maintain them they will have a lot of doctors who stop doing certain critical procedures due to the restrictions placed against them. For instance, a family friend of ours has stopped doing most deliveries and other such procedures and only does some laser procedures now. Why? The malpractice laws!

 

[dutchman]

I agree. I don't think OB/GYN is a good field to go into if you want anything close to peace of mind.

 

[Droopy Snoopy]

Anybody else think that 2.6 is lowball? For any specialty, much less OB.

 

[The Buff]

Anybody else think that 2.6 is lowball? For any specialty, much less OB.

I thought that myself when i read it, but maybe I am just a pessimist. From all the stories you hear, it seems like that 2.6 number would be per year!

 

[dutchman]

Anybody else think that 2.6 is lowball? For any specialty, much less OB.

I have actually heard it's more like 1 every four years.

 

[Disinence2]

I have a family friend who is an OB/Gyn but recently had to switch to only Gyn because of the exorbanant cost of malpractive insurance. Its sad because he really likes his job, but can't take the finiancial risk.

 

[Law2Doc]

I think premeds and medstudents need to abandon OB/GYN as a whole.

All you would succeed in doing is make this specialty very popular with the caribbean grads, or result in a huge rise in the roles of licensed midwives, not get any sort of reform.

 

[dutchman]

All you would succeed in doing is make this specialty very popular with the caribbean grads, or result in a huge rise in the roles of licensed midwives, not get any sort of reform.

Ob/GYN will never be popular among any group with that much litigation going on. It is not like caribbean grads and midwives like to get sued. The call for people to abandon OB is realy insignificant as I believe people are already doing just that. Those residencies are going unfiled at a higher rate lately. You know it is bad when FMGs start ignoring a specialty.

 

[tch001]

Ob/GYN will never be popular among any group with that much litigation going on. It is not like caribbean grads and midwives like to get sued. The call for people to abandon OB is realy insignificant as I believe people are already doing just that. Those residencies are going unfiled at a higher rate lately. You know it is bad when FMGs start ignoring a specialty.

This really upsets me. I am definitely interested in Ob/GYN as a potential specialty but everyone is telling me not even to bother considering it. The only encouragement I got was from a DO Ob/GYN who practices as a hospital physician (so she says she is under the hospital's malpractice insurance). I don't know about other girls, but I've been to a few really really bad gynecologists and I feel like that number is just going to increse if nothing is done to decrease the malpractice cases brought against them.

 

[xylem29]

Now - is ob/gyn a bad specialty for females as well? Is it mostly male ob/gyns who are getting sued?

 

[dutchman]

This really upsets me. I am definitely interested in Ob/GYN as a potential specialty but everyone is telling me not even to bother considering it. The only encouragement I got was from a DO Ob/GYN who practices as a hospital physician (so she says she is under the hospital's malpractice insurance). I don't know about other girls, but I've been to a few really really bad gynecologists and I feel like that number is just going to increse if nothing is done to decrease the malpractice cases brought against them.

It is really unfortunate that people like you are not allowed to follow your interests. If OP is correct, 1 in every 7 OBs quiting is a significant number, and I don't believe that many people are quiting because of incompetence. I really don't believe it is a wise career choice, but that is just my opinion. IMO, that is one area we should be willing to leave to the midlevels and unsuspecting foreign doctors(who seem to have picked up on the gist and have started ignoring the specialty too).

 

[dutchman]

Now - is ob/gyn a bad specialty for females as well? Is it mostly male ob/gyns who are getting sued?

When it comes to lawsuits no one is exempt.

 

[dutchman]

Don't worry, if your Step 1 scores are low enough, and you get mediocre-enough clinical evaluations, you'll be able to get into Ob/Gyn okay.

Dude, I see you don't like OB/GYNs. The fact that they are taking any candidiate they can get means the specialty is on life support waiting to give at anytime.

 

[MrBurns10]

Really? What the hell do we need them for anyway? FP can do the routine Gyn care and uncomplicated deliveries. Gen Surg can start doing C-sections and routine Gyn surgery. IM can take back all the primary care stuff that Ob/Gyn has been trying to steal for years. And we can keep Gyn-Onc as a fellowship out of General Surgery.

You make it sound like Ob/Gyns are getting sued at exorbitant rates because their title says Ob/Gyn, not because of what they actually do. If only FPs do the OB part for "routine births" and general surgeons start taking the C-sections, then these are the people who will get rising malpractice costs. The problem stems from the fact that birth is an extremely anxiety-provoking and sensitive time in the child's life, and that ignorant parents (and lawyers) are allowed to sue for anything from birth defects to a learning disability diagnosed during the kid's teenage years (for all they know, the LD could have been caused by low oxygen levels at birth! let's sue!). Switching the profession of people who actually deliver the babies isn't going to solve anything. Babies are still going to be born, problems are still going to happen, and lawsuits will continue to be handed out like candy.

 

[dutchman]

You make it sound like Ob/Gyns are getting sued at exorbitant rates because their title says Ob/Gyn, not because of what they actually do. If only FPs do the OB part for "routine births" and general surgeons start taking the C-sections, then these are the people who will get rising malpractice costs. The problem stems from the fact that birth is an extremely anxiety-provoking and sensitive time in the child's life, and that ignorant parents (and lawyers) are allowed to sue for anything from birth defects to a learning disability diagnosed during the kid's teenage years (for all they know, the LD could have been caused by low oxygen levels at birth! let's sue!). Switching the profession of people who actually deliver the babies isn't going to solve anything. Babies are still going to be born, problems are still going to happen, and lawsuits will continue to be handed out like candy.

That is why some are suggesting we leave the lawyers to deliver the babies.

 

[dutchman]

At the risk of restarting the malpractice argument (although I suppose that was kind of the point of this thread originally):

1) I'm not suggesting that they get sued at exorbinant rates because their title says Ob/Gyn, I was actually suggesting they are incompetant. The general theme of my post was that nothing they do couldn't be done better by other specialties. I was being tongue-in-cheek, and this does not represent my actual opinion.

2) I specifically reject the notion that they are being "sued at exorbinant rates", and I strongly question the common assumption that, in general, they are leaving the profession out of concerns over lawsuits and malpractice insurance at a rate of any consequence.

3) Obstetricians do screw up sometimes, their mistakes result in profound disability and devastated families, and they should pay out the rear in such cases. The very purpose of our civil tort system is to "make the victim whole again" through monetary damages. It is neither suprising nor unfair that an Ob should pay more for an error that harms a child, than a General Surgeon whose error causes harm to an older adult.

Feel free to tell me how wrong I am; it's been a couple weeks since we got into this topic. Hopefully Law2doc will wander across this thread, since he is far more knowledgeable on the subject than I am.

you are wrong because FMs who practiced OB got their asses handed to them on a platter too. Those suits are easier to win and that is why they get filed more frequently. All OB/GYNs could not be incompetent.

 

[gary5]

Unfortunately, the occupation of medical doctor is being assaulted from many directions, and doctors are failing miserably to protect it. It is still desirable, but fading quickly. I wouldn't be surprised if we are the last generation of an occupation worth doing.

 

[Law2Doc]

There are reasons for this beyond malpractice concerns. Every specialty has seen a shift away from the crazy constant on-call schedule that used to dominate medicine. Lifestyle considerations, I would guess, are probably playing a big role in this shift as well.

I tend to agree with this. The later generation of physicians are pushing harder for lifestyle friendly jobs. Part of this is generational, and part is likely related to the changes in gender composition in the profession, which may be making it more family/pregnancy focused than the older, prior, male dominated group. Yet OB is a field with crummy hours and is anything but a lifestyle, family friendly field. Hence the turmoil. Lawyers just represent a convenient scapegoat for leveraging for change here. I expect the specialty will ultimately take steps to lessen the brutal hours and then magically the medmal concerns won't impede the mad rush of folks into the specialty.

 

[AmoryBlaine]

Really? What the hell do we need them for anyway? FP can do the routine Gyn care and uncomplicated deliveries. Gen Surg can start doing C-sections and routine Gyn surgery. IM can take back all the primary care stuff that Ob/Gyn has been trying to steal for years. And we can keep Gyn-Onc as a fellowship out of General Surgery.

Face it, the whole field is basically a joke, and it would not be too difficult for the other specialties to assume their role. I mean hell, the only people who go into the field are failed applicants to Surgery or people who were too mean to do real primary care.

You clearly have not done your Ob/Gyn rotation.

An FP could manage 95% of routine vaginal deliveries no problem, agreed. Gen Surg could definitely do a C-section, heck I could do a C-section.

It's when your wife/sister/best friend/you/your unborn child get into trouble that you'll find yourself glad that there's someone in the room who "wasted their time" in Ob/Gyn for 4 years.

 

[sirus_virus]

Unfortunately, the occupation of medical doctor is being assaulted from many directions, and doctors are failing miserably to protect it. It is still desirable, but fading quickly. I wouldn't be surprised if we are the last generation of an occupation worth doing.

I am thinking in the next 20 years people will officially start laughing at doctors like they do Mcdonalds clerks.

 

[sirus_virus]

All you would succeed in doing is make this specialty very popular with the caribbean grads, or result in a huge rise in the roles of licensed midwives, not get any sort of reform.

To hell with reform, licensed midwives can go take one for the team. I can just see how that hospital is going to explain why they let the midwife handle that complicated pregnancy.

 

[baylormed]

I am thinking in the next 20 years people will officially start laughing at doctors like they do Mcdonalds clerks.

Not if we start fighting back. Let's all go into private practice and take only the patients we want to take. We don't have to accept crappy insurance policies and put up with hospital bureaucracy, and we don't have to treat patients who can't pay.

Let's stop going into specialties such as ob/gyn and surgery and see what they do without doctors.

(Unfortunate and sad, if we come to that point).

 

[sirus_virus]

Not if we start fighting back. Let's all go into private practice and take only the patients we want to take. We don't have to accept crappy insurance policies and put up with hospital bureaucracy, and we don't have to treat patients who can't pay.

Let's stop going into specialties such as ob/gyn and surgery and see what they do without doctors.

(Unfortunate and sad, if we come to that point).

While I like your instincts and would much rather go into practice with someone with your mindset, you have to realize asking doctors to fight back is like asking the French to go to war. Doctors could easily be the most spineless group of vertebrates to grace the earth's surface.

 

[Towelie]

Sirus, I liked the second of the two articles that you posted, but the first is absolute garbage. Anyone with knowledge of research methods will tell you that a voluntary response survey of this nature will give you results that are completely meaningless; those with strong feelings are most likely to send back the survey, and thus the results are extremely exaggerated.

Something to think about: even after malpractice, the average Ob/gyn makes about $230K per year, according to the 2006 edition of the physician socioeconomic statistics. That's more than a lot of fields.

 

[baylormed]

While I like your instincts and would much rather go into practice with someone with your mindset, you have to realize asking doctors to fight back is like asking the French to go to war. Doctors could easily be the most spineless group of vertebrates to grace the earth's surface.

Call me after graduation and we can talk business. Unless you go into ob/gyn.

 

[sirus_virus]

Sirus, I liked the second of the two articles that you posted, but the first is absolute garbage. Anyone with knowledge of research methods will tell you that a voluntary response survey of this nature will give you results that are completely meaningless; those with strong feelings are most likely to send back the survey, and thus the results are extremely exaggerated.

Something to think about: even after malpractice, the average Ob/gyn makes about $230K per year, according to the 2006 edition of the physician socioeconomic statistics. That's more than a lot of fields.

If you did your research right you will find that they are also the most likely to loose their personal property to litigation even with medmal coverage. OB/GYN is risky business for anyone that wants to sleep at night.

 

[Haemulon]

You clearly have not done your Ob/Gyn rotation.

An FP could manage 95% of routine vaginal deliveries no problem, agreed. Gen Surg could definitely do a C-section, heck I could do a C-section.

It's when your wife/sister/best friend/you/your unborn child get into trouble that you'll find yourself glad that there's someone in the room who "wasted their time" in Ob/Gyn for 4 years.

Agreed. I wouldn't choose this specialty for myself, but I am glad that there are good people out there still doing it.

 

[dutchman]

Not if we start fighting back. Let's all go into private practice and take only the patients we want to take. We don't have to accept crappy insurance policies and put up with hospital bureaucracy, and we don't have to treat patients who can't pay.

Let's stop going into specialties such as ob/gyn and surgery and see what they do without doctors.

(Unfortunate and sad, if we come to that point).

I agree 100%

 

[beenthere2]

Sirus, I liked the second of the two articles that you posted, but the first is absolute garbage. Anyone with knowledge of research methods will tell you that a voluntary response survey of this nature will give you results that are completely meaningless; those with strong feelings are most likely to send back the survey, and thus the results are extremely exaggerated.

Something to think about: even after malpractice, the average Ob/gyn makes about $230K per year, according to the 2006 edition of the physician socioeconomic statistics. That's more than a lot of fields.

OK- but given their hours (unbelievable- even many years out of training), their office manager has a better hourly wage.

 

[etf]

i've got a question: say you're a private practice surgeon - is it illegal or something to have your patients sign some sort of "malpractice waiver"? basically something that says you can't be sued for malpractice? or if that's too strict, maybe a predetermined, reasonable settlement if an independent investigation finds significant negligence involved? of course, most people would have differing opinions on "reasonable", but i think something like present value of future earnings or something might do the trick.

 

[Law2Doc]

i've got a question: say you're a private practice surgeon - is it illegal or something to have your patients sign some sort of "malpractice waiver"? basically something that says you can't be sued for malpractice? or if that's too strict, maybe a predetermined, reasonable settlement if an independent investigation finds significant negligence involved? of course, most people would have differing opinions on "reasonable", but i think something like present value of future earnings or something might do the trick.

All patients sign consent forms indicating that they understand the risks but want to proceed anyhow. However this does not protect a physician who deviates from the standard of care or commits negligence. Additionally, courts won't enforce contracts of "adhesion" where parties are not on reasonably equivalent footing, or those made under "duress". Both these doctrines make any such contract waiving liability for surgery unenforceable in court. So the long-winded answer to your question is no, such liability is not something you can contract away. So you instead contract with an insurance company to limit your exposure. Such is the american legal system.

 

[gujuDoc]

All patients sign consent forms indicating that they understand the risks but want to proceed anyhow. However this does not protect a physician who deviates from the standard of care or commits negligence. Additionally, courts won't enforce contracts of "adhesion" where parties are not on reasonably equivalent footing, or those made under "duress". Both these doctrines make any such contract waiving liability for surgery unenforceable in court. So the long-winded answer to your question is no, such liability is not something you can contract away. So you instead contract with an insurance company to limit your exposure. Such is the american legal system.

That and I think it would be stupid for a patient to say they agree to no malpractice especially if say a doctor screwed up so badly that they killed the baby during something like a c section much less causing it mental ******ation. This actually did happen to the friend of someone I used to know years ago. Well not the signing away part but the part about an OB/GYN screwing up so badly that when they were delivering a set of twins, one twin was killed and the other was severely mentally ******ed.

 

[OncoCaP]

Just to keep things balanced in terms of information, my wife's OB/GYN has a successful practice and seems to be doing quite well. I'm not sure how he does it; maybe he is careful about the patients he chooses. I also helped provide some software to another OB/GYN who was happy in his practice. A friend's dad is an OB/GYN and is very successful in his practice as well. She went so far as to suggest going into OB/GYN. In short, I don't know of any OB/GYNs who do not have successful practices and only know one who left the field. They do worry about liability and really hate to be called in for a patient who has never had a checkup, the physician has never seen before, and is now in labor, ready to give birth. I do know of one OB/GYN who was very successful and decided to go into some type of hospital administrative job (maybe because of the hours?); he is also doing very well now in his new job. In short, there are success stories out there.

American Journal of Obstetrics & Gynecology

November 2006, 195:5 > Job satisfaction among obstetrician-gynecologists:...

"Results: Of the 297 questionnaires mailed, 129 (43%) physicians responded. Ninety-five (74%) respondents rated their overall satisfaction as 4 or 5.

5=completely satisfied.

It seems there are many OB/GYNs out there and if that is what you want to do, there are opportunities to be successful (so it seems anyway).

 

[AmoryBlaine]

Actually I'm about to graduate from med school in May, but that was a good shot, since most posters in pre-allo are pre-med or in their pre-clinical years. I'm just an aberation in the middle of a 2 month vacation with too much time on my hands . . .

And really, you didn't think my dripping bitterness towards Ob arose spontaneously, did you?

Well sure, if there's a problem you want the doc with the most experience, but right now there's no reason for FP to have experience with high risk deliveries or Gen Surg to have experience with C-sections. My point is that these procedures are well within their skill sets, and if they did more of them, they would have more experience with them. The overlap is significant enough that I doubt it would even require additional formal training.

Nah, I don't buy it. The physiology of and pathology associated with pregnancy are a different world.

FP/GS are very broad fields already. When you start making arguments like you are making you could just as easily say "well, an FP can do Derm/Rad/Pulmonary/EM" and "a GS can do ortho/ENT/ophtho." I think at some point we have to admit that certain things require specialization, Ob/Gyn is one of them.

Bitterness with a field doesn't mean it shouldn't exist.

 

[sonofschmilsson]

Nah, I don't buy it. The physiology of and pathology associated with pregnancy are a different world.

FP/GS are very broad fields already. When you start making arguments like you are making you could just as easily say "well, an FP can do Derm/Rad/Pulmonary/EM" and "a GS can do ortho/ENT/ophtho." I think at some point we have to admit that certain things require specialization, Ob/Gyn is one of them.

Bitterness with a field doesn't mean it shouldn't exist.

here in the cuts FP's do most of the C-sections. also the ER has one doc which is usually an FP.

not that the specialties shouldnt exist obviously, but those things are in the generalist's scope of practice, region depending

 

[Anjlprincezz]

There are still plenty of deliveries which would benefit from an experienced OB/GYN over an experienced GS or FP... even if OB was incorporated into GS and FP, i think the specialty would eventually re-evolve, simply due to the sheer volume of pregnancies and deliveries...

 

[AmoryBlaine]

here in the cuts FP's do most of the C-sections. also the ER has one doc which is usually an FP.

not that the specialties shouldnt exist obviously, but those things are in the generalist's scope of practice, region depending

I would say that the evidence shows that those things are done better by specialists, and that having generalists do them in not ideal.

 

[Haemulon]

Well sure, if there's a problem you want the doc with the most experience, but right now there's no reason for FP to have experience with high risk deliveries or Gen Surg to have experience with C-sections. My point is that these procedures are well within their skill sets, and if they did more of them, they would have more experience with them. The overlap is significant enough that I doubt it would even require additional formal training.

I take your point, however the danger in it is that you could apply this logic to many other specialties as well. IM and EM, for example. Neither of these fields are as experienced or capable in the other's field as they are in their own; however, certainly their skill sets are not out of reach of each other. An IM doc does not have the same trama skills or experience with a number of EM procedures generally I would think, and an EM does not have the same depth of diagnostic skills and experience with managing difficult cases with multiple co-morbidities over the long term. But each could in theory learn the other, which is why there are dual residency programs for this.

There are some things that just come with experience. I seriously doubt that a FP with their own general practice would perform as many deliveries as an OB. Therefore, they would not never really gain the same level of experience. Even though a C-section is a relatively simple surgical procedure, the same thing can be said for general surgeons performing them. There is no way that they will perform as many as an OB over time (they obviously have other types of surgeries they need to do as well), and so I would think the OB would be much more proficient and experienced.

 

[sirus_virus]

All this talk about who else could handle OB is insignificant, as whoever touches it is going to get sued to death. Why do you think FMs are staying away from OB now(hell, OBs are staying away from OB).