L&D FM vs OBGYN

[User235]

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In L&D, what is the difference between an OBGYN and FM with OB training? Does it have more to do with managing high risk patients?

 

[Crayola227]

omg

yes

one can sort of stand in and do it if it's not too ****ed up or the last resort, the other is *the* specialist on it

don't get me started

4 weeks of ob/gyn, and the CD looks at me when I ask about ob/gyn in FM, says, "well, it's a little bit of cowboy medicine. We spend 4 years to learn to do one very important thing, and they don't get anywhere near that level of training."

Scarier to me than being an intern trying to run a code off a mother****ing card

yes FM deliver babies is all I should say

I want my babies deliever by ob/gyn

 

[pd1112]

@Crayola227 realize that you would most likely get a similar response from any physician talking about another specialty that has training to cover similar procedures. "4 years to learn to do one very important thing" is a bit of an exaggeration. Do they have more deliveries over 4 years than any FM resident does in 3 years? Of course, but it's not like all 4 years, or even 2 full years, are spent just delivering babies. There are plenty of FM physicians in rural areas primarily that have been doing OB throughout their entire careers.

@User235 The majority of FM physicians choose not to do obstetrics anymore due to the added cost of malpractice and lack of enough training in residency & volume during practice to feel comfortable enough to routinely manage pregnancies & deliveries. As above, there are still some who do obstetrics & there are a number of FM residencies that have a significant amount of OB rotations.

 

[arewethereyet...]

also FM docs aren't trained to do c sections or any other surgeries that OBs do

 

[Crayola227]

also FM docs aren't trained to do c sections or any other surgeries that OBs do

some FM programs have oppportunities to do training to be able to do "simple" "low risk" c sections

of course it's a liability nightmare, and you would have to figure out how to do enough each year in practice to justify continuing to do them, but a few FM docs at my school did them

 

[lymphocyte]

In L&D, what is the difference between an OBGYN and FM with OB training? Does it have more to do with managing high risk patients?

By FM with OB training, do you mean OB fellowship? Last time I looked into this, most OB fellowships require the same minimum vaginal, operative, and Cesarean deliveries as O&G residency (obviously all O&G residents exceed these minimums, but lots of OB fellows do too):

Spontaneous vaginal delivery - 200
Cesarean delivery - 145
Operative vaginal delivery - 15

The minimums for FM residency (without fellowship) are in flux, but I think it was 40 for SVD. So there's a big training gap. (Although some residencies like Natividad are obstetric heavy, so it's also residency dependent).

Practice makes perfect. A FM doc doing obstetrics throughout his or her life will be damned competent, especially with an obstetrician on call for when things go completely FUBAR. (The malpractice alone keeps the bad ones out.) Plus heaps of obstetricians have Cesarean rates > 50% in low risk populations--not ideal.

Either way, high-risk means you'll get bumped to a obstetrician. Higher risk means you might get bumped to a Maternal-fetal medicine (MFM) specialist. But that doesn't mean a low-risk pregnancy should be seeing a MFM specialist, just because the specialist has many more years of formal training. Do you see what I mean?

https://jfmo.cchs.ua.edu/files/2015/05/Avery-Editor-spring-20151.pdf

 

[Smurfette]

One of my good friends is an FP who did a 1 year OB fellowship (designed for FPs, not for OBs) to get training in c-sections, forceps deliveries and other high-risk pregnancy related management. She could have gotten a job doing regular vaginal deliveries without the fellowship (this is pretty common in rural areas; she had a pretty high volume of deliveries in residency) but has a higher income by being in the c-section call pool along with other FPs with similar training and a general surgeon. If one of her partner's laboring moms needs a c-section, they contact the person on c-section call to do it. If my friend's on call for L&D, she also covers c-sections but another partner will come in to help resuscitate baby while she is doing the section. She will also do tubals at the time of c-section but does not do any other surgeries. Any high-risk stuff or VBACs get sent out 40 minutes away; there's no OB/Gyn coverage in her town. My understanding is that her practice skews younger than most of her partners given she has more young female patients and their children; this also keeps her practice pretty busy. I believe she is in a group of 10-12 FPs, and 3 of them do c-sections. A couple of the senior partners no longer do any OB.

I should also mention that all deliveries that are not planned c-sections are automatically reviewed in her hospital to verify that the management was appropriate, as are any deliveries that result in transfer of mom or baby to a higher level of care. If there's an issue with a provider's management, steps are taken to ensure patient safety/quality is maintained going forward (via education/CME), or that provider loses their L&D/C-section privileges. Obviously, every hospital will vary in how this works.