Male Medical student interested in OB needs advice

[mcat_taker]

Came off my third year rotation and surprisingly loved it. Preferred it to all the other cores I did. I really liked the residents and attendings I worked with especially (everyone was so nice and teaching focused!), and I liked the variety between procedures, clinic, L and D, emergency visits, short notes, short rounding, healthy patients for the most part! the pathology, and the very "hands on" aspect of the field.

I found myself waking up everyday for rotation generally excited on going in which I can't say I had the same feeling for during my other rotations. But some questions remain:

First, is it easier as a guy to match ? How competitive is it really? I initially thought I would do peds but I'm not completely sold on working with only kids for the rest of my life and being a general pediatrician just doing well child and sick visits doesn't sound appealing- I don't want to do a field from the get go knowing I would probably need to specialize to be happy. I can see myself happy as a generalist ob without fellowship.

Second, I've never really seen myself as a "surgeon" and am sort of terrified I will not be good in the OR or that I won't be able to figure out how to do the procedures alone- I feel like I'm a little clumsy. did anyone else go into this field terrified of this? and how surgical of a field is it really?

Third, Idk if its just that I really liked the place I rotated at-- but I have heard that OB has a rep of having a lot of malignant programs. This also terrifies me.

Would love some advice from the forum! Thank you all.

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[anonperson]

Came off my third year rotation and surprisingly loved it. Preferred it to all the other cores I did. I really liked the residents and attendings I worked with especially (everyone was so nice and teaching focused!), and I liked the variety between procedures, clinic, L and D, emergency visits, short notes, short rounding, healthy patients for the most part! the pathology, and the very "hands on" aspect of the field.

I found myself waking up everyday for rotation generally excited on going in which I can't say I had the same feeling for during my other rotations. But some questions remain:

First, is it easier as a guy to match ? How competitive is it really? I initially thought I would do peds but I'm not completely sold on working with only kids for the rest of my life and being a general pediatrician just doing well child and sick visits doesn't sound appealing- I don't want to do a field from the get go knowing I would probably need to specialize to be happy. I can see myself happy as a generalist ob without fellowship.

Second, I've never really seen myself as a "surgeon" and am sort of terrified I will not be good in the OR or that I won't be able to figure out how to do the procedures alone- I feel like I'm a little clumsy. did anyone else go into this field terrified of this? and how surgical of a field is it really?

Third, Idk if its just that I really liked the place I rotated at-- but I have heard that OB has a rep of having a lot of malignant programs. This also terrifies me.

Would love some advice from the forum! Thank you all.

You will probably get a few more interviews but being a guy won't make up for glaring deficiencies in your application.

Competitiveness is average. Not on the level of urology, ENT, or derm.

A general OB is not doing that many complex procedures to be honest. If you are in a system like Mayo or certain Kaiser, some generalists are doing the bare minimum of procedures ( c section, hysteroscopy, some in office stuff).

Some programs are malignant.

The field is average in general.

Main thing is the calls can be busy depending on the practice situation. Will you be happy doing a c section or delivery at 3am on a random weekday when you are 50?

That is something you don't have to deal with in an office based specialty. A regular 9 to 5 schedule is a pretty nice thing.

Burn out is a real thing.

Malpractice concerns are a real thing.

There is also a more aggressive push to reduce c sections, which is disingenuous because there is no protection from potentially career threatening lawsuits.

If you have the scores and want to do something procedural you should do urology or ENT. Better pay and lifestyle.

 

[mcat_taker]

You will probably get a few more interviews but being a guy won't make up for glaring deficiencies in your application.

Competitiveness is average. Not on the level of urology, ENT, or derm.

A general OB is not doing that many complex procedures to be honest. If you are in a system like Mayo or certain Kaiser, some generalists are doing the bare minimum of procedures ( c section, hysteroscopy, some in office stuff).

Some programs are malignant.

The field is average in general.

Main thing is the calls can be busy depending on the practice situation. Will you be happy doing a c section or delivery at 3am on a random weekday when you are 50?

That is something you don't have to deal with in an office based specialty. A regular 9 to 5 schedule is a pretty nice thing.

Burn out is a real thing.

Malpractice concerns are a real thing.

There is also a more aggressive push to reduce c sections, which is disingenuous because there is no protection from potentially career threatening lawsuits.

If you have the scores and want to do something procedural you should do urology or ENT. Better pay and lifestyle.

Thanks for the reply and sharing! I have heard that lifestyle is improving especially now with dedicated hospitalist OBs doing shift work.

I have heard burnout is high in the field compared to others, but it also seems like OB people really love OB. I haven't met anyone that seemed really burned out by it.

Hard to predict 20-30 years from now if middle of the night sections would bother me. I have heard in a big group that your call is much more manageable.

Yes of course ENT, urology, derm are great fields but also very competitive. Not looking at them.

 

[Lucky Seven]

Just another 2 cents!

Do not want to discount the previous reply, but the answer does seem to be coming from a place of burn-out it self, which is definitely a problem in medicine in general. A different perspective:

1) Ob/Gyn has become more competitive in recent years, especially at the top programs. This is probably due to 1) more applicants interested in Ob/Gyn, and 2) applicants applying to much higher number of places that before. Because of this, a lot of the top programs are full of people with mostly step 250+. I don't say this to discourage you or scare you, as overall it is still an average competitiveness overall, but I think people may discount how tough it can be at the top (though this is likely true for most fields). Community programs train great doctors, it just makes the climb into fellowship harder (though certainly not impossible!).

2) YES, it is a surgical subspecialty. Whether other surgeons/lay persons recognize that or not, you will spend a LOT of time as a resident in the OR, and it is important not to discount this. Even if you want to end up being a generalist that only does OB, or do a fellowship with less operating (MFM, REI), you still have to graduate from residency. Minimum numbers just increased, so its something like 85 hysterectomies total, 70 of which have to be minimally invasive, as well as 60 other laparoscopies, and then of course C-sections and more minor stuff. Given the increase of minimums, many programs have a large GYN focus, especially during PGY3 and 4, in order to make these minimums, and every resident is expected to strive for these, even if you don't end up liking the OR. I say this because even if your career does not have an OR focus, if you HATE the OR, you could be in for a miserable 4 years of residency. In terms of being clumsy, most medical schools are not really teaching you to operate. Yes, some people have more natural skills, but everyone can learn. As above, I agree that most generalists are not doing super complex cases (may be different if you're in a rural area or a public hospital).

3) Malignancy is a thing! This is true in all specialities and is mostly program dependent. However, while most specialities tend to get easier as you advance, this is NOT true of Ob/Gyn. The PGY3 year tends to be one of the hardest, and PGY4 can be as well depending on where you are. I think this makes it even easier for OB programs to be labeled as malignant because your stuck with bad work hours throughout residency, so it is even more important to find a program that emphasizes wellness, and in general has nicer residents. I am fortunate enough to be at a program that does this, but I agree that burn-out is real, so this is something to pay close attention to when interviewing.

 

[anonperson]

Just another 2 cents!

Do not want to discount the previous reply, but the answer does seem to be coming from a place of burn-out it self, which is definitely a problem in medicine in general. A different perspective:

1) Ob/Gyn has become more competitive in recent years, especially at the top programs. This is probably due to 1) more applicants interested in Ob/Gyn, and 2) applicants applying to much higher number of places that before. Because of this, a lot of the top programs are full of people with mostly step 250+. I don't say this to discourage you or scare you, as overall it is still an average competitiveness overall, but I think people may discount how tough it can be at the top (though this is likely true for most fields). Community programs train great doctors, it just makes the climb into fellowship harder (though certainly not impossible!).

2) YES, it is a surgical subspecialty. Whether other surgeons/lay persons recognize that or not, you will spend a LOT of time as a resident in the OR, and it is important not to discount this. Even if you want to end up being a generalist that only does OB, or do a fellowship with less operating (MFM, REI), you still have to graduate from residency. Minimum numbers just increased, so its something like 85 hysterectomies total, 70 of which have to be minimally invasive, as well as 60 other laparoscopies, and then of course C-sections and more minor stuff. Given the increase of minimums, many programs have a large GYN focus, especially during PGY3 and 4, in order to make these minimums, and every resident is expected to strive for these, even if you don't end up liking the OR. I say this because even if your career does not have an OR focus, if you HATE the OR, you could be in for a miserable 4 years of residency. In terms of being clumsy, most medical schools are not really teaching you to operate. Yes, some people have more natural skills, but everyone can learn. As above, I agree that most generalists are not doing super complex cases (may be different if you're in a rural area or a public hospital).

3) Malignancy is a thing! This is true in all specialities and is mostly program dependent. However, while most specialities tend to get easier as you advance, this is NOT true of Ob/Gyn. The PGY3 year tends to be one of the hardest, and PGY4 can be as well depending on where you are. I think this makes it even easier for OB programs to be labeled as malignant because your stuck with bad work hours throughout residency, so it is even more important to find a program that emphasizes wellness, and in general has nicer residents. I am fortunate enough to be at a program that does this, but I agree that burn-out is real, so this is something to pay close attention to when interviewing.

How is anything I said coming from a place of being burned out? Every single thing I said is a fact so please check yourself before you start labeling me as coming from a place of being burned out.

You're still in residency so honestly your view of what practice is like isn't worth two cents.

Do you disagree with the fact that the OP may be doing deliveries and c sections at 3am? That is being realistic. Patients can and do deliver at inopportune times. It's the nature of the business that he won't deal with in an office based specialty.

As far as the competitive nature of the specialty, any resident at a top program will have a good application. But the applicants at the worst urology or dermatology program will have better credentials than at the worst OB GYN program.

 

[Dr G Oogle]

Came off my third year rotation and surprisingly loved it. Preferred it to all the other cores I did. I really liked the residents and attendings I worked with especially (everyone was so nice and teaching focused!), and I liked the variety between procedures, clinic, L and D, emergency visits, short notes, short rounding, healthy patients for the most part! the pathology, and the very "hands on" aspect of the field.

I found myself waking up everyday for rotation generally excited on going in which I can't say I had the same feeling for during my other rotations. But some questions remain:

First, is it easier as a guy to match ? How competitive is it really? I initially thought I would do peds but I'm not completely sold on working with only kids for the rest of my life and being a general pediatrician just doing well child and sick visits doesn't sound appealing- I don't want to do a field from the get go knowing I would probably need to specialize to be happy. I can see myself happy as a generalist ob without fellowship. Obgyn is a little more competitive than it used to be and there are a lot more 250s out there but the mean usmle score has also gone up, so the 250 means a little less than it did 10 years ago. The mean in 2016 was a 228 while in 2008 it was 221. If you score in the 230s you’ll be fine.

Second, I've never really seen myself as a "surgeon" and am sort of terrified I will not be good in the OR or that I won't be able to figure out how to do the procedures alone- I feel like I'm a little clumsy. did anyone else go into this field terrified of this? and how surgical of a field is it really?

Third, Idk if its just that I really liked the place I rotated at-- but I have heard that OB has a rep of having a lot of malignant programs. This also terrifies me.

Would love some advice from the forum! Thank you all.

Both @anonperson and @Lucky Seven make good points .

If you are a good applicant with good scores/grades/LOR you have a bit of an edge over a female applicant, just like a female applicant will have a bit of an edge for ortho; and there was even a recent article in AJOG (one of our big journals) about recruiting more men to the specialty, however that is one thing to consider as the ratio will probably stabilize around 80:20.

Second, it is most definitely a surgical residency you spend much of your time in the OR either doing Csections or in gyn and even when you’re not in the OR it is very grueling. As an example on oncology I would come in at 4 am and leave at 8 pm every day for 4 years at 2 months per year; gyn you’ll probably come in before 6 to round and leave around 5 or 6; L&D is more predictable hours (usually a 11-12 hour shift) but that’s about all that’s predictable about it. It is much more of a grind then pediatrics. You will have some down time like an REI rotation a research elective or some off service rotation but it is not an easy 4 years.

Third, if you find you get a taste for the OR, these days you pretty much have to do a fellowship (onc, MIGS or fpmrs) if you want a surgical practice unless you want to live in the boonies. The number of hysts you have to graduate with is 75, in my fellowship I’ve done almost 600 majors (and most of the fellowship trained people are generally around that number) and most generalists (unless Bonney bound) do fewer than 12 per year and many don’t even do one as an attending until they’ve been out for a while; so you’re practice as a generalist will consist of minors (tubals, ectopic, hysteroscopies etc) and OB, but you can still make doing that. That being said you will not need to stay late after school to get your numbers, unless you’re at a very very bad residency you should have zero problem reaching the mandatory number of procedures needed to graduate.

Fourth, few obgyns do call these days, most are in large group practices, hospital employed etc so you’re not delivering babies at 3 am and having a full office the next day; instead you cover shifts, but some of those shifts are going to be in the wee hours and you very well could be doing a 3 am section in your 50s, but you could also make your whole practice just office when you’re that age, Obgyn gives you a lot of versatility.

Personally I like the field, patients are appreciative, surgeries are complex and I’m finishing an fpmrs fellowship so I’ll never have to be on L&D unless someone bags a bladder. But if you like OB than more power to you. Also something that really never gets mentioned if you go to an area with poor access and not super desirable you can make money hand over fist without breaking a sweat as a generalist (a fact I wish I was aware of when I was planning for fellowship)

 

[obgyny]

Agree with all the above posts. Just wanted to comment on a few things:

Minimum numbers just increased, so its something like 85 hysterectomies total, 70 of which have to be minimally invasive, as well as 60 other laparoscopies, and then of course C-sections and more minor stuff. Given the increase of minimums, many programs have a large GYN focus, especially during PGY3 and 4, in order to make these minimums, and every resident is expected to strive for these, even if you don't end up liking the OR.

Overall, OB/GYN residents are operating much LESS than before. Especially as we’re getting better with medical management of issues such as AUB or pelvic pain, we are doing less hysts overall, particularly open hyst cases.

Most OB/GYN residency programs struggle to meet minimum surgical numbers in open hysts, and even vag hysts. Just this year, the minimum number of TAHs has decreased from 35 to now 15. Newer graduates from GYN residency have much less surgical experience than before.

That being said, I completely agree with Lucky Seven that OB/GYN is still definitely a surgical specialty. If you hate the OR, it’s going to be a painful 4 years of residency...

I’m sure most people aren’t born naturally gifted in the OR... you will acquire those skills in residency.

However, while most specialities tend to get easier as you advance, this is NOT true of Ob/Gyn. The PGY3 year tends to be one of the hardest, and PGY4 can be as well depending on where you are.

This varies. For our program, PGY2 is the hardest year. PGY3 is the easiest. PGY4 gets busy again as you’re the “chief” of every rotation.

Good luck OP on your decision!



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[mcat_taker]

Thank you all for your perspectives ! @obgyny @Dr G Oogle @anonperson @Lucky Seven And no I definitely don't hate the OR or feel uncomfortable necessarily in it, it's just as a medical student it is difficult to get super involved in the OR especially with a resident and attending both scrubbed in. It's more trying to decide if I would have the projected skills necessary to be competent in that setting since a lot can go wrong. Because obviously in peds you don't operate so you don't need to develop those skills. Would have no problem in a community OB residency. It is a tough decision, and I realize OBGYN residency is probably much more demanding than a peds one, the money doesn't concern me either way. It's just the OBGYN field itself seems much more interesting to me, in terms of the path, the hands on aspect of the field, and variety of what you do.

 

[Dr G Oogle]

You can teach anyone to operate, it just may take someone more cases to get the hang of it then others. But for the majority of things, especially Ob procedures you’ll be more then prepared for practice, you’ll probably have the hang of it by the time you’re half way through 2nd year. Gyn not so much necessarily as has been alluded to above regarding very low numbers of required procedures but fewer and fewer generalists are doing majors these days so it won’t affect your practice.

 

[DocWinter]

I’m a male resident in OB/GYN.

It’s a hard residency. I keep in touch with my old med school buddies, Residence in the psychiatry, family medicine, neurology, pediatrics etc. They all have far better schedule than I do. Most weeks I but up against the 80 hour work week and it’s rare that I work less than 70.

OB is a very surgical residency and well you will hone your skills in the OR, I would be very hesitant going into the field if you are not comfortable in the OR. Much will be expected of you in any surgical based residency.

Regarding the male aspect, I think it may be true that as a male you are more likely to get interviews in the field: however I don’t believe the match process favors anyone but the best candidates and how programs see the candidates. It is difficult and becoming more difficult to match in the field, several of my classmates were not lucky.

I hasn’t fully agree and understand the perspective above, but if you have the numbers you would be wise to go into urology or ENT. However, the heart should do what it wants to do and if this is the field that you love and enjoy I would encourage you to pursue it. My life is incredibly difficult but I do enjoy what I do every day and I’m excited for the future

 

[oblove]

I am an IMG and fresh graduate, will apply for residency in this year. I will have 6 months of USCE. How difficult is it for IMG to match in obgyn with low scores. I heard it is getting very competitive and positions are very less.

 

[Dr G Oogle]

It will be very difficult. Apply to every single program and utilize any contact you may have.