MFM Practice scope

[obpgy1]

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Soon to be starting intern with some quick questions on MFM as a career.

How involved can an MFM be in the abortion process? Specifically, if one doesn't want to perform or be involved in elective terminations of pregnancy? I am fine with EABs that are related to a mothers health or lethal fetal anomalies but feel uncomfortable for abortions for non lethal chromosomal anomalies such as Down syndrome etc?

Reason I ask is I had a fair amount of time on the inpatient high risk Obstetrics floor at my medical school and enjoyed it a lot. Dealing with complex medical issues (preterm births, transplants, heart issues, GDM) along with the clinics was pretty enjoyable.

If I did go down the MFM route, is it possible to focus only on high risk patient management and doing less of the genetics management? Any idea of how it would affect salary etc?

 

[Global Disrobal]

I assume that by termination you are referring to the traditional D&C/D&E and not selective reductions for multi-fetal pregnancies.

Most MFM practices will defer terminations to the primary (consulting) Obstetricians or a termination provider in the area. On a related note, most MFM practitioners also shy away from terminations for anomalies/genetics as it can be viewed as a "self-referral" and/or a conflict of interest. Having said that, I have interviewed at practices where terminations are offered and performed by the practice, and it was mostly due to cultural factors in the practice area.

As far as your other question goes, you can be as little or as much involved as you choose with the process. The only caveat is that you must render the appropriate care to your patient regardless of your belief. Although it is quite alright to not perform terminations, you should be willing to perform the necessary unbiased counseling and (if necessary) provide the patient with the resources (i.e. information) on where to get the procedure.

Lastly, I'm not quite sure what you mean by "genetic management." Genetic counseling, knowledge, and prenatal diagnosis using genetics are all integral parts of the subspecialty. I'm sure you can focus purely on the "maternal" aspect of MFM, but then you'd be limiting your employment opportunities substantially.

Hope this helps. Enjoy your internship and try not to think too much about fellowship until the end of first year so that you can get a feel for all aspect of the specialty. Best of luck!

 

[theshellyb]

Most MFM practices will defer terminations to the primary (consulting) Obstetricians or a termination provider in the area. On a related note, most MFM practitioners also shy away from terminations for anomalies/genetics as it can be viewed as a "self-referral" and/or a conflict of interest. Having said that, I have interviewed at practices where terminations are offered and performed by the practice, and it was mostly due to cultural factors in the practice area.

Sorry for the old thread bump, but I'm curious as to this situation about abortions done by MFMs as "self referral". I'm interested in MFM/genetics and also providing terminations. Is this something that will be difficult? I just think it's weird that if a patient wants a service that I can provide, I wouldn't be able to do that and would have to refer them elsewhere. If you see a dermatologist for a skin cancer and then ask about botox, they would be able to book you for that, no? I'm having difficulty seeing the conflict of interest I guess. Any clarification would be helpful- thanks!

 

[Global Disrobal]

Great question. It's not considered self-referral if the referring provider asks for consult with co-management as it'll be covered by that umbrella.

I see I wrote that response a while back. Having practices for several years now, I've been in that situation and never come across a self- referral dilemma. With that said, I do still let the referring provider know of the situation and leave it to the patient and the provider to tell me what their comfort level is and who they want to do the procedure.

Good luck!