... Residency is going to be tough, but it's not really indicative of how life is afterwards. The type of group practice you join really affects how heavy your work hours are. A friend who's a practicing ob/gyn is starting with a new group - they get their post call day off, rotate day shifts in the hospital so they aren't called out of clinic for deliveries, and are on call once a week and every 7th weekend as primary, with a backup call in between. That doesn't seem too bad to me!
We went through a very similar situation. While it sounds great, the logistics do not work out nearly as well as one would hope. Life is not immensely easier when you graduate, either -- that is a fallacy that is perpetuated b/c residency sucks so bad. Don't get me wrong -- some things improve for the better, but you are trading one set of problems for another.
An OB needs to average +/- 20 deliveries/month (depending on GYN caseload, but in most areas the old blood is tieing the majority of that up) to be doing well. We're not talking maxed out -- just a healthy bottom line (and don't mention ACOG guidelines on limiting to 20/month either -- if you listen to organized medicine you will be one step up from the poor house). It is harder to make good money than you would think.
Which is where the problem comes in -- volume / physician in call pool. For example, if you are in a three MD group who has one or two midwives/NP/PA, your call is one in three and 1/3 (when you are on backup, you are on call for all practical purposes). These call nights are about as busy as you would want them to be if you have to do anything the next day. If you increase the call pool, they get busier. Sure, they are spread out more, but you get hammered all the same.
Taking the postcall day off is what everyone wants -- practicality issue with that is the fact that you are losing 20% of your revenue generating time for that week, give or take depending on scheduling structure.
Once you have more than 5 in the call pool (assuming that everyone is busy), the volume that you have to contend with is too much for any one person to realistically be able to handle without the potential for some compromise in quality of care. Let's face it -- if you have three or four in labor at any given point (remember, it's not like residency where you have a team on the deck), you cannot do your job effectively. In these situations you have "back up" call -- which ties you down and limits that which you can do, effectively making you on call.
There are no real easy solutions to this set of problems, which is, to some extent, unique to the field of OB. The single best solution to date has been in the form of hospitalists OB programs, which is in no way perfect, and only works for larger metropolitan centers.
