Throughout 3rd year I've had a passing interesting in almost everything and enjoyed my EM rotation so I thought EM would be great for me. I love the pace, the variety, the lack of business/overhead concerns, shift work, lack of continuity (to an extent) etc.
I left ob/gyn for last because I thought I'd hate it. Turns out it's been the opposite. It has more variety than I thought. The increased continuity can either be a plus or minus. I hated the OR on surgery mostly due to personalities and length of cases but GYN cases are relatively short and sweet (generally <3 hours), which I like. I like being able to give good news to people (having a baby, etc) and I find it intellectually stimulating.
I like that the hours are set for EM (predictable--but sometimes predictably crappy). If I did ob, I would probably go into a multi person pvt practice group which generally has call q-whatever.
Any advice would be awesome, including where people think each of these fields is going in the future with respect to modes of practice, job security, compensation, etc. Thanks for your help.
My perspective as an OB GYN resident and in my discussion with my attendings:
Obstetrics:
Ob call for a busy practice can be pretty grueling especially if you are on by yourself at night. Call can be very chill though if you are on with a midwife who will do routine vaginal deliveries and only call you for C/Ds, 3rd/4th degree repairs, or operative deliveries.
Gyn:
Surgeries are generally short and straightforward. The scope of a general ob gyn can vary regards of the complexity of procedures they are performing. Some of my attendings are routinely performing robotic sacral colpopexies because of their interests and are not formally fellowship trained while others do not even come close in terms of surgical ability.
The procedural aspect overall is nice, even in office (IUDs, nexplanon/implanon, office based hysteroscopy, TVUS etc) make it a bit more lively than your routine outpatient setting.
As far as the future of OB GYN, heres my take:
The hospitalist role is still limited to a certain extent-Opportunities are available but it's not like the movement has exploded by any means.
Different practices have different call sitatuations. One group here does traditional Q24 hour calls with midwife as first call for part of the day. Another group does 12 hour shifts. Each has their pros and cons.
Compensation is relatively stable. They've already slashed reimbursement for our procedures as it is and I'm guessing if they tried to squeeze even more blood from us that would cause a bit of a revolt. The most recent medscape survey showed a majority earning 200K-350K which is what I have seen in the practices in my area.
Link:
http://www.medscape.com/features/slideshow/compensation/2012/womenshealth
Job security is fine. People will always have children. Women will always have GYN problems and other specialties (other than FP to a certain extent) don't have a desire manage gynecological issues which is good for our bottom line.
Burnout is an issue. The day to day aspect can be rough. Office schedules can be packed. My attendings are seeing anywhere from 30-40 patients a day with only 5 or so being routine prenatals (the rest of the routine prenatals are funneled to NPs etc). This is because of patient demand in addition to the need to generate enough RVUs so you can remain profitable. A efficient staff is key to not killing yourself.
Also take note, a majority of OB GYNs would not choose to the same specialty again which speaks a great deal to the work environment.
In addition, OB GYN is different than others because some consider it primary care while others don't. Either way, it can function as a gatekeeper specialty.
Other benefits include the fellowships. There are 4 accredited fellowships now. Each is pretty interesting in their own way and offer better lifestyles than that of a generalist in addition to competitive pay. They are generally competitive with limited spots but if you match into a solid residency program, you can apply in good confidence that you will match a fellowship.
