MS3 Year Seeking EM vs Ob/gyn advice

[Brewmeister]

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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.

 

[The White Coat Investor]

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.

OB/GYN was my second choice. I made the right decision. In 10 years lifestyle will matter more to you than it does now. The population you're taking care of isn't all that different and you work lots of nights weekends and holidays on OB too, so you're keeping the downsides of EM without getting the upsides.

 

[Arcan57]

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.

I have no qualifications to discuss the future of OB/GYN. There are a decent number of threads covering this already, although the various questions aren't always found in the same thread. Compensation in EM tends towards to be higher than IM (excepting crazy busy hospitalists) probably on par with GS, and lower than neurosurg/derm/surgical subspecialties. We have a lot of job security in that EM trained docs are still scarce in most markets, and ED visits are increasing at a rapid clip. We have relatively little job security at any one shop since most contract management groups have language that you can be fired without cause if the hospital wants you gone. And private groups always have to be concerned about poaching from the CMGs, since very few contracts are untouchable.

Many EM docs think that the healthcare reforms of the current administration will likely be a wash (crappier reimbursement but more patients actually paying their bills). Acute care hospitals are likely going to take a bath with the emphasis on value-based purchasing which may increase our problems on the back-end (ie you can't readmit that patient for CHF because it will screw our metrics, keep them in the ED until they diurese) but with turn-around time becoming a new core-measure that also may end up balancing out.

In terms of modes of practice, there's variety in terms of what type of population your shop attracts and how many docs and midlevels are on. In general though, ED docs earn their money by seeing patients in the ED. The fellowships tend to be for intellectual interest or to try and break into a tough market (Pacific Northwest, New York, etc). None of them allow you to reimburse significantly more than a busy EP.

 

[Flopotomist]

I too was struggling debating between EM and OB/gyn once (ultimately decided EM - and LOVE it). The things I loved about ob/gyn, I realized that I would get in a career with EM, but not the reverse.

One of the best pieces of advice I got though was this (from Dr. Page-Wills at Highland) "EM is like the junior varsity team of OB/gyn" and she was right.