Need help switching residencies- FM to surgery

[drsender]

I have sifted through tons of similar threads and am still feeling pretty lost. I am in my intern year in a community based FM program right now and have been growing more and more certain that I am in the wrong field. I chose FM in large part for lifestyle reasons despite loving the OR and being drawn to surgery. I convinced myself that the breadth of FM and office based procedures would make the job interesting enough. As this year has gone on, I am realizing that it is necessary to refer out most of the complicated and interesting cases because I cannot be an expert in dealing with all the problems we manage. Furthermore, there are far fewer procedures than imagined and it is difficult to gain proficiency when they are so few and far between. The lifestyle concerns are obviously still a consideration, but I don't think the trade off was worth it. I have been exploring different career paths in FM and I just don't see myself being happy in any of these situations. I just recently started seriously entertaining the daunting possibility of switching programs, something I am not approaching lightly. I would say that I am leaning right now at about 60% toward switching, but am definitely still undecided. I am not going to approach my PD until I know for sure this is what I want to do, but I would obviously let him know before I approach any other programs. However, I would like to get some general guidance on the process.

Questions:

I assume that I will need to finish this year and start a surgical program as a PGY1. Is this correct? If so, do I enter the match just like I did as an MS4? Is the process pretty much the same as it was last year? We are well into interview season at this point. Is it too late to match for next year? Is there another way I should be looking for or approaching potential residency programs?

Thanks in advance!

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[Smurfette]

I have sifted through tons of similar threads and am still feeling pretty lost. I am in my intern year in a community based FM program right now and have been growing more and more certain that I am in the wrong field. I chose FM in large part for lifestyle reasons despite loving the OR and being drawn to surgery. I convinced myself that the breadth of FM and office based procedures would make the job interesting enough. As this year has gone on, I am realizing that it is necessary to refer out most of the complicated and interesting cases because I cannot be an expert in dealing with all the problems we manage. Furthermore, there are far fewer procedures than imagined and it is difficult to gain proficiency when they are so few and far between. The lifestyle concerns are obviously still a consideration, but I don't think the trade off was worth it. I have been exploring different career paths in FM and I just don't see myself being happy in any of these situations. I just recently started seriously entertaining the daunting possibility of switching programs, something I am not approaching lightly. I would say that I am leaning right now at about 60% toward switching, but am definitely still undecided. I am not going to approach my PD until I know for sure this is what I want to do, but I would obviously let him know before I approach any other programs. However, I would like to get some general guidance on the process.

Questions:
I assume that I will need to finish this year and start a surgical program as a PGY1. Is this correct? If so, do I enter the match just like I did as an MS4? Is the process pretty much the same as it was last year? We are well into interview season at this point. Is it too late to match for next year? Is there another way I should be looking for or approaching potential residency programs?
Thanks in advance!

You will need to start surgery as a PGY 1. A year of FM won't count.
Given it's the end of November, I doubt you'll get any interviews by submitting your app now. If your current hospital has a surgery residency, you could see if there is a possibility of getting an interview with them. You would need to talk with your PD before you do this.
You could register for the match this year in the hope of SOAPing into an open surgery slot, but this could be a long shot as well depending on your stats, LORs, etc. You will need LORs from surgeons to apply for GS.
Prelim spots would be easier to get, with the hopes of landing a categorical spot down the road.

 

[Winged Scapula]

As Smurfette notes, The biggest issue is one of timing. Most, if not all, surgical programs have closed their application cycle for this year. You might be able to pick up something during SOAP or an open spot on APDS. In addition, as she notes, your best chances are probably at a local general surgery program but you definitely need to repeat your intern year as likely none of your rotations will transfer.

But what if you don't? Are you going to do another year of family medicine? Will your current program director even allow that? Once you've made the decision to switch, and it sounds as if you have, these are really the most salient questions that you're going to need to come up with answers to.


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[NotAProgDirector]

I'd add that it's also important to consider whether you're competitive enough for a surgery spot. Your application now is likely to be less competitive than when you graduated from med school -- simply from time away from the OR and surgical experiences. If you were a very competitive candidate to start, then no problem. If you were marginal, or poorly competitive, you'll find that you may have great difficulty getting a spot now. Most programs will not consider your PGY-1 year a plus.

So, you need to decide what you want to do. You can continue in FM which is safe, but perhaps won't make you happy. Or you can try to switch into surgery -- which is a risk, as if you don't get a spot you'll likely find that your FM spot has already been given away to someone else and you may have nothing.

If you want to do surgery (and have the USMLE's and background to really have a chance), then you need start doing surgical rotations now if possible. If your program has a GS program, then you want to do rotations with them. Likely these may not count towards your FM training. If your institution doesn't have a program, then you need as much face time with the surgeons there as possible. Ultimately the goal is to be competitive for a good prelim GS position, or a categorical position if one is in SOAP (which is unlikely). Ultimately you'll probably need to apply for GS next year, but need to gain experience and LOR's this year.

If there is any GS program within reasonable distance, you should consider seeing if the PD will meet with you to review your application and give you a realistic assessment of your chances.

 

[LucidSplash]

FM at my institution rotates with surgery for 1 month of their intern year. If you have one of these rotations, try to move it up. Then again, this is a bit of a mixed bag. Not gonna lie, there's maybe one FM intern a year that doesn't make us want to rip our hair out when on service.

 

[BobBarker]

Yea, FM isn't like you it used to be. Most run as fast as possible away from any procedures.

 

[drsender]

Thank you all for the great feedback. You've given me a lot to think about. In response to some above points:

I am in an unopposed community FM program. This seemed like a plus when I was looking for a FM residency, but there are no general surgery spots that I could potentially move into. I do have a general surgery rotation this year, but it is too late to get a LOR for this cycle, even for the soap, even if I tried moving it up at this point. I was modestly competitive as an M4. I am a US grad, step 1 227, step 2 253, good clerkship evals. I know that my year in FM makes me less competitive, but it seems like I still have a reasonable chance (to me that is. feel free to be honest if I'm wrong). I spoke to the director of the surgical clerkship at my school, and he let me know that I would have a LOR from him.

Here are the choices I have now as I see them:

1. Tell my PD that I am switching, get my application together, and go for a soap position this year. The benefit is that I have a chance of finding a spot (most likely preliminary) and can get my foot in the door for surgery. I can also spend next year completing my intern year. The drawback is that if I don't find a spot, I will likely have to find something to occupy myself for an entire year while I apply for a position during the next cycle. Depending on what I find, it could be difficult to match the following year. I also will likely have to move two times, considering that I will then have to apply for a PGY2 position. This would be less of an issue if I didn't have a wife and child (soon to be two), which I do.

2. I could finish this year, do my elective time in surgery and work on getting LOR's from surgeons I work with here. I could then apply for a categorical position while completing my second year. This would involve one less move (assuming I find a position) and I would have a little more time to consider my decision. My concern is that I would be less competitive after an additional year in FM. Also, I am not well versed in the intricacies of funding for residency, but I think that an additional year in FM (and maybe even one year) could cause problems with funding for a surgical residency.

I would really appreciate any feedback on what other folks would recommend here. I would also like to hear what you think (PD's especially) my odds are of soaping into a spot next year might be. Again, thanks so much for the help!

 

[Psai]

Yea, FM isn't like you it used to be. Most run as fast as possible away from any procedures.

I used to love procedures until I realized how much time they take out of your day.

 

[drsender]

I am really leaning toward entering the match now and trying to soap into a preliminary spot. If I do this, who should I plan to get LOR's from? Should they all be from surgeons I worked with as a student? Should I include a letter from my PD (if it seems like he'll provide a good one)? Should I include letters from non-surgical faculty from this year?

 

[ThoracicGuy]

I am really leaning toward entering the match now and trying to soap into a preliminary spot. If I do this, who should I plan to get LOR's from? Should they all be from surgeons I worked with as a student? Should I include a letter from my PD (if it seems like he'll provide a good one)? Should I include letters from non-surgical faculty from this year?

Just realize if you end up trying this, you will be shutting the door on FM. You'll have one year done and two to go. Realistically you should apply to try and get a categorical spot as many prelim spots are the bridge to nowhere. What happens if you get a prelim spot, yet you don't manage to get a categorical spot? What would your plans be at that point?

It would be safer to finish FM and then apply, but there are definitely some drawbacks to that as well and the further out you are from graduation the harder it will be to get a spot.

 

[drsender]

Just realize if you end up trying this, you will be shutting the door on FM. You'll have one year done and two to go. Realistically you should apply to try and get a categorical spot as many prelim spots are the bridge to nowhere. What happens if you get a prelim spot, yet you don't manage to get a categorical spot? What would your plans be at that point?

It would be safer to finish FM and then apply, but there are definitely some drawbacks to that as well and the further out you are from graduation the harder it will be to get a spot.

That is a very good point. Do you have any ideas on how I might find a categorical position at this point? My plan right now is to put together my application as quickly as possible and contact program directors with a plea to consider me for preliminary spots in the match and in soap, as it is too late in most cases, if not all, to interview for categorical positions.

I have considered finishing my current residency, but it seems like my odds will only decrease with time. I am fairly certain that I won't be happy in family medicine, so it seems like acting now, though risky, is probably my best bet.

 

[ThoracicGuy]

That is a very good point. Do you have any ideas on how I might find a categorical position at this point? My plan right now is to put together my application as quickly as possible and contact program directors with a plea to consider me for preliminary spots in the match and in soap, as it is too late in most cases, if not all, to interview for categorical positions.

I have considered finishing my current residency, but it seems like my odds will only decrease with time. I am fairly certain that I won't be happy in family medicine, so it seems like acting now, though risky, is probably my best bet.

Have you discussed this with your PD? You'll need a letter from him for any program to give you a shot. As for getting a categorical spot now, I'd expect that to be impossible. To get a prelim? Easy. To get a prelim spot at a place that has a record of placing into categorical residencies? That's likely to be harder to do. Since you don't have a local surgery residency, you'll be relying mostly on letters from when you were a student as well as your PD. If you can get experience with a local surgeon, that can help, but your time is running out on this one.

Have you discussed with your med school program about getting in there, as well as your overall chances from their standpoint on getting into surgery? That would probably be a worthwhile conversation.

 

[BobBarker]

I think you realistically have two safe options.
1. Only apply/SOAP categorical. If you don't get it, keep plugging away at FM.
2. I think anyone that applies FM nowadays can't be too much of a procedure guy. Apply/SOAP to advanced anesthesia positions. They will take your intern year. You can do a pain fellowship and do a very minor "real" surgery after you are done.

 

[Gastrapathy]

See if your Med School program might have a spot for you now. It's about the time of year that folks start quitting.

 

[ThoracicGuy]

See if your Med School program might have a spot for you now. It's about the time of year that folks start quitting.

That wouldn't help him for surgery though...

 

[Gastrapathy]

That wouldn't help him for surgery though...

I meant the affiliated hospital. If his med school chair will write a letter, maybe the affiliated PD needs an intern.

 

[drsender]

I recognize that a preliminary year isn't "safe". However, why would my situation be different than any M4 who soaps into a prelim position? It seems like there must be a pretty reasonable chance of moving into a categorical position or people would not fill those spots. Maybe I'm being too optimistic?

 

[ThoracicGuy]

I recognize that a preliminary year isn't "safe". However, why would my situation be different than any M4 who soaps into a prelim position? It seems like there must be a pretty reasonable chance of moving into a categorical position or people would not fill those spots. Maybe I'm being too optimistic?

They fill them for various reasons - needing a prelim year for another specialty, not matching something like ortho, a poor match list, or even being a poor candidate. The first three will usually get a spot to continue as a categorical if they want. The last group generally doesn't.

 

[Winged Scapula]

I think you are overestimating the ease of getting a Categorical GS position from a Prelim one (remember you will have about 2-3 months of surgical internship under your belt when you start applying and how are you going to get time off to interview) and overestimating the difficulty in finishing FM and then doing a second residency. Forget about the funding issues; if you are a good candidate, a good program will consider you. I cannot recall the data but the majority of people in Prelim GS do not end up with a categorical GS position; some weren't really interested, some change their mind and others show why they didn't match in the first place.

As far as LORs, surgeons want letters from other surgeons, although one from your current PD is expected.

I'm still bemused by non-surgeons equating procedures with doing surgery and being a surgeon, but perhaps if you would be happy doing procedures and not surgeries, you could be happy doing something else.

 

[drsender]

I think you are overestimating the ease of getting a Categorical GS position from a Prelim one (remember you will have about 2-3 months of surgical internship under your belt when you start applying and how are you going to get time off to interview) and overestimating the difficulty in finishing FM and then doing a second residency. Forget about the funding issues; if you are a good candidate, a good program will consider you. I cannot recall the data but the majority of people in Prelim GS do not end up with a categorical GS position; some weren't really interested, some change their mind and others show why they didn't match in the first place.

As far as LORs, surgeons want letters from other surgeons, although one from your current PD is expected.

I'm still bemused by non-surgeons equating procedures with doing surgery and being a surgeon, but perhaps if you would be happy doing procedures and not surgeries, you could be happy doing something else.

Update: I spoke to a surgeon from my med school who works closely with program directors and has advised students in surgery for a long time. What he said is very similar to the quote above. He also felt that entering the match for a categorical position next year was a much better bet. Although I am anxious to switch, I definitely see the wisdom in his thinking. I did some research on preliminary years and have to agree with the above comments, not a sure bet by any means. I will have a lot more options entering the match next year and be relying on luck a lot less. I think I'm going to stick it out for this year and maybe try to do an away rotation for surgery if possible.

As for equating procedures with surgery. I agree. Worlds apart. I talked myself into a residency I wasn't passionate about for lifestyle reasons and consoled myself with the idea that procedures would be an enjoyable bonus. I enjoy procedures, but even if I did a lot, which I don't, family medicine is just not exciting to me. There are certainly parts of the job that I enjoy, but I'm basically watching on the sidelines as the specialists get to do the really cool stuff.

 

[Winged Scapula]

Update: I spoke to a surgeon from my med school who works closely with program directors and has advised students in surgery for a long time. What he said is very similar to the quote above. He also felt that entering the match for a categorical position next year was a much better bet. Although I am anxious to switch, I definitely see the wisdom in his thinking. I did some research on preliminary years and have to agree with the above comments, not a sure bet by any means. I will have a lot more options entering the match next year and be relying on luck a lot less. I think I'm going to stick it out for this year and maybe try to do an away rotation for surgery if possible.

That sounds like a good plan. Fair or not, prelim residents are sometimes seen as "damaged goods". You may have to accept one, but why not apply for the categorical first with your best app possible? You'll have nearly a year to perhaps do a surgical rotation, connect with some surgeons, get updated LORs (rather than the ones from med school) and present your best application. In the unfortunate event that your PD doesn't allow you to stay next year, look at the APDS website for open research positions which would put you in contact with surgeons (right now the pickings are slim but check frequently): http://apds.org/education-careers/open-positions/#job5513

As for equating procedures with surgery. I agree. Worlds apart. I talked myself into a residency I wasn't passionate about for lifestyle reasons and consoled myself with the idea that procedures would be an enjoyable bonus. I enjoy procedures, but even if I did a lot, which I don't, family medicine is just not exciting to me. There are certainly parts of the job that I enjoy, but I'm basically watching on the sidelines as the specialists get to do the really cool stuff.

There is an odd SDN phenomenon where non-surgeons try and equate doing procedures with either being a surgeon or doing surgery or that simply being in the OR (as an anesthesiologist) is good enough. You never see a surgeon state that they'd be happy doing procedures. Nothing wrong with them but it IS different, no matter how non-surgeons try to spin it.

 

[Siggy]

There is an odd SDN phenomenon where non-surgeons try and equate doing procedures with either being a surgeon or doing surgery or that simply being in the OR (as an anesthesiologist) is good enough. You never see a surgeon state that they'd be happy doing procedures. Nothing wrong with them but it IS different, no matter how non-surgeons try to spin it.

I agree. I enjoy procedures. I don't enjoy standing in 1 spot for an hour plus doing surgery. If anything, it seems like being an anesthesiologist is more procedure oriented in the sense that the term is used than surgery itself. I've seen way more intubations, central lines, A-lines, epidurals, etc put in by anesthesiology than by general surgery.

 

[Winged Scapula]

I agree. I enjoy procedures. I don't enjoy standing in 1 spot for an hour plus doing surgery. If anything, it seems like being an anesthesiologist is more procedure oriented in the sense that the term is used than surgery itself. I've seen way more intubations, central lines, A-lines, epidurals, etc put in by anesthesiology than by general surgery.

I'm confused.

Whoever said that surgeons were doing *more* lines, intubations, epidurals etc than anesthesia? While many surgeons and other specialists (especially critical care) do their own lines and intuitions (not so for epidurals), I don't think anyone is arguing that anesthesia doesn't do more in almost all cases.

My point is that the OP wants to be a surgeon. He/she may not be satisfied with doing procedures (which are not surgeries). Non-surgeons try and convince student would-be surgeons that doing procedures = doing surgery = being a surgeon.

It is not.

Nothing wrong with hating "standing in 1 spot" and preferring procedures, but there is no need to try and convince students that makes one a surgeon or that someone that wants to cut will be happy doing procedures.

 

[Gastrapathy]

Us proceduralists don't want to be surgeons either but...people who started as surgical trainees before coming over are some of the most enjoyable to train. You all have a way of making them behave.

 

[Siggy]

I'm confused.

Whoever said that surgeons were doing *more* lines, intubations, epidurals etc than anesthesia? While many surgeons and other specialists (especially critical care) do their own lines and intuitions (not so for epidurals), I don't think anyone is arguing that anesthesia doesn't do more in almost all cases.

Most of the time I see people talk about "loving to do procedures" they tend to refer to the bedside procedures and not OR procedures. I'm just pointing out that surgery generally does not do the type of procedures that people are talking about when someone says that they enjoy procedures.

My point is that the OP wants to be a surgeon. He/she may not be satisfied with doing procedures (which are not surgeries). Non-surgeons try and convince student would-be surgeons that doing procedures = doing surgery = being a surgeon.

It is not.

Nothing wrong with hating "standing in 1 spot" and preferring procedures, but there is no need to try and convince students that makes one a surgeon or that someone that wants to cut will be happy doing procedures.

I agree...

 

[SansaStarkMD]

For future readers...

OP could do an OB fellowship after FM and operate. Worst case.

 

[gutonc]

For future readers...

OP could do an OB fellowship after FM and operate. Worst case.

Yes indeed. Hard to think of anything worse than that.

 

[ThoracicGuy]

For future readers...

OP could do an OB fellowship after FM and operate. Worst case.

That's a bad idea.

 

[Winged Scapula]

For future readers...

OP could do an OB fellowship after FM and operate. Worst case.

Bad idea.

1) OB (without gyn) is not what most people who want to be surgeons consider actually doing surgery.

2) The rate of malpractice is so high it's not prudent for a non-OB to practice. There's a reason why you rarely see family medicine physicians delivering babies anymore


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[SansaStarkMD]

Most FM physicians don't do it because their volume isn't high enough to justify the cost. If OP HAD to operate, he could do L&D only and operate every day. Most FM physicians don't want that lifestyle or set up but it's possible. Rural FM physicians with strong patient relationships get sued less often as well.

 

[ThoracicGuy]

Most FM physicians don't do it because their volume isn't high enough to justify the cost. If OP HAD to operate, he could do L&D only and operate every day. Most FM physicians don't want that lifestyle or set up but it's possible. Rural FM physicians with strong patient relationships get sued less often as well.

Still a bad idea. You just won't get enough volume in a fp residency, even with a one year fellowship, to safely do any surgeries, including c sections. Sure, you could get by a very straight forward one with that training, but what happens when there's an issue? You wouldn't have enough background to safely handle that in many cases.

 

[SansaStarkMD]

The residency programs with fellowships that I'm looking at get 200+ c sections as primary surgeon, training in tubal ligation, D&C, hysterectomy, etc. by an OBGYN that writes a letter for the graduates stating their competence. These graduates have had no problems obtaining privileges in all settings. You can get good training at the right programs. You just have to look around. OP wants to be a surgeon, I'm just saying there are other ways to operate. I'm not going to get lost in pissing match logic that only validates magical training in magical locations. Surgery consists of procedures. You can learn them if people teach you. People are already doing this. The market agrees with the added value they provide.

 

[ThoracicGuy]

The residency programs with fellowships that I'm looking at get 200+ c sections as primary surgeon, training in tubal ligation, D&C, hysterectomy, etc. by an OBGYN that writes a letter for the graduates stating their competence. These graduates have had no problems obtaining privileges in all settings. You can get good training at the right programs. You just have to look around. OP wants to be a surgeon, I'm just saying there are other ways to operate. I'm not going to get lost in pissing match logic that only validates magical training in magical locations. Surgery consists of procedures. You can learn them if people teach you. People are already doing this. The market agrees with the added value they provide.

How much experience to they get in abdominal procedures? What happens when they run into some adhesions from prior surgeries and make an enterotomy? I'd say 200+ c-sections is not enough to adequately do surgery. There's a reason that OBGYN and General Surgery are 4 and 5 year residencies. You will also have some issues with jobs. There will be pushback from boarded OBGYN for providing these services at the same hospital. There will be alot of politics involved in this. You're likely to end up mostly in rural locations for the most part.

As for magical training in magical locations? There's something to do with experience and practice. As I said earlier, you just don't get that in a 1-year fellowship. Just because people are doing it doesn't make it a good thing.

 

[SansaStarkMD]

Adhesions and enterotomy? The same thing an OBGYN does. I've also seen the bladder get stitched up after bad adhesions. It's not malpractice if it couldn't be avoided.

 

[AdmiralChz]

The residency programs with fellowships that I'm looking at get 200+ c sections as primary surgeon, training in tubal ligation, D&C, hysterectomy, etc. by an OBGYN that writes a letter for the graduates stating their competence. These graduates have had no problems obtaining privileges in all settings. You can get good training at the right programs. You just have to look around. OP wants to be a surgeon, I'm just saying there are other ways to operate. I'm not going to get lost in pissing match logic that only validates magical training in magical locations. Surgery consists of procedures. You can learn them if people teach you. People are already doing this. The market agrees with the added value they provide.

Sorry to be blunt, but I would be uncomfortable with my wife getting care from someone with only a year of surgical training. Plus a Family Medicine residency has next to zero operating room exposure, so you the skills you are acquiring during residency won't help you much during fellowship. Maybe I'm biased as a physician, but I agree with @ThoracicGuy that there is a reason OBGYN is a full 4 year residency.

Now for rural places where there may be trouble with consistent OB access issues, I can absolutely see this being appropriate given the right set of circumstances.

 

[ThoracicGuy]

Adhesions and enterotomy? The same thing an OBGYN does. I've also seen the bladder get stitched up after bad adhesions. It's not malpractice if it couldn't be avoided.

As a MS4, you sure seem to know more than people that have actually been through residency training...

 

[SansaStarkMD]

As a MS4, you sure seem to know more than people that have actually been through residency training...

After a half year of electives, 12 residency dinners/interviews, and meeting hundreds of faculty and residents, it's not too hard to gather information. I do know more about the programs that I've applied to than people who haven't so it should seem that way.

 

[ThoracicGuy]

After a half year of electives, 12 residency dinners/interviews, and meeting hundreds of faculty and residents, it's not too hard to gather information. I do know more about the programs that I've applied to than people who haven't so it should seem that way.

You really know less than you think. I would caution you to not blow off what others have told you both here and other threads. If you want to do surgical ob, you should really look for an obgyn residency.

 

[SansaStarkMD]

You really know less than you think. I would caution you to not blow of what others have told you both here and other threads. If you want to do surgical ob, you should really look for an obgyn residency.

I don't blow off what anyone tells me. I just weigh all of the information. I've emailed every OB fellowship director and have detailed lists of where their graduates work with full OB privileges. It's not hard to get good at the easiest surgical procedure and its complications if you take call for four years total while doing 1.5 years of labor and delivery under an OBGYN. We tend to worship the evidence on SDN so go check out the outcomes studies if you need to. Family doctors have lower c section rates despite how surgery hungry you must think they are. People can believe what they want. Most of the FM's deliver because their patients show up at the hospital requesting their doctor, what a privilege. You get points for backing up your friends on the turf war though. They'll need it when OB/GYN evolves into two specialties and suddenly the GYN's who did a residency in OBGYN are suddenly unqualified.

 

[ThoracicGuy]

I don't blow off what anyone tells me. I just weigh all of the information. I've emailed every OB fellowship director and have detailed lists of where their graduates work with full OB privileges. It's not hard to get good at the easiest surgical procedure and its complications if you take call for four years total while doing 1.5 years of labor and delivery under an OBGYN. People can believe what they want.

Surgical ob sounds like what you really want to do. Why are you so opposed to an actual obgyn residency? Why do you feel the FM plus ob fellowship is the better way?

 

[AdmiralChz]

Surgical ob sounds like what you really want to do. Why are you so opposed to an actual obgyn residency? Why do you feel the FM plus ob fellowship is the better way?

I agree, OB is still very much considered primary care and many women use their OB as their family doc (including my wife). I still cant see a major urban/suburban hospital providing privileges to a graduate with only 1.5 years of operative experience vs 4 years. I would be vehemently opposed.

 

[SansaStarkMD]

Surgical ob sounds like what you really want to do. Why are you so opposed to an actual obgyn residency? Why do you feel the FM plus ob fellowship is the better way?

The fellowship isn't a better way. It's a different way to get enough experience. My previous questions aren't an indication of what I really want to do. I was just exploring the options FM has to offer before committing to it. Ultimately, I've most likely decided against taking call, and the ER in my state pays way more per hour than OB.

 

[ThoracicGuy]

The fellowship isn't a better way. It's a different way to get enough experience. My previous questions aren't an indication of what I really want to do. I was just exploring the options FM has to offer before committing to it. Ultimately, I've most likely decided against taking call, and the ER in my state pays way more per hour than OB.

So you would rather do EM? Did you consider an em residency?

 

[SansaStarkMD]

I agree, OB is still very much considered primary care and many women use their OB as their family doc (including my wife). I still cant see a major urban/suburban hospital providing privileges to a graduate with only 1.5 years of operative experience vs 4 years. I would be vehemently opposed.

Not 1.5 years of operative experience, whatever that means. Plenty of surgical residents go a day without operating. I'm talking about unopposed level one trauma centers with no other residents in the entire city letting you take call with an OBGYN and operating whenever you want for four years. No competition from your class usually as well. Unopposed FM programs tailor the curriculum to your goals. While still meeting basic ACGME requirements. It's not hard to be doing clinic, take off for a quick c section, and come back to finish.

 

[SansaStarkMD]

So you would rather do EM? Did you consider an em residency?

Yep, PM'd you.

 

[AdmiralChz]

Not 1.5 years of operative experience, whatever that means

Ummm I'm talking about formal surgical education. @ThoracicGuy is a surgeon and I am almost done with anesthesiology residency - I see surgical training everyday. Just popping in for a quick case is nowhere near enough - you need to be on service and following the patients and dealing with complications. Clearly your interests lie outside of FM (ER and OB) so you should explore those options.

 

[SansaStarkMD]

Ummm I'm talking about formal surgical education. @ThoracicGuy is a surgeon and I am almost done with anesthesiology residency - I see surgical training everyday. Just popping in for a quick case is nowhere near enough - you need to be on service and following the patients and dealing with complications. Clearly your interests lie outside of FM (ER and OB) so you should explore those options.

Ummmm FM residents round on their patients each morning before they start whatever other rotation they have that month. They also see them before and after in clinic. But I guess you wouldn't consider hospital rounds family medicine either. Who do you think was doing ER and OB before those were specialties? And no those specialties weren't formed because masses were dying in the streets.

With your logic, pretty soon you'll just be watching a monitor and another type of doctor will be pushing the medication and another type of doctor will be intubating--all because they're separate jobs requiring separate training... or you won't have a specialty at all and you'll fellowship into something entirely different. If that happens you'll never admit anesthesiology residency wasn't necessary and the poor chumps behind you will have to do even more years of useless education (undergrad comes to mind) with more debt and less years working.

I am checking out ER and OB... and the bread and butter of every other specialty when needed. It's called family medicine. ...so tired of other people dumping on the most needed specialty because of their sensitive egos. If it weren't for people like you this country's healthcare system wouldn't be ~40th in the world.

 

[Winged Scapula]

I'm always amazed, in this era of increasing training and credentialing, when people advocate less. It would seem to be more prudent to ask a fully trained OB/GYN what they think about FM doing OB.


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[AdmiralChz]

Wow, we are trying to offer constructive advice and you just ignore it so never mind. It's not the 1950s or even 80s anymore, the days of FM doing a significantly large amount of OB and ER are effectively over except in rural communities. Which is why I suggested these other avenues.

Best of luck to you.

 

[SansaStarkMD]

I'm not advocating for less. I'm offering a different way to get the same experience. The days of FM doing ER and OB are not over. Every city in my state except the capital has a FM with full OB privileges. Everything I have said is factual, and I can pass along lists with contact info if interested students need. Best of luck to the surgeons who responded. Someone out there is more qualified than you too. I hope you keep practicing.