Neuro vs. OB/GYN. Any advice?

[NWwildcat2013]

Let me know what you think about this pros/cons list. What would you choose based on my pros and cons? Am I incorrect about anything on my list? Anything you'd add for consideration or any insight into the future of each field? When I return to school after break we will start scheduling MS4 electives so the time is really here when I need to start thinking about this decision.

I would be a competitive applicant for both and have honored both of these rotations. They were both things that I was surprised to find that I enjoyed. I'll sum it up by saying that L&D and going on Stroke Codes were the two most enjoyable times I've had in med school.

Neurology
Pros:

• I think I like the subject matter more than anything else.
• I like discussing and thinking about end of life issues.
• Opportunity to work in a critical care setting.
• I felt like the culture was good and the attendings/residents were nice.
• I just love seeing neuro deficits and localizing lesions. In what other field can you see someone eat only half of the food on their place? It is continually weird and surprising. I think it is one of the few specialties that would have the capacity to surprise me once I settled in and things became routine.
• I think the future of neuro is super bright, and I think a career in neuro would allow me to witness many improvements in treatment and diagnosis. I think a lot more people will be wanting to do neuro in 25 years.
• I like the idea of being the person to figure out something that has stumped all the other specialists.

Cons:

• Since I like all of neurology I would be frustrated being pigeonholed into a fellowship. If the neurohospitalist model really becomes a thing I think that would be ideal, but right now I'm not sure whether it will take off. It has a confusing relationship with NCC and Vascular.
• The field is very fellowship driven and a fellowship doesn't really increase earning potential but it does decrease the amount of stuff you see. I like muscular dystrophy, but I'm not sure I want to know all bajillion types and in exchange never treat an acute stroke again.
• General neurology seems like a dying field. It seems like it can only be practiced in the outpatient/inpatient mix that I would prefer in a semi-rural area. An area large enough to have enough pathology but small enough to not have a big academic center. This is very limiting.
• Many programs are advanced which doubles my interview expenses and increases the odds of living apart from my significant other for one year.
• Research heavy at the top. I am a strong applicant but I think neuro, more than most, has the largest difference in what type of applicant they are looking for between a middle and top program. I feel that the top programs will be less impressed with my Step 1 score than they would be in something like OB/GYN. Correct me if I am wrong but the culture at the top seems very academic and I don't think I'd fit in. I'm just not a neurology "nerd" if that makes sense. I know some people who live for neurotransmittors and I'm just a guy who thinks it isn't boring and would keep me engaged.
• Not so great compensation for the length of training and the amount of stress.
• Functional neurological problems and pseudoseizures. Just two examples, but neuro has a disproportionate amount of that stuff.
• A lot of medicine type BS and social work stuff especially when it comes to stroke.
• Neurosurgeons get all the cool acute neurology that I like. I've seen tumors and hemorrhagic strokes go straight to neurosurgery from the ED and a neurologist never even knows about it. That makes me sad.

Obstetrics and Gynecology
Pros:

• Women are better patients. They are nicer, more open, and more willing to follow medical advice.
• Most of the patients are healthy and most babies will be born healthy.
• I am starting to think I'd miss the OR and donning the sterile gloves for a procedure every once and awhile if I did neuro. OB/GYN leaves open the door for as many or as few procedures as I want
• I really didn't get that classic OB/GYN b***h vibe that everyone talks about. I think there has been a fair amount of infighting and gossip in all of my rotations and OB/GYN wasn't any worse. At my school the OB/GYN residents actually seemed the happiest despite working the most. They also seemed like the most competent and advanced for their respective year in training.
• I like maternal-fetal physiology and the changes that occur to normal physiology during pregnancy.
• The pathology is amazing. Endocrinology to oncology. It is all there in OB/GYN.
• I think this is one of the few things that I would be happy stopping after the residency and would not need to do a fellowship and if I did I actually wouldn't mind some of the OB/GYN fellowships.
• I am a male. I have heard this can be beneficial in the residency process.
• The residency is 4 years and categorical so it will be the same length as my significant other's residency.

Cons:

• Very stressful and risky. I am risk averse and it is how I have based most decisions in my life. Im scared of the OR but also sort of like it if that makes any sense. Currently debating to what extent I should let fear influence my choice.
• The residency is really hard and attending life can be too.
• Births are fun when they go well but the idea of a traumatic one or something like a forceps delivery makes me cringe.
• Malpractice.
• I am a male. I have heard this can cause some problems when you are a young OB/GYN trying to get started.

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[SansaStarkMD]

Quick first thoughts... neuro is what you do until the MRI comes back. OBGYN probably more useful and protected from encroachment but harder lifestyle.

 

[NWwildcat2013]

Quick first thoughts... neuro is what you do until the MRI comes back. OBGYN probably more useful and protected from encroachment but harder lifestyle.

Is there much encroachment in neuro? I honestly don't know. What about midwives in OBGYN?

 

[SansaStarkMD]

Midwives can't do surgery so no way

 

[Gastrapathy]

My friend's OB group is very reluctant to hire dudes because they take solo call and so many patients demand a female OB. It means they either anger patients or have to back up the men.

 

[NWwildcat2013]

My friend's OB group is very reluctant to hire dudes because they take solo call and so many patients demand a female OB. It means they either anger patients or have to back up the men.

Thanks for the input. I've heard anecdotes like this before and they really worry me. Is your friend's group in a larger city?

I wonder if this bias is as predominant in a subspecialty like MFM. I know it doesn't seem to be as big of a deal in Gyn Onc.

 

[NWwildcat2013]

Midwives can't do surgery so no way

Now that you have me thinking I am remember a thread awhile back where someone said that their hospital has NPs do the initial workup in a stroke code and the neurologist is just there as a formality to make the call on tPA. I could see stroke care going that way with the huge shortage of vascular neurologists and the silver tsunami that is cresting over our heads.

 

[Gastrapathy]

Thanks for the input. I've heard anecdotes like this before and they really worry me. Is your friend's group in a larger city?

I wonder if this bias is as predominant in a subspecialty like MFM. I know it doesn't seem to be as big of a deal in Gyn Onc.

General OB practice in a larger city.

 

[racerwad]

...

• Very stressful and risky. I am risk averse and it is how I have based most decisions in my life. Im scared of the OR but also sort of like it if that makes any sense. Currently debating to what extent I should let fear influence my choice.
• The residency is really hard and attending life can be too.
• Births are fun when they go well but the idea of a traumatic one or something like a forceps delivery makes me cringe.
• Malpractice.
• I am a male. I have heard this can cause some problems when you are a young OB/GYN trying to get started.

I think based on post length alone, you are best suited for neurology but the above bolded basically seals the deal. In OB/Gyn, you are on the hook until the kid is 18; in addition, many of your patients are young and healthy with a lot of life to be negatively impacted if they were mismanaged.

In contrast, the highest risk procedure for most neurologists is pushing tPA in an elderly person. You're there to (maybe) help someone go from totally devastated to somewhat less devastated during the final few years of life.

 

[Ioannes Paulus]

You know what's funny, I'm actually also interested in both these fields as well but when I tell my friends and family, they tell me "those are two totally dissimilar areas of medicine, how can you be undecided." I'm glad I'm not the only one.
One of the reasons I am leaning more into Ob/Gyn recently is because of just hot "customizable" the profession has become. You can sit in an office and write birth control prescriptions all day or work as an OB hospitalist and everything in between. I've also heard that OB/Gyn fellowships are one of the few fellowships that are much more open and welcoming to physicians that are currently in the workforce as well as those who are still in residency.


Edit: I'm also a dude, but more interested in Urogynecology or MFM. And, from my experience, most patients are okay with a male OB, especially if you a specialist and they are having problems with the pregnancy. Then it changes from "I need an OB to be the same gender as me" to "I need the most competent OB I can find, regardless of gender."

 

[Tenk]

All the power to male ob/gyns out there. I know plenty who (if I were a female) I'd want them to deliver my babies. That being said, I would not touch that field as a man. More and more women are now refusing to see men and I even know personally of several older ob's who have been forced into early retirement for this very reason. Something to seriously consider as I have a strong suspicion this trend will continue as it already has.

 

[DrBowtie]

From your prior posts you like the idea of the OR, but don't actually like the OR.

Do Neuro. Otherwise you'll be dragging a chaperone around everywhere you go.

 

[Ioannes Paulus]

All the power to male ob/gyns out there. I know plenty who (if I were a female) I'd want them to deliver my babies. That being said, I would not touch that field as a man. More and more women are now refusing to see men and I even know personally of several older ob's who have been forced into early retirement for this very reason. Something to seriously consider as I have a strong suspicion this trend will continue as it already has.

Do you think this is the same case for gay male OBs? Or do you think it wouldn't matter? Also, do you think this trend is equally present in the OB sub specialties?

 

[Tenk]

Do you think this is the same case for gay male OBs? Or do you think it wouldn't matter? Also, do you think this trend is equally present in the OB sub specialties?

Dunno and dunno!

 

[gracie369]

Brains vs. boobs and babies

 

[Levo]

I personally had a horrible time on my OB/gyn rotation. Patients didn't want me there, and while some residents and attendings were absolutely awesome, many just didn't make involving me in patient care a priority. I can't say for sure if this was because I'm male, but I suspect it played a role. I'm glad your experience with your med school OB/gyn rotation was so much better than mine. I just wonder if you're going to be able to avoid those problems during your residency and career.

 

[NWwildcat2013]

I'm hearing a lot of arguments against OBGYN but I never usually hear an argument FOR neuro.


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[Gastrapathy]

I'm hearing a lot of arguments against OBGYN but I never usually hear an argument FOR neuro.


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Like what?

 

[Postictal Raiden]

I also vote for OB...


...just because next year I'm applying to Neuro and I want less competition

 

[NWwildcat2013]

I vote for OB. But that's because I enjoy children/ babies and have male OBs in my family so I know the deal. And that's also what I would choose. Based on your original post it sounds like you would enjoy neuro more. I've also noticed you posted in the peds forum. Have you thought of nicu? May be able to fulfill your interest in women/ babies/ fetal physio/ hands on procedures while keeping you out of the OR. Just my 0.02

Funny you say that. In my original post I include Peds but deleted it because I thought it was a distant third. It does appeal to me for all the reasons you mentioned. Maybe I should consider it more.

 

[NWwildcat2013]

Like what?

Everybody just seems pretty down on neuro in general (even neurologists I talk to) and I have never been given a really strong and motivational reason to do neuro other than it is "interesting". I don't know if that is enough for me especially when you slice of the Interesting Pie is going to be smaller after the near mandatory fellowship.

 

[Señor S]

I am a male.

Don't do OB. I say again, DO NOT do OB.

 

[NWwildcat2013]

Don't do OB. I say again, DO NOT do OB.

For similar reasons as previously mentioned or other ones?

 

[Señor S]

For similar reasons as previously mentioned or other ones?

What everybody else said. You'll be protected from the realities of the market to a certain degree in residency, but the preference is for female OBs and it isn't changing anytime soon. Why enter a field where 50% of your potential patients will rule you out a priori?

 

[Ioannes Paulus]

I'm going to chime in here again saying that I think most people here are being a little over dramatic. Really? 50% of women won't see a male OB? My father's urologist was a female and he didn't bat an eye. When you need healthcare all you care about is (1) does he/she take my insurance and (2) is he/she competent AND compassionate.

 

[ACSurgeon]

I'm going to chime in here again saying that I think most people here are being a little over dramatic. Really? 50% of women won't see a male OB? My father's urologist was a female and he didn't bat an eye. When you need healthcare all you care about is (1) does he/she take my insurance and (2) is he/she competent AND compassionate.

While I agree that 50% is likely an exaggerated number, keep in mind that many women don't view child birth as a "medical thing" but rather a "natural thing" where some number of healthcare personnel are involved. Because most are young and healthy, they take for granted that every thing will go well, and forget the million things that can go wrong.

 

[futuremdforme]

IMO neuro is just getting more and more interesting! I'd do that.

As for the comment about a gay male OB -- wouldn't make a difference. The decision of having a male OB is made before the first meeting. No woman is going to call and ask for an OB, get offered a male, and then say "Oh but is he gay or straight?"

 

[DrMcLovin]

I would also do neuro if I were you. It seems like you like it and you would avoid a lot of headaches as a male OB. On my OB rotation I wasn't allowed in >30% of rooms and asked to leave by the patients/ not allowed to do ~50% of pelvic exams despite there being residents. Male attendings were also rejected by several unassigned patients in the hospital and forced to call thier NP's to go see them instead. At thier clinic they made patients sign an aggreement stating that they would let a male OB see them if a female OB was unavailable. MFM may be different though.

 

[Slack3r]

What everybody else said. You'll be protected from the realities of the market to a certain degree in residency, but the preference is for female OBs and it isn't changing anytime soon. Why enter a field where 50% of your potential patients will rule you out a priori?

I think being a male is more of a disadvantage in general OB/GYN. It seems that the sub specialties (gyn onc, urogyn, REI) tend to be more male.

 

[Señor S]

I think being a male is more of a disadvantage in general OB/GYN. It seems that the sub specialties (gyn onc, urogyn, REI) tend to be more male.

True and with OP's stats he could probably go somewhere where a fellowship would be basically guaranteed. He should do whatever's in his heart, but I do think the outlook for male OB/Gyns is grim; younger women are increasingly conditioned to think of OB/Gyns as women by default, so the prejudice against males will grow before it shrinks. The 50% number was just something I made up but I'll bet if you surveyed women under a certain age (45, say) it would be around that if not higher, and that will be OP's patient population, not today's grandmas who came of age in a time when all doctors were men.

 

[NWwildcat2013]

True and with OP's stats he could probably go somewhere where a fellowship would be basically guaranteed. He should do whatever's in his heart, but I do think the outlook for male OB/Gyns is grim; younger women are increasingly conditioned to think of OB/Gyns as women by default, so the prejudice against males will grow before it shrinks. The 50% number was just something I made up but I'll bet if you surveyed women under a certain age (45, say) it would be around that if not higher, and that will be OP's patient population, not today's grandmas who came of age in a time when all doctors were men.

I'm glad people have been so candid about their opinions on this matter. It sounds like I had an unusual experience on my rotation. I only had one patient ask me to step out during a pelvic exam and judging by her attire it was for religious reasons.



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[Slack3r]

True and with OP's stats he could probably go somewhere where a fellowship would be basically guaranteed. He should do whatever's in his heart, but I do think the outlook for male OB/Gyns is grim; younger women are increasingly conditioned to think of OB/Gyns as women by default, so the prejudice against males will grow before it shrinks. The 50% number was just something I made up but I'll bet if you surveyed women under a certain age (45, say) it would be around that if not higher, and that will be OP's patient population, not today's grandmas who came of age in a time when all doctors were men.

Maybe my ob/gyn experience was different (community hospital in an affluent suburb of a major city), but I rarely had anyone ask me to leave or refuse to be seen by a male Med student, and I saw quite a few women <30 yo. That said, my gf refuses to be seen by a male GYN so maybe my experience was the exception rather than the norm?

 

[Dr. Death]

I think this depends on where you live. An OB group my wife went to was all male physicians and was doing just fine. I asked an OB the other day if he had experienced this and he said he did as a student but once he became a resident and physician he had encountered it only a handful of times.

 

[Señor S]

Maybe my ob/gyn experience was different (community hospital in an affluent suburb of a major city), but I rarely had anyone ask me to leave or refuse to be seen by a male Med student, and I saw quite a few women <30 yo. That said, my gf refuses to be seen by a male GYN so maybe my experience was the exception rather than the norm?

The problem I see is that there are a lot of women who won't turn down a male med student when put on the spot (if only because they don't want to hurt his feelings), but who if they're calling to book an appointment will ask for the female doctor. That's what I meant when I said that people are protected from some of the market realities in med school and residency. Anecdotally I'd say your gf is much more typical of younger women.

With that said the demand will always be there; male OB/Gyns aren't going on unemployment. If dealing with a certain amount of this

http://www.thedailybeast.com/witw/articles/2013/12/09/are-male-gynecologists-creepy.html

http://www.xojane.com/issues/why-would-straight-men-become-gynecologists

http://madamenoire.com/622397/are-you-here-for-a-male-gynecologist/

doesn't bother you then have at it. Maybe I'm too sensitive...

 

[bumblebee611]

The problem I see is that there are a lot of women who won't turn down a male med student when put on the spot (if only because they don't want to hurt his feelings), but who if they're calling to book an appointment will ask for the female doctor. That's what I meant when I said that people are protected from some of the market realities in med school and residency. Anecdotally I'd say your gf is much more typical of younger women.

With that said the demand will always be there; male OB/Gyns aren't going on unemployment. If dealing with a certain amount of this

http://www.thedailybeast.com/witw/articles/2013/12/09/are-male-gynecologists-creepy.html

http://www.xojane.com/issues/why-would-straight-men-become-gynecologists

http://madamenoire.com/622397/are-you-here-for-a-male-gynecologist/

doesn't bother you then have at it. Maybe I'm too sensitive...

Didn't read your links but agree--the metric for this isn't whether a patient is surprised and says okay to a male med student because she doesn't want to make a fuss, it's for whom her preference is when she first seeks care. I'm a mother of two and have experienced treatment by male RE (he was fine; I didn't have a choice, but if I did, I'd have gone for a woman in the absence of other information), 1st delivery by female OB (she was fine and my first choice), and second delivery by male OB (I adored him but never would have chosen him in advance).

 

[Peach Newport]

This thread hits home for me.

I LOVE Ob/GYN. In a perfect world I would choose this field in a second. Great patients, the most interesting pathology, coolest scope of practice, a med-surg hybrid specialty, a socially important role? It's my dream.

But I am also a man.

I have, literally, never met a single female under 50 who would ever even consider seeing a male ob/GYN. I have even met women who would rather drive hours to see a woman. The attitude of "who cares, as long as he's good and professional" has been largely a myth in my experience.

Even my girlfriend encourages me to "follow my passion." She's known lots of med students. I ask her "Kate, do you think men can be good gynecologists?"
She says "Of course, as long as he's professional."
"Kate, would you ever see a male gynecologist?"
"Not a f**king chance. Maybe my grandma would."
This is pretty much the same attitude in my med school, my hometown, my family...

Its all the worse because I'm far more interested in gynecology than obstetrics, where men are better received.

It has been with great sadness that I've had to cross ob/GYN off my list of specialties to consider. I would encourage OP to get real and do the same. There's a reason the field has become dominated by women, and it's not because men aren't interested in it.

 

[raiderette]

I started med school thinking I would do neurology or less, but will probably pursue ob/gyn. I know my experience with male OB/gyn has been when there has been no choice.

 

[Chlorini]

This thread hits home for me.

I LOVE Ob/GYN. In a perfect world I would choose this field in a second. Great patients, the most interesting pathology, coolest scope of practice, a med-surg hybrid specialty, a socially important role? It's my dream.

But I am also a man.

I have, literally, never met a single female under 50 who would ever even consider seeing a male ob/GYN. I have even met women who would rather drive hours to see a woman. The attitude of "who cares, as long as he's good and professional" has been largely a myth in my experience.

Even my girlfriend encourages me to "follow my passion." She's known lots of med students. I ask her "Kate, do you think men can be good gynecologists?"
She says "Of course, as long as he's professional."
"Kate, would you ever see a male gynecologist?"
"Not a f**king chance. Maybe my grandma would."
This is pretty much the same attitude in my med school, my hometown, my family...

Its all the worse because I'm far more interested in gynecology than obstetrics, where men are better received.

It has been with great sadness that I've had to cross ob/GYN off my list of specialties to consider. I would encourage OP to get real and do the same. There's a reason the field has become dominated by women, and it's not because men aren't interested in it.

I'm under 30 and I've had 3 male OB/GYNs. My two best girl friends also use male OB/GYNs. It didn't make a difference for me (or for them) at all. They all have flourishing practices and they all seemed very happy to be doing OB/GYN, too! I asked one of them if he would choose OB/GYN again if he could do it all over again and he said he would in a heartbeat.

If you are a guy and WANT to do OB/GYN the doors will fly open for you--many residencies programs are looking for more men to get back into the field because so many residency programs are female-dominated now. And if you really like gyn but aren't into obstetrics, Reproductive Endocrinology (REI) is another great option. All the REIs I've ever met have been men.

 

[deleted393595]

Let me know what you think about this pros/cons list. What would you choose based on my pros and cons? Am I incorrect about anything on my list? Anything you'd add for consideration or any insight into the future of each field? When I return to school after break we will start scheduling MS4 electives so the time is really here when I need to start thinking about this decision.

I would be a competitive applicant for both and have honored both of these rotations. They were both things that I was surprised to find that I enjoyed. I'll sum it up by saying that L&D and going on Stroke Codes were the two most enjoyable times I've had in med school.

Neurology
Pros:

• I think I like the subject matter more than anything else.
• I like discussing and thinking about end of life issues.
• Opportunity to work in a critical care setting.
• I felt like the culture was good and the attendings/residents were nice.
• I just love seeing neuro deficits and localizing lesions. In what other field can you see someone eat only half of the food on their place? It is continually weird and surprising. I think it is one of the few specialties that would have the capacity to surprise me once I settled in and things became routine.
• I think the future of neuro is super bright, and I think a career in neuro would allow me to witness many improvements in treatment and diagnosis. I think a lot more people will be wanting to do neuro in 25 years.
• I like the idea of being the person to figure out something that has stumped all the other specialists.

Cons:

• Since I like all of neurology I would be frustrated being pigeonholed into a fellowship. If the neurohospitalist model really becomes a thing I think that would be ideal, but right now I'm not sure whether it will take off. It has a confusing relationship with NCC and Vascular.
• The field is very fellowship driven and a fellowship doesn't really increase earning potential but it does decrease the amount of stuff you see. I like muscular dystrophy, but I'm not sure I want to know all bajillion types and in exchange never treat an acute stroke again.
• General neurology seems like a dying field. It seems like it can only be practiced in the outpatient/inpatient mix that I would prefer in a semi-rural area. An area large enough to have enough pathology but small enough to not have a big academic center. This is very limiting.
• Many programs are advanced which doubles my interview expenses and increases the odds of living apart from my significant other for one year.
• Research heavy at the top. I am a strong applicant but I think neuro, more than most, has the largest difference in what type of applicant they are looking for between a middle and top program. I feel that the top programs will be less impressed with my Step 1 score than they would be in something like OB/GYN. Correct me if I am wrong but the culture at the top seems very academic and I don't think I'd fit in. I'm just not a neurology "nerd" if that makes sense. I know some people who live for neurotransmittors and I'm just a guy who thinks it isn't boring and would keep me engaged.
• Not so great compensation for the length of training and the amount of stress.
• Functional neurological problems and pseudoseizures. Just two examples, but neuro has a disproportionate amount of that stuff.
• A lot of medicine type BS and social work stuff especially when it comes to stroke.
• Neurosurgeons get all the cool acute neurology that I like. I've seen tumors and hemorrhagic strokes go straight to neurosurgery from the ED and a neurologist never even knows about it. That makes me sad.

Obstetrics and Gynecology
Pros:

• Women are better patients. They are nicer, more open, and more willing to follow medical advice.
• Most of the patients are healthy and most babies will be born healthy.
• I am starting to think I'd miss the OR and donning the sterile gloves for a procedure every once and awhile if I did neuro. OB/GYN leaves open the door for as many or as few procedures as I want
• I really didn't get that classic OB/GYN b***h vibe that everyone talks about. I think there has been a fair amount of infighting and gossip in all of my rotations and OB/GYN wasn't any worse. At my school the OB/GYN residents actually seemed the happiest despite working the most. They also seemed like the most competent and advanced for their respective year in training.
• I like maternal-fetal physiology and the changes that occur to normal physiology during pregnancy.
• The pathology is amazing. Endocrinology to oncology. It is all there in OB/GYN.
• I think this is one of the few things that I would be happy stopping after the residency and would not need to do a fellowship and if I did I actually wouldn't mind some of the OB/GYN fellowships.
• I am a male. I have heard this can be beneficial in the residency process.
• The residency is 4 years and categorical so it will be the same length as my significant other's residency.

Cons:

• Very stressful and risky. I am risk averse and it is how I have based most decisions in my life. Im scared of the OR but also sort of like it if that makes any sense. Currently debating to what extent I should let fear influence my choice.
• The residency is really hard and attending life can be too.
• Births are fun when they go well but the idea of a traumatic one or something like a forceps delivery makes me cringe.
• Malpractice.
• I am a male. I have heard this can cause some problems when you are a young OB/GYN trying to get started.

Neuro: Cool, fun, good lifestyle
Ob/Gyn: After hanging yourself, your body gets discovered in your apartment a month after you miss making rent.