OMS-II here, thanks for the thread🙂
How much women's primary care do you really get to do? Can OB/GYNs truly replace say, FM, and manage HTN, basic cold/flu stuff, etc., just as good as FM or IM can? For example, could an OB/GYN run an urgent care (in theory)?
Along those lines, what factors would you tell someone to consider when choosing between OB residency and being a family med doc who does a lot of OB?
Is there any demographic of women who particularly choose an OBGYN for their primary provider over an FM or IM doc? (I'm guessing they might prefer OB if they're planning on becoming pregnant?)
Is OB/GYN the happy medium it seems to be between some clinic, some surgery, delivering babies, etc.? I see a lot of people complain about the call schedule, but if that doesn't really bother me, then at first glance it seems like a good choice for someone who would like to do some surgery and some primary care and have a varied practice. Any thoughts or pros/cons I'm missing?
Last, have you seen any OB/GYNs do cosmetic or reconstructive surgery in their practice or is that pretty much limited to plastics? (at least for breasts/vulva, and if I understand correctly this is not the focus of "female pelvic med & reconstructive surgery" ... right?)
Thanks again!
These are good questions! As far as primary care, in residency and beyond, a lot of OB/GYNs do some but not a lot of the conditions you mentioned. We can’t replace FM. As an OB/GYN I feel comfortable with taking care of young women with high blood pressure after pregnancy, but I would still recommend they see a PCP. As women age, we take care of mammogram/colonoscopy/DXA orders or referrals, but management of diabetes/HTN/CHF need to be done by a PCP for better quality of care. Not to mention that as you build an OB/GYN practice, you likely won’t want to do those things because it will take away from obstetrics, surgical procedures, etc. It also creates less revenue
I would tell you that unless you are going to practice in a very rural area, the FM doc who does a lot of OB are very few anymore. Due to the extremely litigious nature of obstetrics, this is rare, although maybe does have its place in extremely underserved areas that need someone to deliver the occasional baby.
The old saying is that women are the entry point for medical care in the family unit. Meaning a woman is seen by her OBGYN for pregnancy, and will bring her kids to the doctor and then influence her significant other to attend physician visits as well. For this reason, women will usually seek out and OBGYN strictly because they become pregnant, and then get set up for annual exams after that. It’s then usually up to us as gynecologists to know our limits with medical history and refer to the appropriate provider.
In the real world, obgyn is 3-4 days in the office with a surgery day usually. The call schedule can vary and can be in house or home call, ranging from 1:2 in rural areas to 1:10 in well populated areas. I do think it is a great balance and variety of practice, even in the office we do procedures such as mass removal, LARC placement, EMB, LEEPs, etc.
I have seen OBGYNs do vaginal rejuvenation (Mona Lisa) and there are new things like that some of them do for extra money. Some are certified in Botox, although I have rarely seen this. FPMRS are not involved with the breast at all and usually focus on things like prolapse, incontinence surgeries. As a general OBGYN I will never do any type of elective cosmetic vulvar reconstruction, although perhaps a FPMRS trained obgyn may want to do so depending on clientele. Really performing things outside your scope of medicine is a disservice to your patients if you haven’t seen or done many of them, because mastery takes time to achieve and if you only do one of these surgeries a year it is important to just refer them to someone better.
